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Dr.Sandhu will be leaving Gade at the end of the month

Due to unforeseen circumstances, we regret to advise that Dr.Sandhu will be leaving the practice at the end of the month. Dr. Airey has generously offered to return for a 2 months period while we make further arrangements. We are grateful for the support and understanding of our patients during this transition period

Dr Airey Retirement Message

The decision to retire was not easy. I felt it was the right time to go as I wish to amongst other things pursue physical activities whilst my health allows. I have known some of my patients for almost thirty years and they feel in some ways like an extended family. I have been very touched by the kind messages I have received. A big thank you to my patients for a special career at Gade Surgery.

Dr Airey Announces His Retirement

Dr Airey announces his retirement after almost thirty years at Gade Surgery at the end of January. He says he will be sad to go as he has a warm rapport with his patients over many years. He will be handing over his list to a local doctor, Dr Jagdip Sandhu, and his patients will be officially notified of this in due course

Delivering Special Provision Locally

DSPL is a service supporting Children, Young People & Families in Early Years, Schools, Academies, Colleges & at Home in Watford, Three Rivers, Bushey & Radlet with multi-complex needs, through Early Years Settings, Schools, Colleges and the Community . They provide a service that finds positive solutions to multi-complex needs. The Team will consider service requests to support families, children or young people with multi-complex/agency needs that require intensive involvement. Service Requests are accepted from Professionals, Parents, Carers and Young People. Go to their website ( for more information or call Jan on 07715 415894.

New Doctor starts at Gade

A Message from Dr Hinton

Dear All ,

After over 30 years working at Gade surgery I have decided to reduce my hours but not to retire. As from 1st December I will be doing a job share with Dr Karen Waddington, a young lady doctor who lives locally. I will be working all day Tuesday and Wednesday only whilst Dr Waddington will be working all day on Monday , and on Thursday and Friday mornings.

All patients who are registered with me will be encouraged to see Dr Waddington, especially on days when I am not working. We will be meeting regularly to make sure your care is not affected by having two doctors involved in your management. Dr Waddington will be joining us on 1st November in order to familiarise herself with the practice. I hope you will welcome her and bear with us while any teething problems with the new arrangement are resolved.

My best wishes

Dr.James Hinton

'New IVF eligibility and referral centres

Go to the IVF page through the Information Resource tab for the details.


What is ‘Repeat Dispensing’?

It’s a different system for issuing prescriptions. There are 2 parts. The Authorisation form (green, marked RA on the right and has the number of issues & Doctor’s signature) and the actual prescriptions with no signature (usually 3 or 6, each has RD and the issue number on it). There is no date on them and if you’re going away, this allows the Chemist to issue it earlier if needed.

Why has this changed?

Our new computer system allows this and you can collect a new prescription from the Chemist without having to put in an order as frequently. It can be more flexible if you’re going away on holiday and need your prescription earlier.

What has changed?

There’s an Authorisation Form and the prescriptions (3 or 6). The whole lot needs to be given to the same Pharmacy. They will issue one lot; when you need more you can pick up the next. The Pharmacist should tell you when you need to order more.

Will it be different if my prescriptions are sent electronically?

Yes unlike before the Pharmacist can still issue your medication early if you’re going away but you will need to stay with the same pharmacy. Obviously, there will be no paper prescription for you to collect. Continue ordering in the same way.

What if I don’t want it?

Please inform the receptionist and we can discuss alternate arrangements. However, your Doctor will generally have changed you over if we think it will work out better for you.

Why are some of my medicines not issued this way?

‘Repeat Dispensing’ is only suitable if your medication isn’t changing all the time or doesn’t require close monitoring. Ultimately the Doctor has to decide if your medication regime is suitable and safe to be transferred to ‘Repeat Dispensing’. mental health online for young people

A unique service that provides vulnerable young people, who have emotional or mental health problems, with support when they need it most.

Kooth was developed to provide PCTs, local authorities and GPs with the resource, expertise and support to provide help to young people most at risk and crucially, prevent them from entering the care system. It engages with hard-to-reach young people in a way that other services can't.

Kooth provides users with a free, confidential, safe and above all anonymous way to ask for help. It's currently available to over half a million 11-25 year olds in England and Wales and is now operational in 19 geographical areas.

Kooth is a transformational lifeline that has successfully helped and continues to reach the very vulnerable, many of whom would never have access to face-to-face counselling.

