Proposed closure of Hawkinge Branch Surgery Consultation Survey

Please circle/highlight answers. Further comments can be added below.

Are you/your child registered with the Surgery? / YES / NO
Do you understand the practice’s reason for the branch closures? / YES / NO
Having read the information in this letter do you support the practice’s plan in principle to close the branch surgery / YES / NO
Where do you normally go for your appointments? / Hawkinge Branch surgery / Lyminge Main Surgery
When did you last visit the practice? If you visited the practice today do not count this in your response: / In the last month 1-3 months ago
3-6 months ago 6-12 months ago
More than 12 months
How many times in the last 12 months have you visited a branch surgery? / Not visited 1-3 times
3-6 times 6-12 times
more than 12 times
Thinking about the last 12 months, how often have you visited the main practice in Lyminge? / Not visited 1-3 times
3-6 times 6-12 times
more than 12 times
In the likely event of Hawkinge branch surgery closing, how do you think you would access GP services? / Travel to the main surgery / Register with another practice
We would welcome any other comment you may have:
  • On the change
  • Your concerns
  • What we could do to help you

Patient Name:
Are you: / Male / Female
Your age range is: / Under 18 / 18 - 25 / 26 – 35 / 36 – 45 / 46 – 55 / 56 – 65 / 66 - 75 / over 75 years
Do you consider yourself to have a disability? / Yes - please circle below / No
Visual impairment / Hearing Impairment / Physical disability / Mental Health problem / Learning difficulties / Long term condition
Do you want to discuss any aspects of this letter or questionnaire with the Practice Manager? / YES / NO
If yes please confirm contact information?
Do you look after, or give special help to anyone who is sick, has a disability, or is an older person, other than in a professional capacity? / No, I don’t care for another person / Yes, I care for a person in another household / Yes I care for a person in my own household
To which ethnic group would you say you belong? (Please tick ONE only)
WHITE:  British  Irish  Any other white background (Please specify)…………………………………..
MIXED:  White & Black Caribbean  White & Black African  White & Asian
 Any other Mixed background (Please specify) …………………………………
ASIAN OR ASIAN BRITISH:  Indian  Pakistani  Bangladeshi
 Any other Asian background (Please specify) ………………………………….
BLACK OR BLACK BRITISH:  Caribbean  African
 Any other Black background (Please specify)…………………………….……..
CHINESE:  Chinese
OTHER ETHNIC GROUP:  Any other ethnic group
(Please specify) ……………………………………………………………………….

Thank you for taking the time to complete this survey

Please return to Tara Woolgar by 9th February 2018 by hand, post or via email on