Issue/Question
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Response
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About the Surgery and appointments
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Not Applicable
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Poor
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Fair
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Good
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Very Good
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Excellent
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1. Ease of contacting the Surgery
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2. Satisfaction with the way your appointment booking was made with the Surgery at the Reception Desk in person
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3. Awareness of the phone messages presented when you phone the surgery Poor = No/Not Aware. Excellent = Yes/Aware
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4. Awareness of the Online Website Services and the Automated phone systems which are available 24/7 to make a routine appointment (Poor = No/Not Aware and Excellent = Yes/Aware)
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5. Satisfaction in using the automated phone system when making an appointment (Option 1 on the telephone messages)
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6. Satisfaction in using the Surgery's Online system for booking a routine appointment, ordering a repeat prescription or changing personal details
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7. Awareness that by calling the Surgery on 0844 you are only charged the local rate by using landline and that Mobile phone providers may charge you more. Poor = No/Not Aware and Excellent = Yes/Aware
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8. Potential of seeing a doctor or nurse of your choice
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9. Ability to provide information on services available at the Surgery
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10. Awareness of the opportunity of booking an appointment to speak to a doctor/nurse on the telephone when necessary. Poor = No/Not Aware. Excellent = Yes/ Aware
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11. Ability to make an appointment at the surgery which is convenient to you
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12. Length of time waiting in the Surgery for your appointment (Poor = waited too long)
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13. Overall satisfaction in obtaining an appointment with the Surgery
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About the doctor/nurse
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14. The doctor(s)/nurse(s) ability to really listen to me
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15. The clarity of information and the assurance given to me by the doctor(s)/nurse(s)
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16. Confidence in the doctor(s)/nurse(s) ability
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Question
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Response
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About the doctor/nurse continued
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Not Applicable
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Poor
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Fair
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Good
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Very Good
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Excellent
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17. The opportunity given to me by the doctor(s)/nurse(s) to express my concerns or fears
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18. The comfort and cleanliness of the consultation/treatment room
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19. Overall service given by the doctor(s)/nurse(s)
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Finally
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20. The opportunity for making compliments or complaints about the Surgery
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21. Overall rating of the service received from the Surgery
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22. Please indicate how you would normally contact the surgery (Please mark in the box in order of priority: 1, 2, 3….)
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Land line Phone
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Mobile
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Online
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In person
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Other (Post)
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23. For Patients Under 25. How would you like the Surgery to contact you? Also any suggestions or ideas that could improve the service to your age group. Use box below if necessary
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24. Would you like to see a “one stop” medical services providing minor injuries, ultra sound, clinics to support asthma, diabetes, general medical care currently provided by GPs/Nurses and available 24/7 (Note: this may mean much larger surgeries but still have the opportunity to see your doctor). Please enter Yes or No, or any comments
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General Comments (Please include any additional comments you wish to make - please do not comment about individuals - thank you)
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