Repeat prescriptions – a short guide to safe and effective use of your medication

Following these simple steps will help make sure that you use your medicines safely, get the most out of them and help to prevent waste.

When ordering your repeat prescription, please use your GP’s online ordering system or use the most recent repeat prescription request form.

Check the medicines you already have at home before you order so that you only order the medicines you need. It is important not to stockpile medicines at home.

If you are using a repeat prescription request form then cross out the medicines that you don’t need (you will still be able to order them in the future) and record the number of items ordered. Remember to sign the form.

If you are picking up medicines from your pharmacy and you realise that you have ordered items that you don’t really need then give these back to the pharmacy prior to leaving. Your prescription can be adjusted accordingly.

Let your GP or pharmacist know if you have stopped taking any medicines.

Make an appointment with your GP for a medicines review on a regular basis

Ordering medicines over the phone can lead to mistakes so please order them on line or in person. If this is difficult for you please ask your GP for advice

Did you know?

A medication review by your GP will help make sure that the medicines you are taking are still helping you.

Your local pharmacist can help you with practical advice about your medicines such as how to manage potential side-effects or how to take your medicines effectively eg time of day or with food.

Excessive medicines at home may be a safety risk to you and others. The medicines may be out of date, may no longer be appropriate for your medical condition or may lead to your taking too much medication.

As a patient or carer, you are the best person to order the correct amount of repeat medicines, as you can check what is needed before ordering.

If you lose your repeat prescription request slip, your GP practice receptionist can print another for you.

Medicines that are over-ordered and not used cost the NHS in this part of Hertfordshire around £3m a year. This is money is not available to spend on other health services.

MINOR INFECTIOUS ILLNESSES IN CHILDREN (“Why won't my Doctor give me antibiotics?”)

How effective are antibiotics?
For virus infections they:
  • Do no good
  • Will harm to around 1 in 9 (diarrhoea, rashes, reaction, vomiting)
Antibiotics are powerful medicines that need to be used only when really needed. Often they aren’t useful and can do harm as well. Antibiotic overuse is an increasing problem. Our children face growing up in a world where people may die due to common antibiotic-resistant infections!
  • Cough medicines don't work
  • Most are viral
  • Acute Bronchitis or Chest Infection - generally not recommended
  • Only 1 in 5 will have reduced cough IF it's a bacterial infection
  • Average duration is 3 weeks for 90% of children
Sore throat:
  • 90% are viral
  • 90% resolve by 7 days
  • Even if bacterial, duration of pain only reduced by 16 hours!
  • 'Pus' on tonsils is actually a coating, doesn't always mean a bacterial infection
Ear Infection:
  • Antibiotics do not reduce pain in first 24 hours, subsequent attacks or deafness.
  • Use paracetamol or ibuprofen for pain.
  • Illness resolves in 4 days in 80% without antibiotics
  • Need to treat 20 children > 2 years and seven 6-24 months old to get pain relief in one at 2-7 days.
Doctors may use antibiotics if:
  • < 3 months of age child
  • 4 days symptoms and not improving
  • Child really unwell or at high risk of complication due to underlying medical condition
Immediate prescribing may be appropriate for the following groups:
  • discharging ear
  • <2 year old with ear infections in both ears

Statutory declaration of mean earnings

All GP practices are required to declare mean earnings (ie average pay) for GPs working to deliver NHS services to patients at each practice. The average pay for GPs working in the practice of the Gade Surgery in the last financial year was £46532 before tax and National Insurance. This is for 4 full time GPs and 4 part time GPs who worked in the practice for more than six months.

Meningitis B Vaccination Update

This vaccine is available for new born babies getting three doses in the first year of life as part of their routine vaccination schedule. There have been one or two high profile cases in unvaccinated older children which has started a petition to run a vaccine catch up programme. To get the risk into perspective it is 60 times more likely that your children will die in a road traffic accident than die of meningitis B. It is unlikely that a vaccination catch up programme will happen anytime soon and so parents if they decide to get their children vaccinated they will have to do this privately at a likely cost of around £500. This increased interest has sparked a vaccine shortage which Glaxo say will take a few months to rectify and so recommend not to start a course until a complete course is available. Our local private providers seem to have run out of supplies for the time being. For meningitis symptoms and signs go to

Three Rivers West Children's Centres

Children's Centres offer access to a range of services and advice to families with young children living in the Chorleywood & Loudwater, Croxley Green and Rickmansworth area.

