Charnock Health Primary Care Centre

Patient Experience Questionnaire 2014

Q1. How clean is our Health Centre?

Very clean

Fairly clean

Not very clean

Not at all clean

Q2. How helpful do you find our receptionists?

Very helpful

Fairly helpful

Not very helpful

Not at all helpful

Q3. In the past 6 months, have you tried to see a doctor on the same day or in the next 2 days?

Yes, and I was seen by a Doctor

Yes, but I was unable to get an appointment

No, I have not needed to do this

If you were not seen in the next 2 days, why was this?

The time offered didn’t suit me

The appointment offered was with a Doctor I didn’t want to see

I could have seen a Nurse but I wanted to see a Doctor

There were no appointments available

Other reason

Q4. How important is it for you to see a doctor:

On the day you phone?

Very important

Fairly important

Not particularly important

In the next few days after you phone?

Very important

Fairly important

Not particularly important

In the next few weeks/in advance?

Very important

Fairly important

Not particularly important

Q5. How satisfied are you with the hours we are open?

Very satisfied

Fairly satisfied

Neither satisfied or dissatisfied

Fairly dissatisfied

Very dissatisfied

I'm not sure when my GP Surgery is open

Q6. Last time you saw a doctor or nurse, how good were they at treating you with care?

Very Good

Good

Neither Good nor Poor

Poor

Very Poor

Q7. How easy is it for you to get an appointment with a nurse?

Haven’t tried

Very easy

Fairly easy

Not very easy

Q8. Have you used our triage service? (This is where a GP consults with you by phone)

Yes

No

If yes, do you think this is a good service?

Yes

No

Q9. Do you have any long-standing health problems, disability or infirmity? This includes anything that has troubled you over a period of time or that is likely to affect you over a period of time.

Yes

No

If you have answered yes, please also answer the following questions.

Do you fully understand your problem or illness?

Yes

No

Are you able to cope with your problem?

Yes

No

Are you able to keep yourself healthy?

Yes

No

Q10. Do you have someone who acts as a carer for you in any way?

Yes

No

Q11. Do you act as a carer for someone else in any way?

Yes

No

Q12. Have you been seen in hospital out-patient clinic in the last year?

Yes

No

If yes, would you have preferred to have been seen here if that had been possible?

Yes

No

Q13. Do you use our prescriptions online ordering service for your repeat prescriptions?

Yes

No

If yes, how do you rate it?

Very good

Good

Neither good or poor

Poor

Very poor

Q14. Do you use our website www.charnockhealth.nhs.uk ?

Yes

No

Q15. Are you happy for us to share your record with hospitals or emergency services if this could assist your treatment?

Yes

No

Q16. Can you suggest ways in which we might improve patient confidentiality?

[OR] No changes needed; Don't know; Yes (if so what would you suggest?

Q17. In general, how satisfied are you with the care we provide?

Very satisfied

Fairly satisfied

Neither satisfied or dissatisfied

Fairly dissatisfied

very dissatisfied

Q18. Would you find it helpful if we routinely reminded you of any appointments you have with us by sending you a text message the day before?

Yes

No

I'm not sure

I don't have a phone that can receive text messages

Please help us by answering some questions about yourself

Q19. Are you Male or Female?

Male

Female

Q20.What is your age?

Under 18 years old

18 – 24 years old

25 – 34 years old

35 – 44 years old

45 – 54 years old

55 – 64 years old

65 – 74 years old

75 – 84 years old

85 years old or over

Q21. Which of these best describes what you are doing at present?

Full time paid work (30 hours or more each week)

Part time Paid work (under 30 hours each week)

Full time education at school, college or university

Unemployed

Permanently sick or disabled

Fully retired from work

Looking after the home

Doing something else

Q22. What is your ethnic group?

White British

White Irish

Any other white background

White and black Caribbean

White and black African

White and Asian

Any other mixed background

Indian

Pakinstani

Bangladeshi

Any other Asian background

Caribbean

African

Any other black background

Chinise

Any other ethnic group

Q23. Would you like us to contact you and let you know about any changes we are planning as a result of this survey?

Yes

No

If yes, please enter your name and e-mail address below

Q24. Would you be prepared to join a patient participation group via e-mail?

(This is a group of patients who we will contact from time to time and ask for comments on the services we offer and ways to develop and improve them)

Yes

No

If yes please provide your name and e-mail address below

This is the end of the questionnaire. Many thanks for taking the time to complete it and letting us know what we are getting right and what could be improved

If you have any other comments, compliments, complaints or suggestions about the services we offer please let us know in the space below