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