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Annual provider survey

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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
 
Question 1.

Name of your GP Surgery

Question 2.

I am

This is required
Question 3.

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

Question 4.

Which hospital or community service did you use?

Question 5.

Which department was it?

Question 6.

What was the visit for?

This is required
Question 7.

When was this?

Question 8.

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

Question 9.

How would you rate the service?

This is required
Question 10.

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

Question 11.

To what extent do you agree with the following statements

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
Question 12.

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

Question 13.

Any further comments

Question 14.

Are you:

Question 15.

Your age group

Question 16.

Your ethnic background

This is required
Question 17.

Do you consider yourself to have a disability?

This is required
Question 18.

Your religion or belief

Question 19.

You would describe your sexuality as

Question 20.

Are you a carer?