Appendix 7b – Public Questionnaire
Pharmaceutical Needs - Customer Survey
Community pharmacy services (chemist shops)
Salford is working to help ensure everyone living the area has the right access to pharmacy services that help to improve your
health, such as dispensing prescriptions/ medicines, offering testing, and screening for common conditions, The questionnaire is
asking about community pharmacies (typically located in shopping areas or close to GP surgeries). 84% of adults visit a pharmacy
at least once a year.
What will the survey be used for?
This questionnaire will help the council understand what pharmacies services people use, what services they want, and how they
feel about access to these pharmacies. The survey is important because it will be used to decide whether applications to provide
new services by pharmacists and dispensing doctors will be approved, for example opening a new pharmacy.
Why should I complete the survey?
By completing this questionnaire you are making sure that your views influence the services currently delivered in your local
pharmacy, or that could be provided in future. Your opinions will help us to develop the right services.
Is the questionnaire anonymous and confidential?
Yes. To make sure that all your answers will remain anonymous and confidential, please DO NOT write your name or
address anywhere on the questionnaire.
How much time do I need?
The survey will take about 7-10 minutes to complete. We need to get a minimum number of responses to validate the survey so
please respond by 5th September 2016 to make your views count.
Can I see the results?
It is anticipated that the results will be available in around Spring 2017. If you would like to see the overall results please send a
request to [email protected] and we will send you a weblink when it is made public.
Where do I return the survey?
Please send the completed survey to:
Pharmacy Survey,
Public Health,
Unity House,
Salford Civic Centre,
Swinton,
Salford,
M27 5FS
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Appendix 7b – Public Questionnaire
1. What is the first part of your postcode? (3 or 4 digits) We will not be able to identify you from this
limited information.
2. Do you use a community pharmacy?
Yes
No (never)
3. Do you use a medical appliance supplier (for items such as incontinence products or wound dressings)?
Yes
No
4. Do you use an internet pharmacy (to order prescriptions online)?
Yes
No - aware of this but not used it
No - not aware of this facility
5. If you do use a community pharmacy, how often would you say you used one?
Once a week
Once every couple of weeks
Once a month
Once every couple of months
Less often
Q6 - Definition - A 'regular pharmacy' is one that you choose to use most of the time.
6. Do you have a regular pharmacy?
Yes
No preferred regular pharmacy
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Appendix 7b – Public Questionnaire
7. In terms of location, why do you use this pharmacy regularly? Please tick one box only.
Near to work
Near to home
Near to my doctors
In town/ shopping area
In the supermarket
Other (please specify)
8. In terms of staff and services, why do you use this pharmacy regularly?Please tick as many answers
as appropriate.
The staff are friendly
The staff are knowledgeable
The staff speak my first language (please detail below)
They offer a collection service
They offer a delivery service
They offer medicines in a compliance blister pack
They offer another service which I use (please detail below)
Other (please specify)
9. If your regular pharmacy was not open, or didn't have the things you need would you...Please tick one
box only.
Wait for them to open/get what I need in stock
Find another pharmacy
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Appendix 7b – Public Questionnaire
10. How do you usually travel to your regular pharmacy? Please tick one box only.
Walk
Car (driver)
Car (passenger)
Bus
Bicycle
Taxi
Other (please specify)
11. How far from your home or place of work would you be willing to travel to a pharmacy? Please tick one
box only.
Less than 1 mile
1-2 miles
2-3 miles
More than 3 miles
12. Are you able to get to a pharmacy of your choice? Please tick one box only.
Yes
No, I’m housebound
No, I have mobility issues
No, my preferred pharmacy does not have access suitable for my needs
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Appendix 7b – Public Questionnaire
13. How important are the following aspects of pharmacy services? Please tick one box per row only.
Very important
Important
Unimportant
Very unimportant
Early opening
times (before 9am)
Late opening
times (after 7pm)
Location
Knowledgeable staff
Friendly staff
Short waiting times
Private areas to speak
to the pharmacist
Saturday opening
Sunday opening
14. How satisfied are you with the following aspects of service at your pharmacy?Please tick one box per
row only.
Very satisfied
Satisfied
Unsatisfied
Very unsatisfied
Being open when
you need it
Location
Knowledgeable staff
Staff attitude
Waiting times
Private
consultation areas
The pharmacist taking
time to talk to you
The pharmacy having
the things you need
15. Have you have ever bought or used any of the following services from your pharmacy?
No I have NOT used
this service at my
Yes - this service
pharmacy
met ALL my needs
Yes - this service
met SOME of my
needs
Yes - but this service
did NOT address
I don't know what
my needs at all
this is
Alcohol support services
Blood pressure check
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Appendix 7b – Public Questionnaire
No I have NOT used
this service at my
Yes - this service
pharmacy
met ALL my needs
Yes - this service
met SOME of my
needs
Yes - but this service
did NOT address
I don't know what
my needs at all
this is
Cancer treatment
support services
Collection of prescription
from my surgery/ GP
Collection of prescription
from pharmacy
Purchased medicines
NOT on prescription
(eg. paracetamol)
Delivery of medicines
to my home
Diabetes screening
Early morning
opening (before 9am)
Electronic Prescription
Service (from GP to
pharmacy)
Emergency Hormonal
Contraception
(morning after pill)
Had a flu vaccination
Health tests, e.g.
