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Views on Pharmacy Services

NHS Kirklees are currently reviewing the services provided by pharmacies in the area. We would like to know your thoughts on the services provided by your local pharmacy at the moment, but also on the services which you might like to see provided in the future. Please complete the questionnaire and return it to the FREEPOST address Alternatively you can complete the questionnaire online at www.kirklees.nhs.uk Forms should be returned by 30 April 2010.

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1. Are you responding:

As a member of the public

On behalf of an organisation

2. If you are responding on behalf of an organisation, please indicate which type of organisation you represent:

NHS Social Care Private Health/Independent Sector Third Sector Regulatory Body Professional Body Education Trade Union Local Authority Trade Body Other (please give details) . ...........................................................................................

. .............................................................................................................................................

3. In which of the following areas do you live: (please tick one box only)

The Valleys (Holmfirth, Meltham, Honley, Marsden and Slaithwaite) Huddersfield South (Crosland Moor, Almondbury, Newsome and Dalton) Huddersfield North (Marsh, Fartown and Deighton) Denby Dale and Kirkburton (Shepley, Skelmanthorpe) Dewsbury and Mirfield (Savile Town and Thornhill) Spenborough (Cleckheaton, Liversedge and Heckmondwike) Batley, Birstall and Birkenshaw


4. On average, how often do you use the services provided by your local pharmacy?

Less than twice a year

3-6 times a year

More than 6 times a year

5. Do you always visit the same pharmacy?

All of the time Rarely

Most of the time Never

6. Which of the following services do you use? Regularly

Occasionally

Never

Dispensing of prescriptions Repeat dispensing Home delivery services and prescription collection services Buying over the counter medicines Advice from your pharmacist (e.g. healthy lifestyle, medicines advice, signposting etc) Disposing of old or unwanted medicines Sitting down with your pharmacist and talking about how you use your medicines Stopping smoking / nicotine replacement therapy Sexual health services (pregnancy testing, Chlamydia testing, condom distribution, emergency contraception) Head lice treatment scheme Palliative care (end of life care) Getting medicines for free without a prescription for minor ailments Supervised consumption of methadone and buprenorphine Needle exchange Other (please specify)

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7. Would you like any of the following services available at your pharmacy in the future? Yes

No

Don’t know

NHS Health checks Anticoagulation monitoring clinics Alcohol brief interventions Weight management clinics Chlamydia treating Pain management clinics Vaccination e.g. Seasonal Influenza Other (please specify)

8. Additional comments

. ............................................................................................................................................. . ............................................................................................................................................. . ............................................................................................................................................. . ............................................................................................................................................. . ............................................................................................................................................. . ............................................................................................................................................. . ............................................................................................................................................. . ............................................................................................................................................. . .............................................................................................................................................


Personal details 1. What is your sex? Tick one box only.

Male

Female

Prefer not to say

2. What is your age?

Age

Prefer not to say

3. Are your day-to-day activities limited because of any health problem or disability which has lasted, or is expected to last at least 12 months? Tick one box only

Yes, limited Yes, limited a little No Prefer not to say

4. Do you look after, or give any help or support to family members, friends, neighbours or others because of long-term physical or mental ill-health / disability or problems related to old age? Tick one box only

Yes No Prefer not to say

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5. What is your ethnic group? Tick only box only

A. White

B. Mixed

British Irish Any other white background, write...................................................................

White and Black White and Black African White and Asian Any other mixed background, write...................................................................

C. Asian, or Asian British

Indian Pakistani Bangladeshi Any other Asian background, write....................................................................

D. Black or Black British

Caribbean African Any other Black background, write

E. Chinese, or other ethnic group

F Other

Chinese Any other, write below

Prefer not to say


6. What is your religion or belief?

Tick one box only

Christian includes Church of England, Roman Catholic and all other Christian denominations

None Christian Buddhist Hindu Jewish Muslim Sikh Prefer not to say Other, write below................................................................................................................... . ...........................................................................................................................................

7. Which of the following best describes your sexual orientation? Tick one box only

Only answer this question if you are aged 16 years or over

Heterosexual/Straight Lesbian / Gay Woman Gay Man Bisexual Prefer not to say Other, write below ..................................................................................................................

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Please return your completed form to this FREEPOST address:

NHS Kirklees Freepost RSHB-GRJU-ALSL Patient & Public Involvement Broad Lea House Bradley Business Park Dyson Wood Way Bradley Huddersfield HD2 1GZ

Forms should be returned by 30 April 2010.

This information can be made available in languages other than English. It can also be made available in large print, Braille, or on audiotape. For copies, please telephone 01484 464000.

Date of publication: March 2010 • Ref: HH3568 • © Kirklees Primary Care Trust

http://www.kirklees.nhs.uk/fileadmin/documents/publications/PPI/pharmacy_questionnaire_2010  

http://www.kirklees.nhs.uk/fileadmin/documents/publications/PPI/pharmacy_questionnaire_2010.pdf

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