* 1. Do you currently pay for your prescriptions?

* 2. Do you have a prescription pre-payment card?

* 3. Do you have a long term condition? (such as diabetes, asthma, cancer, a physical disability or a mental health condition)

* 4. Do you understand why NHS Sandwell and West Birmingham Clinical Commissioning Group is proposing changes to prescriptions and medicines? (please select one option)

* 5. Do you agree that we should limit the prescribing of medicines for short term minor conditions?  (please tick one option)

* 6. What impact would this change have on you or your family?

* 7. Do you have any further comments on prescribing for short term, minor conditions?

* 8. What do you think about only prescribing medicines that are recommended by The National Institute for Health and Care Excellence (NICE)?

(NICE - evidence-based guidance, advice and information services for health, public health and social care professionals)

* 9. What do you think about only prescribing medicines that have clear clinical benefits?

* 10. What do you think about only prescribing medicines to patients who have a long term condition or who are in need of urgent care and not suitable for self-care?

* 11. What do you think about prescribing medicines that are not cost-effective?

* 12. Do you have any further comments you wish to add?

* 13. Do you or someone you care for e.g. a family member (please select all the answers that apply to you)

* 14. Are you (please select one option:)

* 15. Are you aware that you can also visit your local pharmacy for advice on your medication?

* 16. What kind of support and advice do you think people might need to help them manage their minor condition?

* 17. If you have any other comments in relation to this consultation, please state these here:

About you

It is important for us to listen to and hear from as many people possible. The following information will allow us to ensure that we collect the views of our population.

* 18. What is your ethnic group?

* 19. What is your postcode? This will help us to assess whether we are receiving responses across Sandwell and West Birmingham CCG.

* 20. What is your gender?

* 21. Are your day to day activities limited by a health problem or disability which has lasted or is expected to last over 12 months?

* 22. Which of the following age categories do you fit into?

* 23. What is your religion?

* 24. Which of the following options best describes how you think of yourself?

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