LINTONVILLE MEDICAL GROUP
Patient Survey Questionnaire 2014-15
Friends and Family Questions
From December the government require all GP Practices to ask Friends and Family questions.
The wording of Question 1 must be exactly as set out below. Question 2 can be chosen by the
Practice.
We thought it would be useful to include this in our Annual Patient Questionnaire so please can
you answer the following 2 questions before moving on the Patient Questionnaire.
FFT Q.1 We would like you to think about your recent experiences of our service.
How likely are you to recommend our GP practice to friends and family if they needed
similar care or treatment?
Extremely likely
Likely
Neither likely nor unlikely
Unlikely
Extremely unlikely
Don’t know
FFT Q.2 How you feel we can improve our services
Q1 From December data from this question will be reported monthly to NHS England.
Q2 Results from this question may be published locally, please tick this box if you DO NOT wish
your comments to be made public.
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LINTONVILLE MEDICAL GROUP
Patient Survey Questionnaire 2014-15
Q1 If you have visited the surgery, how easy did
you find it to get into the building?
Very easy
Fairly easy
Not very easy
Not at all easy
Q2 If you are concerned about other patients
overhearing you in Reception, did you know
you can ask to use our quiet room?
Q3 How clean is the surgery?
Very clean
Fairly clean
Not very clean
Not at all clean
Don’t know
Q4 How helpful do you find the staff?
Very helpful
Fairly helpful
Not very helpful
Not at all helpful
Yes
No
Q5 In the past 6 months, how easy have you found the following?
Haven’t
Very Fairly
tried
easy
easy
a. Getting through on the phone
b. Getting results on the phone
c. On-line patient access
d. On-line repeat medication ordering
Not very
easy
Not at all
easy
Don’t
know
Q6 In the past 6 months, have you tried to see any doctor or nurse fairly quickly? (ie on the same
day or within the next 2 working days). You may wish to tick both
a. Doctor
b. Nurse
Yes
Yes
No
No
Can’t remember
Can’t remember
Q7 If you answered ‘Yes’ to Q6, were you able to see a doctor or nurse on the same day or in the
next 2 working days? You may wish to tick both
a. Doctor
b. Nurse
Yes
Yes
No
No
Can’t remember
Can’t remember
Q8 If you couldn’t be seen within the next 2 working days, why was that? (Please tick all that apply)
There weren’t any appointments
The times offered didn’t suit me
The appointment was with a doctor/nurse I didn’t
want to see
I could have seen a nurse but wanted to see a
doctor
Another reason
Can’t remember
Any other Comments regarding Q8:
Q9 In the past 6 months, have you tried to book ahead for an appointment with any doctor/nurse
(i.e. more than 2 working days in advance) You may wish to tick both
a. Doctor
Yes
No
Can’t remember
b. Nurse
Yes
No
Can’t remember
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LINTONVILLE MEDICAL GROUP
Patient Survey Questionnaire 2014-15
Q10 If you answered ‘Yes’ to Q9, were you able to get an appointment with any doctor/nurse
more than 2 working days in advance? You may wish to tick both
a. Doctor
b. Nurse
Yes
Yes
No
No
Can’t remember
Can’t remember
Q11 When did you last see any doctor or nurse
at this Surgery?
In the past 3 months
Between 3 and 6 months ago
More than 6 months ago
I have never been seen at this surgery
Q13 How long after your appointment time do
you normally wait to be seen?
I am normally seen at my appointment time
Less than 5 minutes
5 to 15 minutes
16 – 30 minutes
More than 30 minutes
Can’t remember
Q12 If you haven’t seen a doctor or
nurse in the past 6 months, why is that?
I haven’t needed to see a doctor/nurse
I couldn’t be seen at a convenient time
I couldn’t get to the surgery easily
I didn’t like or trust the doctors
Another reason
Q14 How do you feel about how long you
normally have to wait?
I don’t normally have to wait too long
I have to wait a bit too long
I have to wait far too long
No opinion
Q15 When are you most likely to access the Surgery?
Before 8:00 am
8:00 – 12:00 weekdays
12:00 – 16:00 weekdays
16:00 – 18:00 weekdays
Q16 How satisfied are you with the hours that we are open?
Very satisfied
Fairly satisfied
Neither satisfied or dissatisfied
Fairly dissatisfied
Very dissatisfied
I’m not sure when the surgery is open
Other comments regarding Q16
Q17 In general, how satisfied are you with the care you receive from the surgery?
Very satisfied
Fairly satisfied
Neither satisfied or dissatisfied
Fairly dissatisfied
Very dissatisfied
Other comments regarding Q17
ANY OTHER COMMENTS:
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LINTONVILLE MEDICAL GROUP
Patient Survey Questionnaire 2014-15
Q18 Are you male or female?
Male
Female
Q19 How old are you?
Under 18
18 to 24
25 to 34
35 to 44
45 to 54
55
65
75
85
Q23 In general, would you say your health
is:
to
to
to
or
Excellent
Very good
Good
Fair
Poor
64
74
84
over
Q20 Which of these best describes what you
are doing at present (Please tick ONE only)
Full time paid work (30 hours or more per 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
Q24 Do you have any of the following long
standing conditions? Please include problems
which are due to old age.
Deafness or severe hearing impairment
Blindness or severe visual impairment
A condition that substantially limits one or
more basic physical activities, such as walking,
climbing stairs, lifting or carrying
A learning difficulty
A long-standing psychological or emotional
condition
Other, including any long-standing illness
No, I don’t have a long-standing condition
Q21 In general, how long does your journey
take from home to work (door to door)?
Up to 30 minutes
31 minutes to 1 hour
More than 1 hour
Q25 Are you a deaf person who uses sign
language?
Yes
No
Q22 If you need to see a doctor during your
typical working hours, can you take time away
from work to do this?
Yes
No
Q26 Do you have any carer responsibilities
for anyone in your household with a longstanding health problem or disability?
Yes
No
P.T.O.
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LINTONVILLE MEDICAL GROUP
Patient Survey Questionnaire 2014-15
The following questions will help us to see how experiences vary between different groups of the population.
We will keep your answers completely confidential.
Q27 What is your ethnic group?
A White
British
Irish
Any other white background
Details if other :
Q28 Which of the following best describes
how you think of yourself?
Heterosexual / straight
Gay/Lesbian
Bisexual
Other
I would prefer not to say
B
Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Details if other:
C
Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background
Details if other:
Q29 Which of the following best describes
your religion?
None
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Other
I would prefer not to say
D
Black or Black British
Caribbean
African
Any other Black background
Details if other:
E
Chinese or other ethnic group
Chinese
Any other ethnic group
Any other white background
Details if other :
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