Your thoughts on the proposed merger of The Alexandra Practice and Princess Road Surgery Survey

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* 1. I am completing this survey... (Please select one button below)

For myself (the patient)

On behalf of the patient (family friend)

On behalf of the patient (member of staff)

Other (please specify)

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* 2. At which practice are you currently registered?

The Alexandra Practice

Princess Road Surgery

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* 3. Do you understand the reasons why The Alexandra Practice & Princess Road Surgery are proposing to merge together? (Please tick only one box).

Yes

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* 4. What are your views on the proposal to merge the practices? Please tell us about them in the space below:

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* 5. If the practices were to merge, would this create any challenges for you in accessing your health care?

Yes

And if ‘Yes’, how might be we able to help solve them?

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* 6. Merging of the practices would create more doctor appointments at both sites. Would this be important to you?

Yes

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* 7. Merging would increase the availability of nursing appointments. Would this be important to you?

Yes

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* 8. Please can you tell us how many times you have used your GP practice for the following reasons in the past 6 months: (Please select one button on each row)

	More than six times	Five or six times	Three or four times	Once or twice	Not visited in last 6 months
Nurses	Nurses More than six times	Nurses Five or six times	Nurses Three or four times	Nurses Once or twice	Nurses Not visited in last 6 months
Doctors	Doctors More than six times	Doctors Five or six times	Doctors Three or four times	Doctors Once or twice	Doctors Not visited in last 6 months
To collect a prescription	To collect a prescription More than six times	To collect a prescription Five or six times	To collect a prescription Three or four times	To collect a prescription Once or twice	To collect a prescription Not visited in last 6 months
To have bloods taken	To have bloods taken More than six times	To have bloods taken Five or six times	To have bloods taken Three or four times	To have bloods taken Once or twice	To have bloods taken Not visited in last 6 months
For a different reason	For a different reason More than six times	For a different reason Five or six times	For a different reason Three or four times	For a different reason Once or twice	For a different reason Not visited in last 6 months

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* 9. Thinking about the service you receive from your GP practice, how would you rate it? (Please select one button only)

Very Good

Good

Neither good nor poor

Poor

Very poor

Don't know / no opinion

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* 10. Please can you rank the following from most important to least important

	Most important	Fairly important	Average	Less important	Least important
Quality of care	Quality of care Most important	Quality of care Fairly important	Quality of care Average	Quality of care Less important	Quality of care Least important
Location	Location Most important	Location Fairly important	Location Average	Location Less important	Location Least important
Opening times	Opening times Most important	Opening times Fairly important	Opening times Average	Opening times Less important	Opening times Least important
Access to a doctor	Access to a doctor Most important	Access to a doctor Fairly important	Access to a doctor Average	Access to a doctor Less important	Access to a doctor Least important
Access to a nurse	Access to a nurse Most important	Access to a nurse Fairly important	Access to a nurse Average	Access to a nurse Less important	Access to a nurse Least important
Seeing the same doctor or nurse	Seeing the same doctor or nurse Most important	Seeing the same doctor or nurse Fairly important	Seeing the same doctor or nurse Average	Seeing the same doctor or nurse Less important	Seeing the same doctor or nurse Least important

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* 11. Are you? (Please select only one button)

Male

Female

Non-binary

Prefer not to say

Other (please specify)

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* 12. How old are you? (Please select only one button)

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 13. What is your postcode?

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* 14. Do you consider yourself to be disabled? (Please select only one button)

Yes

Rather not say

Yes (please specify below)

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* 15. What is your sexual orientation? (Please select only one button)

Heterosexual or straight

Gay

Lesbian

Bisexual

Rather not say

Other (please specify)

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* 16. Which race or ethnicity best describes you? (Please select one button only)

Arab

Asian/British Asian: Bangladeshi

Asian/British Asian: Chinese

Asian/British Asian: Indian

Asian/British Asian: Pakistani

Black/British Black: African

Black/British Black: Caribbean

White: British

White: Irish

White: European

Mixed Race: Black & White

Mixed race: Asian & White

Gypsy or traveller

Rather not say

Other (please specify)

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* 17. What do you consider your religion to be? (Please select only one button)

Buddhism

Christianity

Hinduism

Islam

Judaism

Sikhism

No religion

Rather not say

Another religion (please specify below)