General

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* 1. Which age group do you belong to?

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* 2. Which ethnic group do you associate with?
Please tick all the boxes that apply to you

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* 3. Does the GP surgery meet your cultural needs?

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* 4. Do you have or are you eligible for a community services card?

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* 5. Generally, how easy is it to get through to someone at your GP surgery on the phone?

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* 6. How do you normally book appointments to see a GP or nurse at your GP (how easy) surgery?
Please tick all the boxes that apply to you

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* 7. And in the past 6 months, which of the following online services have you used at your GP surgery?
By ‘online’ we mean on a website or smartphone app
Please tick all the boxes that apply to you

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* 8. Last time you wanted to see or speak to a GP or nurse from your GP surgery what did you want to do?

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* 9. And when did you want to see or speak to them?

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* 10. Were you able to get an appointment to see or speak to someone?

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* 11. Thinking about the last time you had a visit to the surgery, what type of appointment did you get? I got an appointment…

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* 12. How long after initially contacting the surgery did you actually see or speak to them?

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* 13. Is your GP surgery currently open at times that are convenient for you?

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* 14. Which of the following additional opening times would make it easier for you to see or speak to someone?
Please tick all the boxes that apply to you

Planning your care
The next few questions are about care plans. A care plan is an agreement between you and your health professional(s) to help you manage your health day-to-day.

It is usually a written document you can carry with you to appointments and use at home. It can include information about your medicine, an eating or exercise plan, or goals you want to toward, like losing weight.

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* 15. Do you have a written care plan?

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* 16. Did you help put your written care plan together?
By ‘help’ we mean setting goals for yourself or choosing how you want to manage your health

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* 17. Do you use your written care plan to help you manage your health day-to-day?

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* 18. Do you have a named Care Plan Coordinator (for example nurse, doctor, or pharmacist) to help you keep your care plan up-to-date and organises help from other healthcare providers involved in your care?

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* 19. If you do not have a care plan already would you like to have one to help you manage your health day-to-day?

Overall experience

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* 20. Overall, how would you describe your experience of your GP surgery?

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