Annual provider survey


NHS West Hampshire Clinical Commissioning Group (CCG) is responsible for making sure that local people get high quality NHS care.
We want to hear about your experience when you or your family last used services from local NHS hospitals or community services, such as district nurses, mental health teams or health visitors.
All these surveys are anonymous and the information will only be used to help the CCG plan healthcare.
Please complete this if you or a relative, a friend or someone you care for has used local healthcare services in the last six months.
If you want to get more involved with planning local healthcare services, you can join our Health Involvement Network. Please contact for more information.

If you have significant concerns about a particular organisation, please use also use their complaints process to resolve the issue. You can also leave comments at CQC or NHS Choices

1. Name of your GP Surgery


2. I am


3. Were you offered a choice of providers for the healthcare services you needed?


4. Which hospital or community service did you use?


5. Which department was it?


6. What was the visit for?


7. When was this?


8. Was this for on-going regular treatment or a one-off visit?


9. How would you rate the service?


10. Was there an opportunity at the time to rate the service using the friends and family test?


11. To what extent do you agree with the following statements

Strongly agreeSomewhat agreeNeither agree nor disagreeTend to disagreeStrongly disagreeN/A
I had confidence in the staff providing care
The staff cared about the patients
Staff worked together to treat all the patient’s needs
There were enough opportunities for visiting
There was good and clear communication with the patient about their care needs
There was good communication with friends, relatives and carers
Specific cultural or religious needs were considered
There was clear guidance about the discharge process
The information about ongoing care needs and support was clear
Staff had understood the patient's condition
Staff gave the patient information and support to manage their health problem themselves
Staff listened to the patient

12. Did you have a conversation with a health professional about any of the following lifestyle factors? [tick all that apply]


13. Any further comments


14. Are you:


15. Your age group


16. Your ethnic background


17. Do you consider yourself to have a disability?


18. Your religion or belief


19. You would describe your sexuality as


20. Are you a carer?