Estates engagement questionnaire
NHS Waltham Forest Clinical Commissioning Group Estates engagement questionnaire
This questionnaire should be answered after viewing a presentation on, or reading, the draft estates strategy.
Please email the completed questionnaire to by Thursday 30 June 2016.
1. What is most important to you about the health services you access at your GP practice?
2. Do you agree with the principle of creating GP hubs / networks that would allow more healthcare services to be delivered in one place without you needing to visit the hospital?
☐ Yes
☐ No
Please use the space below to add any further comments:
3. People have told us that journey times are important. On some occasions, to get seen quicker in the future, you may need to travel further to see a different GP to your regular one. On average you will be able to access a GP hub within 1.5km (20 minute walk) from your home. Would you travel further (within the borough) than you currently do to see a GP if needed?
☐ Yes
☐ No
Please use the space below to add any further comments:
4. Are you aware of your practice’s Patient Participation Group?
☐ Yes
☐ No
☐ I don’t know what this is
5. Do you agree with the location of the GP hubs for the area where your GP practice is located, as set out in the information you have seen? Please only answer for the area where your GP’s surgery is based, and please use the text box to expand on your answer if you wish.
1. Chingford
☐ Yes
☐ No
Please use the space below to add any further comments:
2. Leyton and Leytonstone
☐ Yes
☐ No
Please use the space below to add any further comments:
3. Walthamstow
☐ Yes
☐ No
Please use the space below to add any further comments:
Your use of local healthcare services
If you have time, please answer the following questions to help us understand how you currently use local healthcare services:
1. One a scale of 1 – 10 (10 being almost impossible) do you find it difficult to get an appointment with:
1. Your GP
2. Community hospital services
2. Did you know you can ask your pharmacy for advice?
☐ Yes
☐ No
Have you ever done this?
☐ Yes
☐ No
3. Are you aware of patient online access?
Patient online access is a relatively new service which allows you to book and change appointments online, order repeat prescriptions and view part of your medical record.
☐ No, I haven’t heard of it
☐ No, but I do not want to use it
☐ Yes, but I do not want to use it
☐ Yes, but I do not use it
☐ Yes, I have signed up for it
☐ Yes, how do I get more information on it?
☐ Yes, I am using it
☐ Other response not listed: ……………………………………………………..
Do you have any other comments you would like to make? Please use the space below:
About you
Please tell us a little about yourself. This section is NOT compulsory. If you wish to remain anonymous, your view will still be taken into account, however we would be grateful if you would fill in some of this section so that we can understand whether there are differences in the answers given by different groups of people.
1. Are you providing this response:
☐ in a personal capacity
☐ as a representative of a group (please state which group you are representing)
______
2. Name (optional)
______
3. Would you like to be kept up to date with information about the NHS (including this programme)
☐ Yes
☐ No
If so, please give us your email or postal address
______
4. Are you employed by the NHS?
☐ Yes
☐ No
☐ Prefer not to say
5. What is your age?:
☐ Under 16
☐ 16-25
☐ 26-40
☐ 41-65
☐ 65-80
☐ 81+
☐ Prefer not to say
6. What is your gender?
☐ Male
☐ Female
☐ Prefer not to say
7. Are you a resident of Waltham Forest?
☐ Yes
☐ No (go to question 18)
8. Which part of the borough do you live in?
☐ Leyton
☐ Walthamstow
☐ Leytonstone
☐ Chingford
9. Ethic Background (please tick all boxes that refer to you)
☐ British
☐ Asian British
☐ White and Black Caribbean
☐ Irish
☐ Indian
☐ White and Black African
☐ Bangladeshi
☐ Any other White background
☐ White and Asian / ☐ Pakistani
☐ Black
☐ Black British
☐ Chinese
☐ Any other ethnic group
☐ Black Caribbean
☐ Any other Asian background
☐ Prefer not to say
☐ Black African
☐ Any other Black background /
10. Which belief or religion, if any, do you most identify with?
☐ Atheism
☐ Buddhism
☐ Christianity
☐ Hinduism
/ ☐ Islam
☐ Judaism
☐ Sikhism
☐ Other
☐ Prefer not to say /
11. Do you consider yourself to have a disability?
☐ Yes
☐ No
☐ prefer not to say
Thank you for your feedback.
Page 2