The centres details are as follows:

Croxley Green Children's Centre, Dulwich Way, Croxley Green, Herts, WD3 3PX
Tel: 01923 805110

Rickmansworth Children's Centre, Shepherds Lane, Mill End, Rickmansworth, WD3 8JJ
Tel: 01923 772094

Chorleywood & Loudwater Children's Centre, Chorleywood Library, Lower Road, Chorleywood, Herts, WD3 5LB
Tel: 01923 484903

The link to their website for patients to access more information is:

New alcohol support service is launched

Action for Change

The contract for providing alcohol counselling and / or support to the residents of Hertfordshire has been awarded by Hertfordshire County Council to Action for Change.

This service compliments the existing treatment CRI Spectrum and provides residents of Hertfordshire with telephone support and counselling concerning alcohol. This service is available to those who are current experiencing issues with alcohol, who would like to maintain any positive changes that they have made and those who are affected by someone else’s alcohol use.

The main aims of the service are to engage with those:

  • Unwilling to engage in face to face/group support
  • Living in rural areas
  • Aged 18+
  • Working and unable to access services during a working day
  • Who have childcare responsibilities
  • Aged 65+
  • Have learning disabilities
  • Have a number of health related concerns which inhibits the ability to travel
  • Do not wish to re-access drug and alcohol services after exiting treatment.

How to Refer

You can self refer by calling 0300 111 2470 (Monday to Friday 9:00 - 17:00) or emailing .

Appointments areavailable on Monday, Tuesday and Wednesday evening and on Saturdays from 9:00 - 13:00.

The team at Action for Change are all skilled in delivering counselling and psychosocial interventions helping people to reach their goals or supporting them to maintain their goals.

The Living Room

The Living Room exists to promote access to quality treatment for those with addiction to drugs, alcohol and addictive behaviours such as eating disorders and self-harming. We also support their affected families, children and friends. Addiction is an illness damaging not just to individuals, but harms families and children too. Addiction can lead to communities bearing the cost of antisocial or criminal behaviour and increased health and social welfare costs. Up to 70 people a year leave our Stevenage centre free of addiction, we anticipate that 36 people a year will also gain abstinent recovery within our new but smaller St Albans centre. Each year many children in ‘looked after care’ are returned to parents who have gained recovery with us. Whilst many people re-enter employment, education or see their families once broken restored.

Weight management referral programme for children aged 5 – 15

BeeZee Bodies is a weight management referral programme for children aged 5 – 15 and their families.

Behaviour change techniques are used to engage with parents and children in a meaningful way that takes into account individual and family circumstances.

We have demonstrated that this increases the likelihood of making sustainable changes that help to control weight and improve parent and child self-efficacy and self esteem. How does it work? BeeZee Bodies is comprised 3 main components:

Physical Activity

The first 4 sessions focus on outdoor and team building activities known to enhance self-efficacy and promote group cohesion in both parents and children. Remaining sessions are delivered by local coaches who offer opportunities to get involved with local activities.

Healthy Eating

Healthy eating sessions for children and parents, delivered by trained nutritionists and dietitians, covering topics such as: portion sizes; energy balance; takeaways, snacks and drinks and much more! The emphasis is on making practical and realistic changes. Practical sessions include cooking healthier versions of popular meals and a supermarket tour.

Behaviour Change


We work with the children on realistic ways they can make small changes by setting weekly targets.


Behaviour change with a specialist who helps families to identify the barriers that prevent effective weight management. This is a process which requires honest dialogue and social support within the group.

Go to 01438 355649 website for further information

Friends and Family Test 2014-2016

Survey Results – 1st to 28th February 2015

The question posed by the Friends & Family Test survey was:

How likely are you to recommend our GP practice to friends and family if they needed similar care or treatment?

A total of 39 responses were received during February 2015. No survey forms were spoiled. A breakdown of responses is as follows:

FFT Response: Extremely likely Number of responses 15
FFT Response: Likely Number of responses 4
FFT response: Neither likely nor unlikely Number of responses 1
FFT response: Unlikely Number of responses 2
FFT response: Extremely Unlikely Number of responses 1
FFT response: Don’t Know Number of responses 0

Patients can submit their responses to the Friends and Family Test either in writing, using the response forms available in the surgery waiting rooms or electronically (through Survey Monkey), via the this link. A breakdown of collections during January is as follows:

Total handwritten responses received 18
Total responses submitted electronically 5

We are grateful to patients who have already submitted a response to the questionnaire and would encourage more patients to do so.

