Annual provider survey

YOUR VIEWS OF YOUR LOCAL HOSPITAL SERVICES

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 communications@nhs.net 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?

Yes
No
Not Applicable

5. Which department was it?

6. What was the visit for?

An emergency with no stay in hospital
An emergency with a stay in hospital
Planned inpatient (an overnight stay in hospital)

Clinic appointment (no overnight stay in hospital)
Day-case procedure (no overnight night stay in hospital)
Other service (please describe)

7. When was this?

in the last month
in the last three months
in the last six months

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

On-going regular treatment
One off

9. How would you rate the service?

Comments:

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

Don't know
Not applicable

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

	Strongly agree	Somewhat agree	Neither agree nor disagree	Tend to disagree	Strongly disagree	N/A
I had confidence in the staff providing care	I had confidence in the staff providing care Strongly agree	I had confidence in the staff providing care Somewhat agree	I had confidence in the staff providing care Neither agree nor disagree	I had confidence in the staff providing care Tend to disagree	I had confidence in the staff providing care Strongly disagree	I had confidence in the staff providing care N/A
The staff cared about the patients	The staff cared about the patients Strongly agree	The staff cared about the patients Somewhat agree	The staff cared about the patients Neither agree nor disagree	The staff cared about the patients Tend to disagree	The staff cared about the patients Strongly disagree	The staff cared about the patients N/A
Staff worked together to treat all the patient’s needs	Staff worked together to treat all the patient’s needs Strongly agree	Staff worked together to treat all the patient’s needs Somewhat agree	Staff worked together to treat all the patient’s needs Neither agree nor disagree	Staff worked together to treat all the patient’s needs Tend to disagree	Staff worked together to treat all the patient’s needs Strongly disagree	Staff worked together to treat all the patient’s needs N/A
There were enough opportunities for visiting	There were enough opportunities for visiting Strongly agree	There were enough opportunities for visiting Somewhat agree	There were enough opportunities for visiting Neither agree nor disagree	There were enough opportunities for visiting Tend to disagree	There were enough opportunities for visiting Strongly disagree	There were enough opportunities for visiting N/A
There was good and clear communication with the patient about their care needs	There was good and clear communication with the patient about their care needs Strongly agree	There was good and clear communication with the patient about their care needs Somewhat agree	There was good and clear communication with the patient about their care needs Neither agree nor disagree	There was good and clear communication with the patient about their care needs Tend to disagree	There was good and clear communication with the patient about their care needs Strongly disagree	There was good and clear communication with the patient about their care needs N/A
There was good communication with friends, relatives and carers	There was good communication with friends, relatives and carers Strongly agree	There was good communication with friends, relatives and carers Somewhat agree	There was good communication with friends, relatives and carers Neither agree nor disagree	There was good communication with friends, relatives and carers Tend to disagree	There was good communication with friends, relatives and carers Strongly disagree	There was good communication with friends, relatives and carers N/A
Specific cultural or religious needs were considered	Specific cultural or religious needs were considered Strongly agree	Specific cultural or religious needs were considered Somewhat agree	Specific cultural or religious needs were considered Neither agree nor disagree	Specific cultural or religious needs were considered Tend to disagree	Specific cultural or religious needs were considered Strongly disagree	Specific cultural or religious needs were considered N/A
There was clear guidance about the discharge process	There was clear guidance about the discharge process Strongly agree	There was clear guidance about the discharge process Somewhat agree	There was clear guidance about the discharge process Neither agree nor disagree	There was clear guidance about the discharge process Tend to disagree	There was clear guidance about the discharge process Strongly disagree	There was clear guidance about the discharge process N/A
The information about ongoing care needs and support was clear	The information about ongoing care needs and support was clear Strongly agree	The information about ongoing care needs and support was clear Somewhat agree	The information about ongoing care needs and support was clear Neither agree nor disagree	The information about ongoing care needs and support was clear Tend to disagree	The information about ongoing care needs and support was clear Strongly disagree	The information about ongoing care needs and support was clear N/A
Staff had understood the patient's condition	Staff had understood the patient's condition Strongly agree	Staff had understood the patient's condition Somewhat agree	Staff had understood the patient's condition Neither agree nor disagree	Staff had understood the patient's condition Tend to disagree	Staff had understood the patient's condition Strongly disagree	Staff had understood the patient's condition N/A
Staff gave the patient information and support to manage their health problem themselves	Staff gave the patient information and support to manage their health problem themselves Strongly agree	Staff gave the patient information and support to manage their health problem themselves Somewhat agree	Staff gave the patient information and support to manage their health problem themselves Neither agree nor disagree	Staff gave the patient information and support to manage their health problem themselves Tend to disagree	Staff gave the patient information and support to manage their health problem themselves Strongly disagree	Staff gave the patient information and support to manage their health problem themselves N/A
Staff listened to the patient	Staff listened to the patient Strongly agree	Staff listened to the patient Somewhat agree	Staff listened to the patient Neither agree nor disagree	Staff listened to the patient Tend to disagree	Staff listened to the patient Strongly disagree	Staff listened to the patient N/A

Annual provider survey

1. Name of your GP Surgery

2. I am

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

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

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?

20. Are you a carer?

Annual provider survey

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

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?