docgatley group practice - Gatley Medical Centre
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gatley group practice - Gatley Medical Centre
GATLEY GROUP QUESTIONAIRE 1. PRACTICE PATIENT What is your name? 2. What is your email address? Would you like to register an email address? 3. Please could you tell us a little about yourself? Are you male or female? Male Female 4. What is your ethnic background? White - British White - Irish White - Other Background Black - Caribbean Black - African Black - Other Background Asian - Indian Asian - Pakistani Asian - Bangladeshi Asian - Other Background Mixed Race - White & Black African Mixed Race - White & Black Caribbean Mixed Race - White & Asian Mixed Race - Other Background Chinese Gypsy / Traveller Any other background Do not wish to declare 5. How old are you? <18yrs 18-24yrs 55-64yrs 25-34yrs 65-74yrs 75-84yrs 35-44yrs 45-54yrs 85yrs and over 6. How do you travel to the practice? (Please tick all the boxes that apply to you) Walk Drive Cycle Public transport Taxi Other 7. Are you the main Carer for a relative or friend? Yes No Do not wish to say 8. When did you last see or speak to a GP or nurse at GMC? In the past 3 months Between 3 and 6 months ago Between 6 and 12 months ago More than 12 months ago I have never seen a GP or nurse from my surgery WWW.GATLEYMEDICALCENTRE.CO.UK 1 9. Last time you saw or spoke to a GP or nurse from your GP surgery, how good were they at the following? Giving you enough time Very good Good Neither good nor poor Poor Very poor Doesn’t apply Listening to you Very good Good Neither good nor poor Poor Very poor Doesn’t apply Explaining tests and treatments Very good Good Neither good nor poor Poor Very poor Doesn’t apply Involving you in decisions about your care Very good Good Neither good nor poor Poor Very poor Doesn’t apply Treating you with care and concern Very good Good Neither good nor poor Poor Very poor WWW.GATLEYMEDICALCENTRE.CO.UK 2 10. How convenient was the appointment you were able to get? Very convenient Fairly convenient Not very convenient Not at all convenient Not applicable 11. Generally, how easy is it to get through to someone at your GP surgery on the phone? Very easy Fairly easy Not very easy Not at all easy Haven’t tried 12. Which of the following method/s would you prefer to use to book appointments with your GP Practice? (please tick all the boxes that apply to you) In person By phone By fax machine Online No preference 13. Overall, how would you describe your experience of making an appointment? Very good Fairly good Neither good nor bad Fairly poor Very poor 14. Have you ever made an appointment at the practice that you failed to keep? Yes No 15. If yes did you let the practice know you were unable to attend Yes No, I did not know I needed to No, I forgot 16. How would you like to be able to cancel appointments? (Please tick all the boxes that apply to you) In person By phone By text By fax Online 17. When is it most convenient for you to come to the practice for your appointment? I prefer early morning appointments I prefer evening appointments I prefer daytime appointments I prefer weekend appointments I have no preference 18. Are you aware of our opening hours: The surgery is open for appointments: Monday & Friday:8am 6pm Tuesday & Wednesday: 7.30am - 6pm Thursday: 8am - 7.30pm Yes No 19. How satisfied are you with our opening hours? Very satisfied Fairly satisfied Very dissatisfied Neither sarisfied or dissatisfied I am not sure of the opening hours 20. How helpful do you find the receptionists at your GP surgery? Very helpful Fairly helpful Not very helpful Not at all helpful Don’t know 21. How satisfied are you by the service and care offered by the practice? Very satisfied Fairly dissatisfied Fairly satisfied Neither satisfied or dissatisfied Very dissatisfied WWW.GATLEYMEDICALCENTRE.CO.UK 3 22. Would you recommend our practice to someone who has just moved into the area? Yes definately Not sure No, definately not 23. Are there any particular concerns you have or would be interested in the practice organizing health promotion events? Asthma Cancer Common child ailments Smoking - support on quitting Alcolated related illness Dementia Diet and healthy eating Bereavement Long standing pain Heart Disease Sexual Health Not interested 24. Are there any additional services you would like to see provided by the practice? 25. Do you have any comments that you would like to make regarding the practice, opening times, appointment times, cancelling appointments, accessibility, the practice generally? 26. How would you like the practice to communicate with you share information? (Please choose one or all that are applicable to yourself) By post By phone By text By email Website 27. At present the practice website is for information and repeat prescriptions. What do you/would you like to use the website for? Opening times Clinical information Online repeat prescriptions Online appointments - booking and canceling Accessing medical records Emailing the practice I do not / would not use the website 28. Many practices confirm appointments / update patients re text and email as well as by post or telephone, would you be happy to be contacted in these manners if applicable. I do not have a mobile Yes to text messaging Yes to email massages No to email messages No to text messaging I donot have email 29. Do you wish to be included on our mailing list for future surveys or health events? Yes No 30. If you would like to be part of the patient involvement group please leave your email address here. Yes I would like to be part of the patient group and have shown my email address below: Yes No 31. Employment status Self/Employed Retired Unemployed Student Please return completed form back to Gatley Medical Centre Reception FAO: Sylvia Obrien, Practice Manager. WWW.GATLEYMEDICALCENTRE.CO.UK 4