If you are unable to submit your responses electronically or in writing, we are happy to receive your survey by telephone.

Responses for the remainder of the survey will be published monthly.

The Partners
Gade Surgery

Updated Patients Charter

The PPG have updated the Patients Charter which can be found on the main menu

PPG Report 14/15 Published

Please go to the PPG button to find the 2014/15 report:

Change of email address for prescriptions

Due to the phasing out of old NHS email addresses please the following new address for prescription ordering:

This can be found on our repeat prescription ordering form.

Electronic prescribing service

Gade Surgery has launched its electronic prescription service. This means that your prescriptions once prepared by the Surgery can go directly to your nominated chemist electronically. To use this service simply go to your preferred chemist and ask them to nominate themselves as your nominated chemist.As has previously been the case, the chemist can order repeat prescriptions for you or you can order yourself . This can be in person, in writing, by email or using our ‘VOS’ electronic ordering service which after applying allows you to log into your account on our medical system and amongst other things allows you to order your repeat medications. On ordering please state whether you would like to pick up your prescriptions as previously from the surgery or be sent to your nominated chemist electronically. Once you have ordered your medications they will available within two working days at your preferred destination.

Self referral abortion service opens in Watford

Marie Stopes is pleased to announce a medical abortion service to open at Upton Road Surgery, Colne House, Watford. Medical abortion is available up to nine weeks gestation. All forms of contraception are also available and testing for sexually transmitted infections. Self referral is by way of Marie Stopes 24 hour One Call service on 0345 300 8090.

FREE 12 weeks subscription to either Slimming World or Weight Watchers

Public Health at Hertfordshire County Council are pleased to announce a continuing weight management on referral scheme to offer a FREE 12 weeks subscription to either Slimming World or Weight Watchers for Hertfordshire patients who are registered to a GP practice in the county and who meet the criteria below:

Inclusion Criteria

  • 16 years and above
  • Body Mass Index (BMI)
  • BMI > 28 with co – morbidities (e.g. high blood pressure, diabetes, arthritis etc.)
  • BMI >27.5kg/m2 of South Asian Origin  with or without co-morbidities
  • Motivated to lose weight
  • Able to attend weekly support meetings for 12 weeks

Exclusion Criteria

  • Pregnant women (accepted only by Slimming World and not Weight Watchers)
  • Currently have an eating disorder
  • Attended Weight Watchers / Slimming World or a similar commercial weight management programme in previous 3 months
  • Previously referred, re-referral is not permitted or funded

Referrals are being accepted by way of GPs, Practice Nurses and Healthcare Assistants amongst others.

Places are strictly on a first come first served basis and so please contact your health care professional to book your place.

Bath oils no longer prescribable

As you are aware every aspect of NHS spending has been scrutinised for cost effectiveness not least prescribing. Bath oils have been shown to be potentially dangerous and less effective than applying cream after washing. Further details can be found by following this link.

We will therefore, effective as of now, no longer prescribe bath oils and they will be removed from repeat lists. If you would prefer to continue with this practice then you can buy them 'over the counter'.

Weight Management Course Males Age 18-50

Herts Public Health have asked Watford Football Club Community Trust to run a Weight Management Programme on their behalf for:

  • adult males of 18-50 years of age
  • with a BMI of 30 and above.
They will be running a series of 12 week programmes over the next 15 months. These programmes will run from the following two venues and are free. The first courses are at:
  • Oxhey Wood Primary School WD19 7SL every Wednesday from 7 to 8.30 pm starting 4th February
  • Vicarage Road Stadium, WD18 0ER every Thursday from 7 to 8.30 pm starting 5th February.

The first thirty minutes is Nutritional Education and then a hour of Physical Activity.

To book your place ring Mark Smith on 01923 496385 or email to

Family Support

The mission of is to work around the clock, transforming the lives of families, supporting parents and making happier relationships, happier families and a stronger society. "Our experience enables us to help families with any problem or challenge that they face. Our trained family support workers, both paid and volunteer, offer all family members immediate and on-going help on the phone, online or in local communities. We use the knowledge gained through our work to inform, support and train professionals and campaign for changes to improve and support family life."

