‘General Practice Out of Hours Service’ Available week nights and Saturdays.

1. Which of the following best applies to you

I am answering these questions about myself
I am answering these questions on behalf of another patient
I am answering these questions on behalf of another patient as their carer

2. Which GP Practice are you or the person you are completing for registered at:

3. What is your age

18-49
50-65
65-80
81+

4. What is your gender

Male
Female
Prefer not to say
Other (please specify):

5. Do you consider yourself to be disabled and if so what is the nature of your disability

Yes (Please specify)
No

Comments:

6. Please indicate how happy you would be to attend the following appointments at a different location to your usual practice, if it meant you could be seen faster:

	Very happy to attend	Happy to attend	Not ideal but I would attend	If it was the only option I would attend	Very unhappy and I would not attend
Physio appointment	Physio appointment Very happy to attend	Physio appointment Happy to attend	Physio appointment Not ideal but I would attend	Physio appointment If it was the only option I would attend	Physio appointment Very unhappy and I would not attend
Urgent Same Day	Urgent Same Day Very happy to attend	Urgent Same Day Happy to attend	Urgent Same Day Not ideal but I would attend	Urgent Same Day If it was the only option I would attend	Urgent Same Day Very unhappy and I would not attend
Planned Pre-Booked Appointment	Planned Pre-Booked Appointment Very happy to attend	Planned Pre-Booked Appointment Happy to attend	Planned Pre-Booked Appointment Not ideal but I would attend	Planned Pre-Booked Appointment If it was the only option I would attend	Planned Pre-Booked Appointment Very unhappy and I would not attend
Specialist appointment ie Diabetic, Mental health etc	Specialist appointment ie Diabetic, Mental health etc Very happy to attend	Specialist appointment ie Diabetic, Mental health etc Happy to attend	Specialist appointment ie Diabetic, Mental health etc Not ideal but I would attend	Specialist appointment ie Diabetic, Mental health etc If it was the only option I would attend	Specialist appointment ie Diabetic, Mental health etc Very unhappy and I would not attend
GP Appointment	GP Appointment Very happy to attend	GP Appointment Happy to attend	GP Appointment Not ideal but I would attend	GP Appointment If it was the only option I would attend	GP Appointment Very unhappy and I would not attend
Nurse appointment	Nurse appointment Very happy to attend	Nurse appointment Happy to attend	Nurse appointment Not ideal but I would attend	Nurse appointment If it was the only option I would attend	Nurse appointment Very unhappy and I would not attend
Chronic Disease Management	Chronic Disease Management Very happy to attend	Chronic Disease Management Happy to attend	Chronic Disease Management Not ideal but I would attend	Chronic Disease Management If it was the only option I would attend	Chronic Disease Management Very unhappy and I would not attend
Minor Illness	Minor Illness Very happy to attend	Minor Illness Happy to attend	Minor Illness Not ideal but I would attend	Minor Illness If it was the only option I would attend	Minor Illness Very unhappy and I would not attend
Screening such as cervical smears	Screening such as cervical smears Very happy to attend	Screening such as cervical smears Happy to attend	Screening such as cervical smears Not ideal but I would attend	Screening such as cervical smears If it was the only option I would attend	Screening such as cervical smears Very unhappy and I would not attend
Support Groups	Support Groups Very happy to attend	Support Groups Happy to attend	Support Groups Not ideal but I would attend	Support Groups If it was the only option I would attend	Support Groups Very unhappy and I would not attend

7. How far in advance would it be most useful for you to book appointments

Same day
Next day
Within a few days
More than a week and up to two weeks

8. How likely are you to use additional appointments at the following times:

	Very Likely	Sometimes	Not Very Likely	Not at all	Don’t know/ unsure
Weekday evening 6:30 -8 pm	Weekday evening 6:30 -8 pm Very Likely	Weekday evening 6:30 -8 pm Sometimes	Weekday evening 6:30 -8 pm Not Very Likely	Weekday evening 6:30 -8 pm Not at all	Weekday evening 6:30 -8 pm Don’t know/ unsure
Saturday morning 9am -12pm	Saturday morning 9am -12pm Very Likely	Saturday morning 9am -12pm Sometimes	Saturday morning 9am -12pm Not Very Likely	Saturday morning 9am -12pm Not at all	Saturday morning 9am -12pm Don’t know/ unsure
Saturday afternoon 1pm - 5pm	Saturday afternoon 1pm - 5pm Very Likely	Saturday afternoon 1pm - 5pm Sometimes	Saturday afternoon 1pm - 5pm Not Very Likely	Saturday afternoon 1pm - 5pm Not at all	Saturday afternoon 1pm - 5pm Don’t know/ unsure
Sunday morning 9am - 1 pm	Sunday morning 9am - 1 pm Very Likely	Sunday morning 9am - 1 pm Sometimes	Sunday morning 9am - 1 pm Not Very Likely	Sunday morning 9am - 1 pm Not at all	Sunday morning 9am - 1 pm Don’t know/ unsure
Weekdays early morning 7:00 -8:00	Weekdays early morning 7:00 -8:00 Very Likely	Weekdays early morning 7:00 -8:00 Sometimes	Weekdays early morning 7:00 -8:00 Not Very Likely	Weekdays early morning 7:00 -8:00 Not at all	Weekdays early morning 7:00 -8:00 Don’t know/ unsure

9. Of all potential Enhanced Access appointment slots, which are your preferred time/s?

Weekday (7am-8am)
Weekday Evening (6:30pm – 8pm)
Saturday Morning (9am-1pm)
Saturday Afternoon (1pm-5pm)

10. If you were offered an appointment at another location at a convenient time, how long would you be prepared to travel/be able to travel for?

	0-10 minutes	10-20 minutes	20-30 minutes	30-40 minutes	I am not willing / able to travel to another practice
Urgent Same day appointment	Urgent Same day appointment 0-10 minutes	Urgent Same day appointment 10-20 minutes	Urgent Same day appointment 20-30 minutes	Urgent Same day appointment 30-40 minutes	Urgent Same day appointment I am not willing / able to travel to another practice
A routine appointment	A routine appointment 0-10 minutes	A routine appointment 10-20 minutes	A routine appointment 20-30 minutes	A routine appointment 30-40 minutes	A routine appointment I am not willing / able to travel to another practice

11. Please select your preferred consultation type

12. Please share more details on your views about the following methods of appointment consultations:
Please state how far you agree with the following statements:

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
I am happy to attend face to face when this is appropriate	I am happy to attend face to face when this is appropriate Strongly agree	I am happy to attend face to face when this is appropriate Agree	I am happy to attend face to face when this is appropriate Neither agree nor disagree	I am happy to attend face to face when this is appropriate Disagree	I am happy to attend face to face when this is appropriate Strongly disagree
I am happy to have an appointment over the telephone where this is appropriate	I am happy to have an appointment over the telephone where this is appropriate Strongly agree	I am happy to have an appointment over the telephone where this is appropriate Agree	I am happy to have an appointment over the telephone where this is appropriate Neither agree nor disagree	I am happy to have an appointment over the telephone where this is appropriate Disagree	I am happy to have an appointment over the telephone where this is appropriate Strongly disagree
I am happy and able to attend appointments via video call	I am happy and able to attend appointments via video call Strongly agree	I am happy and able to attend appointments via video call Agree	I am happy and able to attend appointments via video call Neither agree nor disagree	I am happy and able to attend appointments via video call Disagree	I am happy and able to attend appointments via video call Strongly disagree

13. Which mode of transport do you use most often to get to your GP practice?

14. In minutes, how long does it normally take you to get to your GP practice using your most-used method of transport?

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