This consultation is about proposals to change some medicines and products which are made available to patients by prescription in Derbyshire.  For further information and background to these proposals click here.

* 1. Which GP Practice are you registered with?

* 2. Please write the first half of your home Postcode.

* 3. In Derbyshire the NHS spends over £3million a year on medicines to treat common minor conditions that are suitable for self-care and can be managed using medicines that can be bought over-the-counter. (To see the full list of minor conditions suitable for self-care click here)

Please select which statement you agree with, adding comments in the box below to explain your answer.

* 4. Are there any additional comments you wish to make?

* 5. Have you, or the person you care for, ever received NHS prescriptions for medicines that are available over-the-counter to treat minor conditions that are suitable for self-care?

* 6. Do you currently pay for prescriptions?

* 7. Equalities Monitoring
The answers to the next group of questions will be used to understand who has provided feedback.  In answering these questions you will help us understand who we are reaching and how to better serve everyone in our community.  This information will only be used for the purpose it has been collected for and will not be passed on to third parties.

What is your age?

* 8. Are you Male or Female?

* 9. What is your relationship status?

* 10. How would you describe your sexual orientation?

* 11. Is  your gender identity different to the sex you were assumed at birth?

* 13. What is your religion / belief?

* 14. Are you pregnant or are you caring for a child under 24 months?

* 15. Do you consider yourself to have a disability?

* 16. If you selected yes, which type of disability do you have? (You may tick more than one box)

* 17. 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
- Problems related to old age

* 18. If you selected yes, please indicate your caring responsibility (select all that apply)

* 19. What is your employment status?

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