Family Lives was formally registered as a charity in 1999, and operated under the name of Parentline Plus. The charity's original formation as Parentline was founded in response to the tragic child abuse case of Maria Colwell in 1973, who was killed by her step-father. The parents that founded Parentline believed that there needed to be a dedicated organisation supporting parents, before they reached crisis point which could result in abuse. A merger in 1999 between the National Stepfamilies Association, Parentline and Parent Network built on the collective experience of these three charities, to provide a range of national and local services to support parents and families across the country. Parentline Plus reverted back to its registered name of Family Lives in 2011. We still have senior members of staff from all three organisations working at Family Lives. Family Lives has also merged with two small organisations, Bullying UK and TeenBoundaries in 2010 and 2011 respectively, to further the expertise and reach of the organisation. In addition a merger with the respected Parenting UK occurred in November 2012, enhancing our work with professionals and practitioners in the parenting field. Currently Family Lives employs 186 staff and 236 volunteers across our central and local offices.

Any one can seek their help. Go to their website for full information.

Another useful website is Young Minds an organisation that is dedicated to improving the emotional wellbeing and mental health of children and young people.

Cancer Support Services

Cancer services in West Herts are offering a wide range of support, therapy and professional help based on The Grove in St Albans, The Starlight Centre in Watford and The Spring Centre in Berkampsted. For further information including services offered please follow these links for Grove House, Spring Centreand Starlight Centre.

Friends and Family Test

From the 1st December it will become a contractual obligation for practices to offer the 'Friends and Family Test' to all patients using their services, and from the end of January to report the results to the Area Team which will be published nationally. It will be in the format of a simple questionaire which will be freely available to all patients using our services.

Access to Patient Records

By the 30th September we are contractually obliged to promote and offer the facility for our patients to view online, export or print any summary information from their records relating to medications, allergies, adverse reactions and any other items agreed between ourselves and our patients. We have been notified by our medical systems supplier,'In Practice Systems' that this facility will not be available on-line until December. The facility will be available through 'Vision On line Services' which is currently available for prescription ordering and appointment booking. If in the meantime you would like to access your records please contact our management team.

A Sad Farewell to Dr Deborah Kemp

Dr Deborah Kemp joined Gade Surgery in 1998 and throughout her 16 year tenure has proved to be a dedicated and popular doctor. It is with great regret, therefore, that we have to announce that she has decided to leave the practice at the end of October 2014 to pursue other career interests. She will be greatly missed by all the members of the practice team and we wish her every happiness and success for the future.

Dr Kemp will be replaced by Dr Sonali Sudarshi who joins the practice team on 1st November; patients currently registered with Dr Kemp will be transferred to her automatically by the Health Authority to ensure continuity of patient care. As the mother of a young family, Dr Sudarshi brings with her a wealth of experience gained in diverse communities around London and the South East. We are confident that this experience will benefit patients and their families and fully expect that she will maintain the exceptional standards of care established by Dr Kemp. We look forward to working with a new partner and to supporting her as she establishes herself in the practice community and we trust that patients will offer their own invaluable support in welcoming her to the practice. To that end, and in line with practice policy, we expect that patients will remain registered with her for a minimum of six months before considering a request for a change of GP.

Dr Kemp has asked us to thank those patients who have already expressed their appreciation and good wishes and sends this message to her patients.

"As a lot of you will now be aware, I am leaving Gade Surgery at the end of October 2014 to take on a new and exciting career challenge in medical education.

It has been a very difficult decision to make as I have thoroughly enjoyed working at Gade and will miss both my patients and the staff here greatly. It has been both an honour and a privilege to have been entrusted with helping you look after your health over the past sixteen years. I would like to take this opportunity to thank you all for your trust and many kindnesses – it has been very much appreciated.

With best wishes to you all for the future,"

Debbie Kemp

Welcome to Nurse Marie

We are pleased to welcome nurse Marie to the team. She has slotted into the team with ease and is already providing a high quality service.


In response to patient comments and suggestions, we are installing a new telephone which we hope will enhance our service to patients. Our clinical computer software also has to undergo a major upgrade to a remote server system. To move out patient database will unfortunately require very limited use of the system for three days.

Telephones – a completely new system will be installed during the week commencing Monday 11th August. This will introduce call queuing and other features which we hope will significantly reduce pressure at busy times and make it easier for us to handle calls more efficiently. There will be no change to telephone numbers and minimal interruption to telephone services.

