Dear Patient

We would be grateful if you could complete this short survey about Prescot Medical Centre.

The Practice team want to provide the highest standard of care for our patients. Feedback from this survey will help us to identify areas that may need improvement. Your opinions are very valuable.

Your answers will be kept strictly confidential, separate to your patient records. No individuals will be identified and your Doctor will NOT know what answers you have put.

Thank you for your time in advance.

Q1. Have you signed up to Patient Access
YES (go to question 2) / WOULD LIKE TO / NOT AWARE OF SERVICE
NO (go to EPS section) / NOT BEEN ABLE TO LOG ON
Q2. Have you tried to book your appointment on line
YES / NOT BEEN ABLE TO LOG ON / TRIED BUT COULD NOT GET APPOINTMENT
NO / WOULD PREFER TO CALL THE SURGERY
Q3. Have you tried to order your repeat prescription on line
YES / NOT BEEN ABLE TO LOG ON / TRIED BUT WAS NOT ABLE TO ORDER
NO / WOULD PREFER TO ORDER AT THE SURGERY
Q1. Have you signed up for EPS (Electronic Prescribing)
YES (go to question 2) / WOULD LIKE TO / NOT AWARE OF SERVICE
NO (go to Vaccination section) / HAPPY WITH PAPER PRESCRIPTION
Q2. EPS – (Electronic Prescribing Service) – ARE YOU HAPPY WITH THE SERVICE
YES / SOMETIMES / PREFFERED PAPER ORDER/COLLECTION FROM THE CHEMIST
NO / THINKING OF CHANGING CHEMIST TO SEE IF THERE IS AN IMPROVEMENT
Q1. Shingles Vaccine
Were you, on the 01.09.2014,
70 


None of the above 
go to Pneumococcal Vaccine) / Would you like to have the shingles vaccine
Yes 
 / Not aware of the offer of this vaccine
Have you had the Shingles Vaccine
Yes 
 / Have you booked your appointment for your shingles vaccine
Yes 

Q1. Pneumococcal Vaccine
Are you
65 – 74 years 
75 – 84 years 
Over 85 years
None of the above 
go to General Information) / Would you like to have the Pneumococcal vaccine
Yes 
 / Not aware of the offer of this vaccine
Have you had the Pneumococcal Vaccine
Yes 
 / Have you booked your appoi ntment for your pneumococcal vaccine
Yes 

Q1. Information about you
Are you
Under 16 years 
17 – 24 years 
25 – 34 years
35 – 44 years 
45 – 54 years 
55 – 64 years 
65 – 74 years 
Over 75 years  / Are you :
Male 
Female
Q2. Please tell us your race.
Asian or Asian British: Bangladeshi / Asian or Asian British: Indian / Asian or Asian British: Pakistani / Other Asian background
Black or Black British: African / Black or Black British: Caribbean / Other Black background / Chinese
Polish / Other ethnic group / Mixed Heritage: White and Asian / Mixed Heritage: White and Black African
Mixed Heritage: White and Black Caribbean / Other Mixed Heritage background / White: British / White: English
White: Irish / White: Scottish / White: Welsh / Other White background
Prefer not to say
Q2. Information about your surgery –
How often do you come to the practice to see the doctor
Regularly / Occasionally
Very rarely
Prescot Medical Centre keeps information about you - these are known as your patient records. These records might include:
*your address *date of birth*notes about your visits with the Doctors *test results.
Q1. Were you aware of this?
Yes / No
Your information is used to allow health professionals to give you the best care. It may also be used anonymously by other people, such as the NHS for research and auditing purposes. For example, to monitor the number of patients with a particular health problem (e.g. the number of people who smoke), or the number of people being prescribed a certain drug or treatment (e.g. Nictotine patches).
Q2. Were you aware of this?
Yes / No

Did you know that we have a patient group who work alongside our GP’s and Practice staff to help improve our services?We really value all comments and feedback from patients and would love as many people as possible to be involved in our patient group. This could simply mean sending your comments on specific issues via o be discussed at the bi-monthly meetings with the minutes posted on our Practice Website
If you would like more information on the group, please complete your details below. These will be kept separate to your answers above and will not be used for any other purpose.

Yes, I would like more information on joining the Practice Participation Group
Name
Address
Telephone Number
Email address

FRIENDS AND FAMILY TEST

We would like you to think about your recent experiences of our services

How likely are you to recommend our GP Practice to friends and family if they needed similar care or treatment:-

Extremely likely / [ ]
Likely / [ ]
Unlikely / [ ]
Neither likely nor unlikely / [ ]
Extremely unlikely / [ ]
Don’t know / [ ]

If you could change one thing about your care or treatment to improve your experience, what would it be.

Date ………………………………..

Thank you for your valuable answers.
Please hand this to a member of staff. The results of this survey will be displayed in the Practice Web Site during March 2015