PPG patient questionnaire 2013-2014

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The Elms Surgery, PPG Patient Questionnaire 2013-14
The Elms Surgery
36 The Avenue
Watford Hertfordshire
WD17 4NT
Phone: 01923 224203
Fax: 01923 247341
www.theelmssurgery.co.uk
Dr A Ahmad
Dr S Khan
Dr E Khamzina
How long have you been a patient at the surgery? Please indicate below
……… years ………… months
Please provide your answer to the following questions by circling your preferred answer
1.
What was your method of travel to the surgery today?
Walked
Car
Car
(Pay & Display)
(Disabled badge)
2.
If you used Pay and Display parking, how easy was it to find parking?
1
2
3
4
5
Very easy
Easy
Fair
Difficult Very difficult
Any comments: ……………………………………………………………………………………………
Bike
Bus
Dropped
Off
Other
Reception & Appointments
3.
How do you rate the surgery in how efficiently the receptionists answer your call?
1
2
3
Excellent
Good
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
4.
How satisfied are you with the service provided by the reception staff?
1
2
3
Excellent
Good
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
5.
How easy do you find it to book medically urgent appointments at the surgery?
1
2
3
Excellent
Good
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
6.
How easy do you find it to book routine appointments at the surgery?
1
2
Excellent
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
7.
Are you satisfied with the surgery’s opening hours?
1
Very satisfied
2
Satisfied
3
Fair
4
Not satisfied
Any comments: …………………………………………………………………………………………….
8.
The surgery provides a late Tuesday evening surgery for working adults who have difficulty in attending
during working hours. Do you feel that this additional surgery is Useful
Not necessary
N/A
Any comments: …………………………………………………………………………………………….
The surgery offers telephone appointments with Doctors for medical problems that can be dealt with by
telephone assessment. Have you used this service?
9.
□
□
Yes
No
Not aware of service
If yes, did you find this service:
□
Useful
Not useful
No opinion
Any comments: …………………………………………………………………………………………….
10.
Do you feel the surgery should increase the number of telephone appointments for patients?
"Drugs are not always necessary. Belief in recovery always is." Norman Cousins
The Elms Surgery, PPG Patient Questionnaire 2013-14
□
□
□
Yes
No
No preference
Any comments: …………………………………………………………………………………………….
SERVICES & FACILITIES
11.
How do you rate obtaining a repeat prescription at the surgery?
1
2
3
4
Excellent
Good
Average
Fair
Any comments: …………………………………………………………………………………………….
5
Poor
The surgery offers online repeat prescription requesting service via our website
www.theelmssurgery.co.uk. Have you used this service?
Yes
12.a
□
No
□
Not aware of service
□
If yes, did you find this service:
Useful
Not useful
No opinion
Any comments: …………………………………………………………………………………………….
The surgery offers online appointment booking service via https://patient.emisaccess.co.uk and our
website www.theelmssurgery.co.uk. Have you used this service?
Yes
12. b
□
No
□
Not aware of service
□
If yes, did you find this service:
Useful
Not useful
No opinion
Any comments: …………………………………………………………………………………………….
The surgery offers a physiotherapy service provided by an external provider. Have you used this
service?
Yes
13.
□
No
□
Not aware of service
□
If yes, did you find this service:
Useful
Not useful
No opinion
Any comments: …………………………………………………………………………………………….
The surgery will be offering an in-house ‘Stop Smoking Service’ from April 2014. If you smoke, would
you consider using this service?
14.
Yes
□
No
□
N/A
□
If yes, please inform the receptionist, who will then book an appointment for you.
The surgery has purchased an automated blood pressure monitor for patients use.
Have you used this facility?
Yes
15.
□
No
□
Not aware of facility
□
If yes, did you find this service:
Useful
Not useful
No opinion
Any comments: …………………………………………………………………………………………….
16.
17.
If you have attended our blood test clinic at The Elms Surgery, how do you rate the service?
1
2
3
4
Excellent
Good
Average
Fair
Any comments: ……………………………………………………………………………………………
Do you like our automated appointment check-in service (computer screen in reception)?
