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GP referral support service
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West Hampshire CCG is keen to ensure we provide high quality healthcare for local people, this includes how you are directed to different services.
We would like to hear about patients’ experience of being referred by your GP to a consultant or other health professional in hospital or other health centre. Was it straightforward or could things be improved?
Please answer the following questions based on your most recent experience.
1.
Question 1.
What has been your experience of being referred for an outpatient appointment?
Excellent
Good
OK
Not very good
Poor
2.
Question 2.
When I saw my GP and a referral was required, I understood the next steps that I needed to take to ensure I received an appointment
Yes
No
Comments:
This is required
3.
Question 3.
I had a conversation with my GP about where I could be seen
Yes
No
Comments:
This is required
4.
Question 4.
I understood how long I would have to wait for an outpatient appointment
Yes
No
Comments:
This is required
5.
Question 5.
I understood when the appointment was made that I needed to make sure I was available to attend my appointment
Yes
No
Thinking about your most recent visit to the Outpatient Department
6.
Question 6.
Were you given a choice of appointment times?
Yes
No
7.
Question 7.
Was your appointment date changed by the hospital?
Yes
No
If yes, please give more details
This is required
8.
Question 8.
What could be improved with the referral process?
What are your thoughts on doctors seeking advice before making a referral in future?
9.
Question 9.
Would you be happy to let your doctor seek clinical advice before a decision to refer is made? This could ensure you are seen at the right place, first time or that any investigations can be done before referral.
Yes
No
Comments:
This is required
10.
Question 10.
Would you consent to share your referral information with other local doctors to help your GP when considering whether a referral is required
Yes
No
Comments:
This is required
11.
Question 11.
If you would be interested in taking part in a focus group to help us further with this project or would like to be kept informed of future plans, please give us your email address.
This will only be used for this purpose and will not be shared with anyone outside the CCG. If you wish to have your name removed from our database at anytime you can do so by emailing whccg.communications@nhs.net
12.
Question 12.
Any further comments?
13.
Question 13.
Are you:
Female
Male
Prefer not to say
14.
Question 14.
Your age group
17 or under
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Prefer not to say
15.
Question 15.
Your ethnic background
Indian
Pakistani
Bangladeshi
Nepali
Any other Asian background
Black Caribbean
Black African
Any other Black background
Chinese
White and Black Caribbean
White and Black African
White and Asian
White British
White Irish
Any other white background
Prefer not to say
Any other ethnic background - please specify
This is required
Input box for - Any other ethnic background - please specify
16.
Question 16.
Do you consider yourself to have a disability?
Yes
No
Prefer not to say
If yes, please tell us about your disability
This is required
17.
Question 17.
Your religion or belief
Atheism
Buddhism
Christianity
Hinduism
Islam
Judaism
Sikhism
Other religion or belief
Prefer not to say
18.
Question 18.
You would describe your sexuality as
Bisexual
Gay man
Heterosexual/ Straight
Lesbian/ Gay woman
Prefer not to say
19.
Question 19.
Are you a carer?
No
Yes, for child/children under 18 years living at home
Yes, for a relative or person living with you
Yes, for a relative or person living elsewhere