We have developed this survey to try and better understand your thoughts and experiences of using NHS 111. The information you provide will be anonymous and will be used to help identify potential ways the NHS can communicate this service with its patients and the benefits to those that require it. Have you used the 111 service within the past 12 months? Yes No Why did you access this service? Because I was instructed to by a health professional Because it was something that needed attention but wasn’t an emergency Because I couldn’t get a GP appointment Something else Please use the space provided to explain why you accessed the service Please tell us how you would rate your experience of using NHS 111 using a score between 1-5 stars with 1 star being very poor and 5 stars being very good. What was the outcome of your experience of using NHS 111? If you were in a similar situation in the future, would you follow the same process of using NHS 111? Yes No Can you provide more information on why you haven’t used the NHS 111 service? If applicable, what other service did you use instead of NHS 111? In your own words, what do you think the 111 service is, what can it be used for and when should you use it? What does the term urgent care mean to you? Do you have any other thoughts you’d like to share about the 111 service? Which of the following options best describe how you think of yourself? Man (including trans man) Woman (including trans woman) Non-binary Other… You can use this space to describe your gender in your own terms. Is your gender identity the same as it was at birth? Yes No Your age group 0-12 13-15 16-17 18-24 25-49 50-64 65-79 80+ Prefer not to say Not known Ethnicity Ethnicity - None -ArabAsian / Asian British: BangladeshiAsian / Asian British: ChineseAsian / Asian British: IndianAsian / Asian British: PakistaniAsian / Asian British: Any other Asian / Asian British backgroundBlack / Black British: AfricanBlack / Black British: CaribbeanBlack / Black British: Any other Black / Black British backgroundMixed / Multiple ethnic groups: Asian and WhiteMixed / Multiple ethnic groups: Black African and WhiteMixed / Multiple ethnic groups: Black Caribbean and WhiteMixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic groups backgroundWhite: British / English / Northern Irish / Scottish / WelshWhite: IrishWhite: Gypsy / Traveller / Irish Traveller White: RomaWhite: Any other White backgroundPrefer not to sayNot knownOther ethnic group… Please use this space to describe your ethnicity Sexual Orientation Heterosexual / Straight Gay Man Gay Woman / Lesbian Bisexual Asexual Prefer not to answer Prefer to self descibe Please use this space to describe your sexual orientation Do you have a disability? Yes No Prefer not to say Not known Town or area you live in Town or area you live in - None -ChaddertonColdhurstDelphDenshawDiggleDobcrossFailsworthGlodwickGrasscroftGreenfieldHathershawHollinwoodMoorsideOldhamRoytonSaddleworthSpringheadShaw & CromptonWaterheadWernethWestwoodOther… Please use this space to tell us what town or area you are in Submit Leave this field blank
