NOTTINGHAM CITY EAST PCN Extended Access Survey

Background Information

Please note, this survey may be available in different languages soon. Links to follow.

Thank you for taking the time to complete this survey. Your answers will help us to:

Here is how we will respond:
Your answers will help us understand the needs of the local population and help direct how future care is provided within Practices and the Primary Care Network.

This survey is open to anyone registered with the following practices:

Bakersfield Medical Centre

Greendale Primary Care Centre

Parliament Street Medical Centre

Family Medical Centre

Wellspring Surgery

The Windmill Practice

Victoria and Mapperley

We value the views of everyone who lives in our community.

You can answer as many or as few questions as you feel able to.

The results of this survey are for internal use. We will post the details of the survey results on the Practice websites.

If would like to participate in our focus group please enter your contact details in question 29 at the end of the survey.

Please complete the survey by 8th July 2022.

The survey will take approximately 10 minutes to complete.

If you have any queries about completing this survey, please contact 0115 883 1900.

If you need a paper copy of this survey, please contact your GP practice.

Question Title

* 1. Please enter the first 3 characters of your postcode, for example NG6

Question Title

* 2. Which of the following best describes you?

Female

Male

Non-binary

Prefer not to say

Other (please specify)

Question Title

* 3. Is your gender identity the same as the sex you were registered at birth?

Yes

Prefer not to say

Question Title

* 4. What is your ethnic group?

White - English, Welsh, Scottish, Northern Irish or British

White - Irish

White - Gypsy or Irish Traveller

White - Roma

White - Any other White Background

Mixed or Multiple ethnic groups - White and Black Caribbean

Mixed or Multiple ethnic groups - White and Black African

Mixed or Multiple ethnic groups - White and Asian

Mixed or Multiple ethnic groups - Any other Mixed or Multiple ethnic background

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Asian or Asian British - Bangladeshi

Asian or Asian British - Chinese

Asian or Asian British - Any other Asian background

Black, Black British, Caribbean or African - Caribbean

Black, Black British, Caribbean or African - African

Black, Black British, Caribbean or African - Any other Black, Black British, Caribbean or African -

Other ethnic group - Arab

Other ethnic group - Any other ethnic group

Question Title

* 5. How old are you?

Under 16

16 to 17

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 to 84

85 and over

Question Title

* 6. Which of these best describes what you are doing at present?

If more than one of these applies to you, please select the box next to the main one only.

In full-time paid work (30 hours or more a week)

In part-time paid work (under 30 hours each week)

In full-time education at school, college or university

Unemployed

Permanently sick or disabled

Fully retired from work

Looking after the family or home

Carer

Doing something else

Question Title

* 7. Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?

Yes

Question Title

* 8. How would you describe this health problem or disability? Please select all that apply to you.

Developmental Disorder

Injury

Learning Disability

Long Term Physical Illness

Mental Health Condition

Physical Impairment

Sensory Impairment

Other (please specify)

Question Title

* 9. Do you look after, or give any help or support to, family members, friends, neighbours or others because of either:

• long-term physical or mental ill health / disability, or
• problems related to old age?

Don’t count anything you do as part of your paid employment.

Yes, 1 to 9 hours a week

Yes, 10 to 19 hours a week

Yes, 20 to 34 hours a week

Yes, 35 to 49 hours a week

Yes, 50 or more hours a week

Question Title

* 10. Are you a parent or a legal guardian for any children aged under 16 living in your home?

Yes

Question Title

* 11. Are you a deaf person who uses sign language?

Yes

Question Title

* 12. Are you blind or partially sighted?

Yes

Question Title

* 13. If you answered yes to question 11 or question 12, what is your preferred method of communication?

Question Title

* 14. Which of the following best describes your smoking habits?

Never Smoked

Former Smoker

Occasional Smoker

Regular Smoker

Question Title

* 15. Which, if any, of the following best describes your religion?

No religion

Buddhist

Christian (including Church of England, Catholic, Protestant, and other Christian denominations)

Hindu

Jewish

Muslim

Sikh

Other

I would prefer not to say

NOTTINGHAM CITY EAST PCN Extended Access Survey

Background Information

Question Title

* 1. Please enter the first 3 characters of your postcode, for example NG6

Question Title

* 2. Which of the following best describes you?

Question Title

* 3. Is your gender identity the same as the sex you were registered at birth?

Question Title

* 4. What is your ethnic group?

Question Title

* 5. How old are you?

Question Title

* 6. Which of these best describes what you are doing at present?If more than one of these applies to you, please select the box next to the main one only.

Question Title

* 7. Are your day to day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?

Question Title

* 8. How would you describe this health problem or disability? Please select all that apply to you.

Question Title

* 9. Do you look after, or give any help or support to, family members, friends, neighbours or others because of either:• long-term physical or mental ill health / disability, or• problems related to old age?Don’t count anything you do as part of your paid employment.

Question Title

* 10. Are you a parent or a legal guardian for any children aged under 16 living in your home?

Question Title

* 11. Are you a deaf person who uses sign language?

Question Title

* 12. Are you blind or partially sighted?

Question Title

* 13. If you answered yes to question 11 or question 12, what is your preferred method of communication?

Question Title

* 14. Which of the following best describes your smoking habits?

Question Title

* 15. Which, if any, of the following best describes your religion?

* 6. Which of these best describes what you are doing at present?

If more than one of these applies to you, please select the box next to the main one only.

* 9. Do you look after, or give any help or support to, family members, friends, neighbours or others because of either:

• long-term physical or mental ill health / disability, or
• problems related to old age?

Don’t count anything you do as part of your paid employment.