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Urgent Care QuestionnaireThis survey is about the urgent medical attention you received on your most recent visit tothe NHS Trust named in the letter enclosed with this questionnaire. The department youvisited might have been called an Urgent Treatment Centre (UTC), Urgent Care Centre(UCC) or Minor Injury Unit (MIU). You might also think of it as A&E. These are places thatyou can go to for minor injuries or illnesses instead of going to A&E. Throughout thequestionnaire, we will use the term ‘Urgent Treatment Centre’.What you tell us is confidential and taking part is voluntary.WHAT TO DOPut a cross clearly inside one box using a black or blue pen.If you make a mistake, just fill in the box and put a cross in the correct box.If you cannot answer a question, or do not want to answer it, just leave it blank andgo to the next question.Please remember not to write your name or address anywhere on the questionnaire.When you have filled in as much as you can, please return it in the Freepostenvelope provided.NEED MORE HELP?For help completing the questionnaire, please call the survey helpline on inserthelpline number here or email insert helpline email here If you have concerns about the care you or others have received please contact theCare Quality Commission (CQC) on 03000 61 61 61.Copyright of the Care Quality Commission

ARRIVALWere you given enough privacy whendiscussing your condition with thereceptionist?4.Please remember, this questionnaire is about yourmost recent visit to the Urgent Treatment Centre atthe NHS Trust named in the letter. This may havebeen called an Urgent Care Centre (UCC) or MinorInjury Unit (MIU). You might also think of it as A&E.123Was this Urgent Treatment Centre the firstservice you went to, or contacted, for help withyour condition?1.12 Yes No4receptionist Go to 4 Go to 25. Before your most recent visit to this UrgentTreatment Centre, had you previously been tothe same Urgent Treatment Centre about thesame condition or something related to it?Before going to this Urgent Treatment Centre,where did you go to, or contact, for help withyour condition? (Cross ALL that apply)2.12345678 999 emergency service NHS 111 telephone service NHS 111 online service A&E department Pharmacist GP practice GP out-of-hours service A different Urgent Treatment Centre /1234512 The service(s) (above) referred / took me I couldn’t get a GP appointment quicklyenough3456 I am not registered with a GP My condition became worse I was not satisfied with the help I received A different reasonCopyright of the Care Quality Commission Yes, more than a month earlier No Don’t know / can’t rememberWAITINGDid you have an appointment on your mostrecent visit to the Urgent Treatment Centre?6.12 Somewhere elseWhat was the MAIN reason for going to theUrgent Treatment Centre following your contactwith the service(s) above? (Cross ONE only)3. Yes, within the previous week Yes, between one week and one monthearlierUrgent Care Centre/ Minor Injuries Unit /Walk-in Centre9 Yes, definitely Yes, to some extent No I did not discuss my condition with a3 Yes No Don’t know / can’t rememberHow long did you wait before you first spoketo a health professional? This does not includestaff screening for coronavirus at the entranceto the Urgent Treatment Centre.7.123456 0 - 15 minutes 16 - 30 minutes 31 - 60 minutes More than 1 hour but no more than 2 hours More than 2 hours Don’t know / can’t remember

Did the health professional explain what wouldhappen next?8.12345 Yes, definitely Yes, to some extent No I did not need an explanation Don’t know / can’t rememberSometimes, people will first talk to a healthprofessional and be examined later. From thetime you arrived, how long did you wait beforebeing examined?9.12345 I did not have to wait Go to 11 Up to 15 minutes Go to 10 16 – 30 minutes Go to 10 31 – 60 minutes Go to 10 More than 1 hour but no more than 2 hours Go to 1067 More than 2 hours Go to 10 Don’t know / can’t remember Go to 10SEEING THE HEALTHPROFESSIONAL12. Did you have enough time to discuss yourcondition with the health professional?12313. While you were in the Urgent TreatmentCentre, did a health professional explain yourcondition and treatment in a way you couldunderstand?1234had to say?13wait to be examined?12 Yes, but the wait was shorter Yes, and I had to wait about as long as I was45 Yes, but the wait was longer No, I was not informed Don’t know / can’t remember Yes, definitely Yes, to some extent No15. If you had any anxieties or fears about yourcondition or treatment, did a health professionaldiscuss them with you?informed3 Yes, completely Yes, to some extent No I did not need an explanation14. Did the health professional listen to what you210. Were you informed how long you would have to Yes, definitely Yes, to some extent No1234 Yes, completely Yes, to some extent No I did not have any anxieties or fears11. Overall, how long did your visit to the UrgentTreatment Centre last?12345 Up to 1 hour More than 1 hour but no more than 2 hours More than 2 hours but no more than 4 hours More than 4 hours Can’t rememberCopyright of the Care Quality Commission16. Did you have confidence and trust in the healthprofessional examining and treating you?123 Yes, definitely Yes, to some extent No

