Your NHS Wales GP Experience Access Standards Questionnaire Question Title * 1. How recent was the experience you are thinking of? In the last 6 months Between 6 months and 1 year ago Between 1 and 2 years ago More than 2 years ago Question Title * 2. Thinking about your overall first impressions of the care you received: Did you feel that you were listened to? Always Usually Sometimes Never Question Title * 3. Were you able to speak in Welsh to staff if you needed to? Always Usually Sometimes Never Not Applicable Question Title * 4. From the time you realised you needed to use this service, was the time you waited: Shorter than expected About right A bit too long Much too long Question Title * 5. Thinking about the place where you received your care: Did you feel well cared for? Always Usually Sometimes Never Question Title * 6. If you asked for assistance, did you get it when you needed it? Always Usually Sometimes Never Not Applicable Question Title * 7. Thinking about your understanding and involvement in care: Did you feel you understood what was happening in your care? Always Usually Sometimes Never Question Title * 8. Were things explained to you in a way that you could understand? Always Usually Sometimes Never Question Title * 9. Were you involved as much as you wanted to be in decisions about your care? Always Usually Sometimes Never Question Title * 10. Using a scale of 0 – 10 where 0 is very bad and 10 is excellent, how would you rate your overall experience? 0 (Very Bad) 5 (Average) 10 (Excellent) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 11. Thinking of your responses: Was there anything particularly good about your experience that you would like to tell us about? Question Title * 12. Was there anything that we could change to improve your experience? Question Title * 13. Equality monitoring: We are committed to ensuring that everyone receives fair and equal respect. Whatever your age, disability, ethnicity, faith, gender reassignment or sexual identity, you can expect to be treated with dignity. We can only achieve this with your help by providing the information below. Data will be used for monitoring purposes only and held in strictest confidence. Your identity will not be disclosed to anyone. Question Title * 14. What is your age? 0-15 years 16-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75+ years I prefer not to say Question Title * 15. What is your gender? Male Female Other I prefer not to say Question Title * 16. At birth, were you described as: Male Female Other I prefer not to say Question Title * 17. 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, a lot Yes, a little Not at all I prefer not to say Question Title * 18. Which of the following options best describes how you think of yourself? Heterosexual or straight Gay or lesbian Bisexual Other I prefer not to say Question Title * 19. What is your religion? (Please choose one option that best describes your religion) No religion Christian (all denominations) Buddhist Hindu Jewish Muslim Sikh Any other religion I prefer not to say Question Title * 20. What is your ethnic group? (Please choose one option that best decsribes your ethnic group or background) Welsh (White) Irish (White) English (White) Northern Irish (White) Irish (White) Scottish (White) Gypsy or Irish Traveller (White) British (White) White and Black (Mixed / Multiple Ethnic Groups) Caribbean White and Black African (Mixed / Multiple Ethnic Groups) White and Asian (Mixed / Multiple Ethnic Groups) Any other Mixed / multiple ethnic background (Mixed / Multiple Ethnic Groups) Indian (Asian / Asian British) Pakistani (Asian / Asian British) Bangladeshi (Asian / Asian British) Chinese (Asian / Asian British) Any other Asian background (Asian / Asian British) African (Black / African / Caribbean / Black British) Caribbean (Black / African / Caribbean / Black British) Any other Black / African / Caribbean background (Black / African / Caribbean / Black British) Arab (Any other ethnic group) Any other ethnic group (Any other ethnic group) I prefer not to say (Any other ethnic group) Other (please specify) Question Title * 21. Any other comments? Done