Patient computer records – the system will change during the week commencing Monday 4th August. There should not be major disruption except on Thursday 7th August when we can only offer urgent appointments to be booked on the day. Patients may also find appointments take slightly longer and waiting times may be extended on that day. We apologise for any inconvenience while this essential work takes place.

We will do everything possible to keep disruption to a minimum and thank patients for their understanding while work is in progress.

The Partners

Removal of cosmetic skin lesions

The NHS with its budget constraints does not remove skin lesions which it considers to be solely cosmetic but does offer a service through Watford General to have these treated for a fee. Your GP will refer you to the dermatology department at Watford General Hospital in the usual way and if the lesion is deemed not to be treatable as an NHS service you will be offered this private service. This service is offered by 'Dr Sam Anthony Skin' and further information can be found by following this link to her website.

Charity event sponsorship

Dr Airey is taking part in a charity triathlon event in a few weeks time for the Wooden Spoon charity which helps disadvantataged children. He would be grateful if you would support him in his endeavours bysponsoring him.


The event took a grueling nine hours of canoeing, cycling, and running but was finished. Thank you to those that supported Dr Airey and consequently raised money to help disadvantaged children.

Changing Doctor Policy

We have a personnal list system as we feel that this offers the best service to our patients. However we know this relationship may not always work and that patients not unreasonably want to change doctors. The information about this can be found on this page. what you need to know

The government through the Health and Social Care Information Centre is planning to extract General Practice patient data and amalgamate this with Hospital Episodes and Statistics (HES) data to provide a database which will used for commissioning, planning and research. The data once amalgamated with be ‘pseudonymised’ to protect patient privacy. Approved organisations will be able to buy this data. Advocates such as Tim Kelsey of NHS England has said that it will improve patient care, improve treatments, and prevent the likes of Mid Staffordshire situation happening again. There have been some concerns that the data may not be secure but he points out that the HES which has been around for 25 years has always been secure and the is only an extension of this. Some GP's are also concerned as they are legal custodians of the data and also that some patients may not be forthcoming with their GP’s if they feel the information they are divulging may not secure. Patients will be automatically opted in and have to specifically opt out if they do not want their data used. To do this they need to tell their GP in writing. It is very likely that the roll out date of May will be delayed due to recent adverse publicity. As there will be further discussion and information dissemination, patients do not have to decide yet.


Mental Health Service offers self referral for psychological help

Enhanced Primary Mental Health Service (EPMHS) delivers Improved Access to Psychological Therapies (IAPT) in Hertfordshire. The service provides psychological interventions for people with mild to moderate depression and anxiety disorders including Panic, Obsessive Compulsive Disorder, Generalised Anxiety, Post Traumatic Stress and Health Anxiety.

Go to the Enhanced Primary Mental Health Services web page to read more about this service where a self referral form may be found.

Request prescriptions on-line - update

As we are experiencing some technical problems with some prescription requests when ordering prescriptions online (see Vision Online Services-VOS- news item below) and so we have postponed the discontinuation date of the old email mailbox: until the end of June. If you wish to request prescriptions online after that date you must register for VOS with the surgery using this link to download the application form. This service can also be used for booking or cancelling routine GP appointments. You can email your request to register using the mailbox until the end of June when this mailbox will be discontinued.

Peace Hospice Starlight Centre

The Peace Hospice Starlight Centre has been set up for patients and there families who have recently diagnosed with or living with a serious illness. The Starlight Centre offers a range of services to patients, their carers and families whose lives are affected by cancer or other conditions. Their aim is to help our patients to 'live well'.

Services include:

  • A centre to learn
  • A centre to relax and create
  • A centre to get involved in
For further information to be found on their website please follow this link.

Patient Participation Group Survey 2014

Gade Surgey had introducing some exciting new changes this year with on line booking of appointments and online ordering of prescriptions. We are keen to get your feedback as to how we are doing so far. Please follow the link below; it will only take a minute to fill out. We would like to know we are doing.