cholesterol,
blood pressure
Healthy Weight advice
Late night opening
(after 7pm)
Medicine use reviews
Purchased
anti-malarials
Stop Smoking Service
Substance Misuse
Service
Saturday opening
Sunday opening
Advice about a longterm condition (ie. a
life-long /permanent
condition managed with
treatment /or support)
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Appendix 7b – Public Questionnaire
No I have NOT used
this service at my
Yes - this service
pharmacy
met ALL my needs
Yes - this service
met SOME of my
needs
Yes - but this service
did NOT address
I don't know what
my needs at all
this is
Minor Ailment Scheme
(Access to certain
subsidised over the
counter medicines to
avoid GP visits)
Other
Other (please specify)
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Appendix 7b – Public Questionnaire
16. Which of the following services would you like to have at a pharmacy in future, if available? Please
tick as many answers as appropriate
Alcohol support services
Blood Pressure check
Cancer Treatment support services
Collection of prescription from your GP
surgery Delivery of medicines to your home
Diabetes screening
Early morning opening (before 9am)
Electronic Prescription Service
Emergency Hormonal Contraception (morning after
pill) Flu vaccination
Health tests, e.g. cholesterol, blood
pressure Healthy Weight advice
Late night opening (after
7pm) Medicine use reviews
Prescription dispensing
Purchasing anti-malarials
Purchasing Over the Counter medicines
Respiratory Services e.g. inhaler
technique Stop Smoking Service
Substance Misuse
Service Sunday opening
Advice about a long-term condition (ie. a life-long /permanent condition managed with treatment /or support)
Minor Ailment Scheme (Access to certain subsidised over the counter medicines to avoid GP visits)
Other (please specify)
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Appendix 7b – Public Questionnaire
17. Are there any other services you would like your pharmacy to offer?Please tick one box only.
No
Yes (please specify)
18. Are you aware that pharmacists can access summary care records?
Yes
No
Don't know what this is
19. Overall, how satisfied are you with the service you receive from your pharmacy?
Very satisfied
Satisfied
Unsatisfied
Very unsatisfied
Background Information
We are committed to supporting all our communities and providing our services to everyone fairly and with respect. To make sure
we do this we need to collect information and we need to ask the questions below. You do not have to fill in this section, but it will
assist us to offer better services.
All your information is treated confidentially; we protect your information and only use it in such a way so that no one can be
identified. We will always follow the laws that protect against its misuse such as the Data Protection Act 1998.
Thank you for taking the time to fill it in.
20. My sex or gender is:
Male
Female
Prefer not to say
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Appendix 7b – Public Questionnaire
21. Is your gender identity the same as the gender you were assigned at birth?
Yes
No
Prefer not to say
22. My age is:
18 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55 - 64 years
65 - 74 years
75 + years Prefer
not to say
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Appendix 7b – Public Questionnaire
23. I would describe my ethnic origin as:
White - British
White - Irish
White - Gypsy Traveller, or Irish Traveller
Mixed - White and Black Caribbean
Mixed - White and Black African
Mixed - White and Asian
Mixed - Other Mixed / Multiple ethnic background
Asian - Indian
Asian - Pakistani
Asian - Bangladeshi
Asian - Chinese
Asian - Other
Black - African
Black - Caribbean
Black - Other
Other - Arab
Prefer not to say
Other - Any other ethnic group
24. Do you consider yourself to have a disability?
Yes
No
Prefer not to say
Please use this space if you would like to give more information...
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Appendix 7b – Public
Questionnaire
25. I would describe my sexuality as:
Heterosexual/ Straight
Gay man
Bisexual
Lesbian
Other
Prefer not to say
26. Please tell us your faith or religion.
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
No religion
Prefer to not say
Other (please specify)
27. What is your marital status?
Single
Married
Civil Partnership
Separated
Divorced
Widowed
Other
Prefer not to say
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Appendix 7b – Public Questionnaire
28. Which of the following best describes your working situation?
Working Full-time
Working Part-time
Volunteer
Not working - Studying
Not working - Unemployed
Not working - Looking after home/ family
Not working - Long term sick / disabled
Retired
Other
Prefer not to say
29. Do you look after (unpaid), or give any help or support to family members, friends, neighbours or
others because of either:
• long-term physical or mental ill-health?
• disability?
• old age?
No
Care for young person/s aged less than 25 years of age
Care for adult/s aged 25 to 49 years of age
Care for older person/s aged 50 years or older
Two or more of the above age groups
30. Are you or your spouse/partner pregnant, or during the last 12 months given birth/ adopted a child?
Pregnant
Gave birth in last 12 months
Adopted a child in last 12 months
None of the above
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