New Patient Health Questionnaire Under 16s « The Old Dairy Health Centre

PLEASE HELP US TO PROVIDE THE HIGHEST STANDARD OF CARE BY COMPLETING THIS SHORT SURVEY. FEEDBACK FROM THIS SURVEY WILL HELP US TO IDENTIFY AREAS THAT MAY NEED IMPROVEMENT AND TO DEVELOP AN ACTION PLAN. WE WILL THEN WORK TOGETHER WITH YOUR PATIENT PARTICIPATION GROUP TO ACHIEVE THE GOALS SET OUT IN THAT ACTION PLAN. YOUR OPINIONS ARE VERY VALUABLE AND WILL BE COMPLETELY CONFIDENTIAL
The Doctor/Nurse/Healthcare Assistant I saw was:-*
I came to see the Doctor/Nurse/Healthcare Assistant for:-

How good was your Doctor at:*

	Very good	Good	Satisfactory	Poor	Very poor	Does not apply
Putting you at ease?
Being polite and considerate?
Listening to you?
Giving you enough time?
Assessing your medical condition?
Explaining your condition and treatment?
Involving you in decisions about your care?
Providing or arranging treatment for you?
Did you have confidence that the doctor is honest and trustworthy?
Did you have confidence that the doctor will keep your information confidential?
Would you be completely happy to see this Doctor again?

If you have any additional comments about this doctor please add them here:

How good was your Nurse at:*

	Very good	Good	Satisfactory	Poor	Very poor	Does not apply
Putting you at ease?
Listening to you?
Giving you enough time?
Explaining your condition and treatment?
Involving you in decisions about your care?
Providing or arranging treatment for you?
Would you be completely happy to see this Nurse again?

If you have any additional comments about this Nurse please add them here:

How good was your Healthcare Assistant at:*

	Very good	Good	Satisfactory	Poor	Very poor	Does not apply
Putting you at ease?
Being polite and considerate?
Listening to you?
Giving you enough time?
Explaining your condition and treatment?
Involving you in decisions about your care?
Providing or arranging treatment for you?
Would you be completely happy to see this Healthcare Assistant again?

If you have any additional comments about this HCA please add them here:

How helpful do you find the receptionists?*
Very hekpful Fairly helpful Not very helpful Not at all helpful Don't know
How easy is it to get through to someone at the Practice on the phone?*
Very easy Fairly easy Not very easy Not at all easy Don't know Haven't tried
How easy is it to speak to a doctor or nurse on the phone?*
Very easy Fairly easy Not very easy Not at all easy Don't know Haven't tried
If you need to see a doctor urgently can you get seen on the same day?*
Yes No Don't know/never needed to
How important is it to you to be able to book appointments ahead of time?*
Important Not important
How easy is it to book ahead?*
Very easy Fairly easy Not very easy Not at all easy Don't know Haven't tried
How do you normally book your appointments?*
In person By phone Online Doesn't apply
Which of the following methods would you prefer to use to book your appointments?*
In person By phone Online Doesn't apply
At times when you want to see A PARTICULAR DOCTOR - how quickly do you usually get seen?*
Same day or next day 2-4 days 5 days or more I don't usually need to be seen quickly Don't know, never tried
At times when you want to see A PARTICULAR DOCTOR how do you rate how quickly you get seen?*
Excellent Very good Good Satisfactory Poor Very poor Does not apply
At times when you are willing to see ANY DOCTOR how quickly do you usually get seen?*
Same day or next day 2-4 days 5 days or more I don't usually need to be seen quickly Don't know, never tried
When you are willing to see ANY DOCTOR - how do you rate how quickly you get seen?*
Excellent Very good Good Satisfactory Poor Very poor Does not apply

Do you take regular medication?*
Yes No (please go to the next page)
How do you find the system for ordering repeat medication?*
Very easy Fairly easy Difficult to understand
How do you order your repeat prescriptions?*
Online - website Online - Patient Access Email to the Practice By post In person
How would you rate the repeat prescription service?*
Excellent Good Satisfactory Poor
Do you use the electronic prescribing service? (The option to have your prescription sent to a pharmacy of your choice)*
Yes No Don't know about it
How would you rate the electronic prescribing service?*
Excellent Poor
All patients on regular medication must have at least one medication review a year. This is a special appointment to discuss your medication with you. Do you know when your medication review is due?*
Yes No I was not aware I had to have a medication review
Please add any comments you wish to make about repeat prescriptions here?

How clean do you find the GP Surgery?*
Very clean Fairly clean Not very clean Not at all clean
Thinking of your most recent consultation with a doctor/nurse, how long after your appointment time did you wait to be seen?*
I was seen on time Less than 5 minutes 5-10 minutes 11-20 minutes 21-30 minutes More than 30 minutes There was no set time for my consultation
How do you rate how long you waited?*
Excellent Very good Good Satisfactory Poor Very poor Does not apply
Is the Practice currently open at times that are convenient to you?*
Yes No Don't know
Which of the following additional opening hours would make it easier for you to see or speak to someone?*
Before 8 am At lunchtime After 6.30 pm On a Saturday On a Sunday None of these
Is there a particular doctor you usually prefer to see or speak to?*
Yes No
How often do you see or speak to the doctor you prefer?*
Always or almost always A lot of the time Some of the time Never or almost never
Thinking about the care you receive from the doctors, nurses and healthcare assistants overall, how well does the Practice help you to:*
Very well Unsure Not very well Does not apply
Understand your health problems?
Cope with your health problems?
Keep yourself healthy?
Overall, how would you describe your experience of the Practice?*
Excellent Very good Good Satisfactory Poor Very poor
How likely are you to recommend the Practice to friends and family?*
Extremely likely Likely Neither likely nor unlikely Unlikely Extremely unlikely Don't know

Are you?*
Male Female
How old are you?*
Under 16 16-30 31-44 45-64 65-74 75 or over
Do you have a long-standing health condition?*
Yes No Don;t know/can't say
What is your ethnic group?*
White Black or Black British Asian or Asian British Mixed Chinese Other ethnic group