Gade Surgery Patient Participation Group Survey 2014


PSA prostate cancer screening guidelines

Screening asymptomatic men for prostate cancer with the prostate specific antigen (PSA) blood test should no longer be routine, say new guidelines issued by the American Urological Association (NICE has not produced any specific guidance). But this benefit needed to be weighed against the potential harms of screening, the panel said, which included complications from biopsy procedures, overtreatment of “indolent” disease that would never have caused symptoms, and the “considerable distress involved in the decision making process, the biopsy, and deciding among treatment options.” Despite these concerns the panel “felt that in men aged 55 to 69 years, there was sufficient certainty that the benefits of screening could outweigh the harms that a recommendation of shared decision making in this age group was justified.” It concluded, “For this reason, the Panel strongly recommends shared decision-making for men aged 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences.” Although some men aged over 70 who were in excellent health may benefit from prostate cancer screening, the panel did not recommend routine PSA screening in men over age 70 or for any man with a life expectancy of less than 15 years. The new recommendations do not go as far as those released last year by the US Preventive Services Task Force, which advised against routine PSA screening regardless of age,but are closer to those released earlier this year by the American College of Physicians, which recommended against routine screening and concluded that men aged 50 to 69 should undergo PSA testing only after discussing with their physicians the “limited potential benefits and substantial harms of screening for prostate cancer.”

BPAS Self Referral

British Pregnancy Advisory Service in conjunctiion with the NHS in Hertfordshire is able to accept self referrals for medical and surgical terminations,contraceptive services and STD services. This service is based in Luton and is fully NHS funded. They can be contacted 24 hours a day on 08457304030.

Prescription requests on-line: discontinuation of old service

As more patients are registering for our on line prescription requests we are going to discontinue the email request service on 1st November 2013. If you have not already signed up for the new service then we would strongly urge you to do so now.


This leaflet describes shingles and the benefits of the vaccination.
Most of us had chickenpox when we were young and some will not be aware that we’ve had it. If we did have it, then the virus that caused it can stay in our bodies for the rest of our lives without our knowing it is there. Sometimes, however, the virus reactivates when we’re older and causes a disease called shingles. So shingles isn’t like other infectious diseases because you don’t catch it from someone else.
Shingles can be very painful and tends to affect people more commonly as they get older. And the older you are, the worse it can be. For some, the pain can last for many years.
There is now a vaccine that can reduce your risk of getting shingles or reduce the severity of its symptoms should you develop the disease.
What is shingles?
Shingles (also known as herpes zoster) is caused by the reactivation of an infection of a nerve and the area of skin that it serves, resulting in clusters of painful, itchy, fluid-filled blisters. These blisters can burst and turn into sores that eventually crust over and heal. These blisters usually affect an area on one side of the body, most commonly the chest but sometimes also the head, face and eye.
How long does it last and how serious can it be?
The rash usually appears a few days after the initial pain and tingling and lasts for about a week. In serious cases the pain can last much longer. The older you are, the more likely you are to have long-lasting pain. Sometimes shingles develops in the eye and may also affect the eyelid. This can cause severe pain and lead to decreased vision or even permanent blindness in that eye. Most people recover fully, but for some, the pain goes on for several months or even years – this is called post-herpetic neuralgia (PHN). This is a particularly unpleasant condition with severe burning, throbbing or stabbing nerve pain. Current treatments for PHN are not very effective. The new vaccine reduces the risk of getting shingles and PHN. Even if you still get shingles, the symptoms may be much reduced.
What causes shingles?
Shingles is caused by the same virus that causes chickenpox – varicella zoster. When you recover from chickenpox most of the virus is destroyed but some survives and lies inactive in the body in the nervous system. It can then reactivate later in life when your immune system is weakened by increasing age, stress or treatments that reduce your immunity. 
How do you catch shingles?
You don’t catch shingles. Chickenpox virus caught earlier in your life reactivates later to cause shingles. You can’t catch shingles from someone who has chickenpox. However, if you have shingles blisters, the virus in the fluid can infect someone who has not had chickenpox and they may develop chickenpox.
How common is shingles?
About one in five people who have had chickenpox develop shingles. This means that in every year in England and Wales, tens of thousands of people will get shingles. It is more common in people aged over 70 years, and of these, about 14,000 go on to develop PHN and over 1400 are admitted to hospital because of it.
How effective is the vaccination?
By having the vaccination you will be significantly reducing your chances of developing shingles. And, if you do go on to have shingles the symptoms may be milder and the illness shorter, than if you had not had the vaccination.
Where is the vaccination given and will I need one every year?
Like most vaccinations, the vaccine will be given in your upper arm. You will only have the vaccination once – unlike the flu jab, you do not need to be re-vaccinated every year.
Will there be any side effects?
Side effects are usually quite mild and don’t last very long. The most common side effects, which occur in at least one in every ten people, are headache, and redness, pain, swelling, itching, warmth, and bruising at the site of the injection. If the side effects persist for more than a few days you should discuss this with your GP or practice nurse.
How safe is the vaccine – has it been used in other countries?
Like all licensed vaccines, the shingles vaccine has been thoroughly tested and meets UK and European safety and licensing requirements. It has been used extensively in several countries including the United States of America and Canada.
Who will get the vaccine?
All people aged 70 on 1 September 2013 are eligible (i.e. all those born between 2 September 1942 and 1 September 1943, inclusive). People aged 79 will also be offered the vaccine in a catch-up programme (i.e. all those born between 2 September 1933 and 1 September 1934, inclusive).
What about people who aren’t 70 or 79, will they be getting it?
People under 70 years of age will get the vaccine in the year following their seventieth birthday. If you’re under 70 and have a history of getting shingles, speak to your GP. People aged 80 and over will not get the shingles vaccination because the vaccine is less effective as people get older.
Speak to your GP or practice nurse, for more information before or after you’ve had the vaccination. You can also visit the NHS Choices website at
Do I need to do anything to get the vaccination?
No; your doctor will invite you in for the vaccination. You can have it at the same time as your flu jab in the autumn (although you can have it at any time of the year once you’re eligible).
Are there people who shouldn’t have the vaccination?
People who have weakened immune systems, for example due to cancer treatment, should not have the vaccine. Your doctor will advise whether this applies to you. Also, if you’ve had a severe reaction to any of the substances that go into the vaccine, you shouldn’t have it. Again, your GP will advise you.