17. Did health professionals talk to each other aboutTESTSyou as if you weren’t there?1234 Yes, definitely Yes, to some extent No Not applicable22. Did you have any tests (such as x-rays, scansor blood tests) when you visited the UrgentTreatment Centre?12 Yes No Go to 23 Go to 2623. Did a member of staff explain why you neededYOUR CARE AND TREATMENT18. While you were at the Urgent Treatment Centre,how much information about your condition ortreatment was given to you?1234 Not enough Right amount Too much I was not given any information about mythese test(s) in a way you could understand?12324. Before you left the Urgent Treatment Centre,did you get the results of your tests?1condition or treatment219. Were you given enough privacy when being3examined or treated?123 Yes, definitely Yes, to some extent No20. Sometimes, a member of staff will say one thingand another will say something quite different.Did this happen to you?123 Yes, definitely Yes, to some extent No21. Were you involved as much as you wanted to bein decisions about your care and treatment?1234 Yes, definitely Yes, to some extent No I was not well enough to be involved indecisions about my care Yes Go to 25 No Go to 26 I was told that the results of the tests wouldbe given to me at a later date4 Don’t know / can’t remember Go to 26 Go to 2625. Did a member of staff explain the results ofthe tests in a way you could understand?1234 Yes, definitely Yes, to some extent No Not sure / can’t rememberPAIN26. Do you think the staff did everything they couldto help control your pain?1234 Yes, definitely Yes, to some extent No I was not in pain while I was in the UrgentTreatment Centre5Copyright of the Care Quality Commission Yes, completely Yes, to some extent No Can’t say / don’t know

ENVIRONMENT AND FACILITIESLEAVING THE URGENT TREATMENTCENTRE27. In your opinion, how clean was the UrgentTreatment Centre?1234531. What happened at the end of your visit to the Very clean Fairly clean Not very clean Not at all clean Can’t sayUrgent Treatment Centre?123did you see any of the following?1Yes2Social distancing measures(such as markers on thefloor or signage at theentrance)Handwashing with handsanitiser or soapStaff wearing PPE (e.g.gloves, masks, plasticaprons, eyewear)4 Staff disposing of glovesand plastic aprons5 Cleaning of surfaces3 2No3 Don’tknow 32. Did a member of staff tell you about whatsymptoms to watch for regarding your illnessor treatment after you went home?12 34you were worried about your condition ortreatment after you left the Urgent TreatmentCentre? 1Waste bins provided 273did you feel threatened by other patients orvisitors?23 Yes, definitely Yes, to some extent No Yes, completely Yes, to some extent No I did not need this type of information33. Did a member of staff tell you who to contact ifTissues available29. While you were in the Urgent Treatment Centre, I was sent to A&E Go to 38 I went home / somewhere else Go to 32INFORMATION61 Go to 38ward28. While you were in the Urgent Treatment Centre,1 I was admitted to or transferred to a hospital Yes No Don’t know / can’t remember34. Did staff give you enough information to helpyou care for your condition at home?1234 Yes, definitely Yes, to some extent No I did not need this type of information30. Were you able to get suitable food or drinkswhen you were at the Urgent Treatment Centre?12345 Yes No I was told not to eat or drink I did not know if I was allowed to eat or drink I did not want anything to eat or drink35. Before you left, did a member of staff discussyour transport arrangements for leaving theUrgent Treatment Centre?1234Copyright of the Care Quality Commission Yes No It was not necessary Don’t know / can’t remember

36. Did a member of staff discuss with you whetheryou may need further health or social careservices after leaving the Urgent TreatmentCentre (e.g. services from GP, physiotherapistor community nurse, or assistance from socialservices or the voluntary sector)?123ABOUT YOU40. Who was the main person or people that filledin this questionnaire?1envelope) Yes No, but I would have liked them to No, it was not necessary to discuss it234the care and support you expected availablewhen you needed it?23 Yes No I did not expect any further care or support A friend or relative of the patient Both patient and friend/relative together The patient with the help of a healthprofessional37. After leaving the Urgent Treatment Centre, was1 The patient (named on the front of theReminder: All questions should be answered fromthe point of view of the person named on theenvelope, including these background questions.41. Do you have any physical or mental healthconditions, disabilities or illnesses that havelasted or are expected to last for 12 months ormore?after I leftInclude problems related to old age.OVERALL138. Overall, did you feel you were treated withrespect and dignity while you were in the UrgentTreatment Centre?123 Yes, all of the time Yes, some of the time No2I had a verypoor experience232I had a very goodexperience45 Go to 44Select ALL conditions you have that havelasted or are expected to last for 12 months ormore.39. Overall. (please circle a number)1 Go to 4242. Do you have any of the following?10 Yes No6789341056789101112131415Copyright of the Care Quality Commission Breathing problem, such as asthma Blindness or partial sight Cancer in the last 5 years Dementia or Alzheimer’s disease Deafness or hearing loss Diabetes Heart problem, such as angina Joint problem, such as arthritis Kidney or liver disease Learning disability Mental health condition Neurological condition Autism or autism spectrum condition Stroke (which affects your day-to-day life) Another long-term condition