Ferry Road Health Centre, Rye

THE PRACTICE
1. When contacting the surgery by telephone how do you rate the ability to get through?
	Very easy
	Fairly easy
	Not very easy
	Not easy at all
	Don’t know/never tried

2. When telephoning the surgery today, after you were connected, how long did you have to wait to speak to a Receptionist?
	Less than a minute
	1-2 minutes
	3-4 minutes
	Over 5 minutes
	No answer

3. In the past twelve months how many times have you attended for an appointment here at the surgery?
	First time today (please go to next section on Accident & Emergency)
	Once or twice
	Three or four
	Five or six
	Seven or more

4. How long do you normally have to wait in the practice for your consultation to begin?
	5 minutes or less
	6-10 minutes
	11-20 minutes
	21-30 minutes
	More than 30 minutes

5. In general how satisfied are you with the care you receive at the surgery?
	Very satisfied
	Fairly satisfied
	Neither satisfied or dissatisfied
	Quite dissatisfied
	Very dissatisfied

The following questions provide us only with general information about the range of people who have responded to this survey. It will not be used to identify you, and will remain confidential.
	How old are you?	under 25	26-45
		46-64	65-84
		over 85
	Are you	Male	Female

What is your ethnic group (e.g. British/mixed British or British Indian/Pakistani/Bangladeshi or British Pakistani/Irish/White and Black African/Chinese)


ACCIDENT & EMERGENCY
1. How many times have you been to A&E in the past twelve months?
	None (go to Q6)		1-2
		3-4	5-6
		7-8	9-10
		11-12	12 or more

2. Why did you got to A&E? (please tick all that apply)
	Breathing difficulties
	Persistent, severe chest pains
	Serious accident
	Suspected broken bones
	Deep wound/severe bleeding
	Loss of consciousness
	Acute confused state
	Pain not relieved by analgesia
	Other, please specify


3. How was the decision made to go to A&E? (please tick all that apply)
	Made decision yourself
	Following advice/instruction from the surgery
	Following advice/instruction from Out of Hours Doctor
	Following advice/instruction from NHS Direct
	Following advice/instruction from 999

4. Was the surgery open when you attended A&E?
	Yes
	No

5. Did you try to contact the surgery about the problem before going to A&E?
	Yes
	No
	Comments


6. Are you aware there are alternative services available when the surgery is closed? (Plaza Walk In Centre, NHS Direct, South East Health Out of Hours)
	Yes
	No

7. Did you know there is a cost incurred against the surgery budget for attending A&E, even if you do not wait to be seen?
	Yes
	No