Proposed Merger Engagement Questionnaire

We are commencing formal consultation for the proposed merger of Burnt Ash Surgery and Downham Family Medical Practice.

The two practices will come together to form Ashdown Medical Group, pooling their management and clinical teams to offer greater resilience and a wider choice of services to our patients. Both practices have been sharing their values and commitment to high quality clinical care over the past year and now believe a full merger will help to provide improved access and choice for patients.

For further information, please visit your surgery or look at our practice websites: www.burntashsurgery.nhs.uk or www.downhamfamilymedicalpractice.co.uk

We would like to hear what you think about this proposal.

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* 1. 1. Please tick the main option which applies to you. I am;

A patient at one of the GP practices

A parent, relative, friend or carer of a patient who is registered at one of the GP practices

A staff member at one of the GP practices

I am interested in these services

Other (external stakeholder organisation)

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* 2. If you are a patient, please select the practice you are registered with;

Burnt Ash Surgery

Downham Family Medical Practice

I am NOT a patient at either practice

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* 3. Would you be prepared to go to another of our practices to receive
specialist care;

Yes

Unsure

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* 4. After the merger, patients would be able to book an appointment at either practice. Would this be beneficial to you?

Yes

Unsure (please specify)

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* 5. Do you have any comments regarding the proposed merger?

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* 6. At present each practice has its own Patient Participation Group (PPG). Do you feel it would be beneficial to combine the groups?

Stay as one PPG for each practice

Combine the PPGs

Unsure

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* 7. Please share any other comments below;

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* 8. Equality Monitoring Questions

Gender - Male

Gender - Female

Gender - Non-binary

Gender - prefer not to say

Gender - other

Age under 16

Age 16-24

Age 25 - 34

Age 35 - 59

Age 60 - 75

Age 76+

Prefer not to disclose age

Proposed Merger Engagement Questionnaire

Question Title

* 1. 1. Please tick the main option which applies to you. I am;

Question Title

* 2. If you are a patient, please select the practice you are registered with;

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* 3. Would you be prepared to go to another of our practices to receivespecialist care;

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* 4. After the merger, patients would be able to book an appointment at either practice. Would this be beneficial to you?

Question Title

* 5. Do you have any comments regarding the proposed merger?

Question Title

* 6. At present each practice has its own Patient Participation Group (PPG). Do you feel it would be beneficial to combine the groups?

Question Title

* 7. Please share any other comments below;

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* 8. Equality Monitoring Questions

* 3. Would you be prepared to go to another of our practices to receive
specialist care;