Yes
□
Neither dislike or like
□
No
□
Prefer face to face check-in
□
"Drugs are not always necessary. Belief in recovery always is." Norman Cousins
5
Poor
The Elms Surgery, PPG Patient Questionnaire 2013-14
Clinical Care – The Doctors
The last time you saw a doctor at the surgery, how good was the doctor at each of the following?
Giving you enough time
1
Excellent
18.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Asking about your symptoms
1
Excellent
19.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Listening to you
1
Excellent
20.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Explaining tests and treatments
1
Excellent
21.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Involving you in decisions about your care
1
Excellent
22.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Treating you with care and concern
1
Excellent
23.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Did you have confidence and trust in the doctor you saw?
1
Excellent
24.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Clinical Care – Practice Nursing
The last time you saw a Nurse at the surgery, how good was she at each of the following?
Giving you enough time
1
Excellent
25.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Asking about your symptoms
1
Excellent
26.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Listening to you
27.
1
Excellent
2
Good
3
Average
4
Fair
Any comments: ……………………………………………………………………………………………
"Drugs are not always necessary. Belief in recovery always is." Norman Cousins
5
Poor
The Elms Surgery, PPG Patient Questionnaire 2013-14
Explaining tests and treatments
1
Excellent
28.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Involving you in decisions about your care
1
Excellent
29.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Treating you with care and concern
1
Excellent
30.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Did you have confidence and trust in the nurse you saw?
1
Excellent
31.
2
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
GENERAL
How do you rate the surgery’s premises?
Reception/Waiting area?
1
Good
2
Fair
3
Poor
Consulting rooms?
1
Good
2
Fair
3
Poor
32.
Any comments: ………………………………………………………………………………………….
Would you recommend this surgery to a neighbour? Yes
□
No
□
33.
Please give reasons for your choice of answer.
………………………………………………………………………………………………………………..
34.
How do you rate your overall patient experience in the surgery?
1
2
Excellent
Good
3
Average
4
Fair
5
Poor
Any comments: ……………………………………………………………………………………………
Are you interested in joining the practice’s Patient Participation Group? Yes
□
No
□
The aim of the group is to work with the practice to improve the surgery’s service to patients and
improve the patient experience.
IF YES,
Would you prefer:
35.
□ Contributing via email or an on-line “virtual group”
□ Attending face to face meetings
□ A mixture of the two
IF YOU WISH TO JOIN OUR PATIENT REFERENCE GROUP PLEASE ASK RECEPTION FOR AN
APPLICATION FORM
……………………………………………………………………………………………
"Drugs are not always necessary. Belief in recovery always is." Norman Cousins
The Elms Surgery, PPG Patient Questionnaire 2013-14
Any additional comments
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
36.
Please tick the Ethnic Group you belong to
White
British
Black or Black British
Caribbean
Irish
Any other White background
African
Any other Black background
Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background
Other Ethnic Groups
Chinese
Any other ethnic group
37.
Mixed
White and Black
Caribbean
White and Black African
White and Asian
Any other mixed
background
Prefer not to
Please tick (√) the faith group that you belong to
□ Christianity □ Hindu □ Judaism □ Jehovah’s Witness □ Muslim □ Sikh □
None □ Do not wish to Answer□ Other religion, please state. ………………………..
Buddhist
38.
Please tick the age group that you fall within.
18 – 24
□
25 – 34
□
35 – 44
□
45 – 54
□
55 – 64
□
65 – 74
□
75 – 84
□
□
85+
The Elms Surgery, Patients’ Participation Group is working together with the practice to provide a
continuous improving service at the surgery for all patients. To enable us to achieve this purpose,
it will be very helpful if you could kindly hand this completed questionnaire in to us.
The completed form can be handed in at the reception of the surgery or posted to The Elms
Surgery, 36 The Avenue, Watford, Hertfordshire, WD17 4NT.
A report based on our findings from this survey will be posted on our website and also made
available to all patients in the surgery.
Thank you very much for taking time out to complete this questionnaire.
"Drugs are not always necessary. Belief in recovery always is." Norman Cousins
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