Should I take any precautions after having the vaccination?
Get advice from your GP if you get a rash after having the vaccination.
Summary of the disease and the vaccine
• is a common disease that can cause long-lasting, severe pain
• has been known to cause permanent disability
• occurs more frequently in those over 70 who are also more likely to have worse symptoms.
The vaccine:
• is expected to reduce significantly the number of cases
• will reduce the symptoms in vaccinated people if they still develop the disease
• has been used extensively in the USA and Canada.

New streamlined travel clinic launched at Gade Surgery

Gade Surgery is launching a new streamlined travel clinic. Once the preliminary forms (which can be downloaded here ) are returned to the surgery then the first appointment can be booked. The onus will be on the traveller to provide the necessary information to plan required vaccination and to read the necessary information for a safe trip. More information can be found on the preliminary forms.

Book appointments and request prescriptions on-line

Vision Online Services (VOS) is a web-based tool designed to enable you to manage some of your general practice needs without having to attend the GP surgery.
The following modules are currently available:
  • VOS - Online Appointments - This enables you to view, book, or cancel appointments with your doctor online
  • VOS - Online Repeats - This allows you to request your repeat prescriptions online. After the practice has dealt with your request, you will be able to collect the prescription in the usual way.
To use VOS you must:
  • Have internet access and an email account
  • Fill in a registration form available from the surgery or via the attached link: (separate document)
  • We will send you a registration letter for VOS which details all the information needed to register Online
  • Register your account from
  • Once registered, you will need to activate your account via an email link.
Internet Browsers
The Following browsers can be used to access VOS:
  • Microsoft Internet Explorer 6 or higher
  • Firefox 3.x or higher
  • Safari 2.x or higher
  • Chrome 5.x or higher
Mobile Operating/Software Systems
VOS can also be accessed from a mobile phone (smartphone), your phone can be used if it has one of the following mobile operating/software systems:
  • iPhone
  • Android
  • Blackberry (OS6)
  • Nokia (S40/S60)

Prostate cancer screening messages for men

Major evidence based guidelines recommend against the prostate specific antigen (PSA) blood test for prostate cancer screening because:
  • The test is unlikely to prevent you from dying of prostate cancer over 10-15 years or help you live longer
  • Elevated PSA values are common and lead to additional tests that have harms
  • PSA testing finds many cancers that will not cause health problems
  • Once we find cancer it is hard not to treat it
  • Treatments have harms that occur early, can be serious, and may persist, but have very little, if any, benefit
  • By choosing not to have the PSA test you can live a similar length of life, have little to no difference in your risk of dying from prostate cancer, and avoid the harms associated with tests, procedures, and treatments

Gade Surgery Patient Participation Group - Patient Survey 2013

Gade Surgery Patient Participation Group have created a new survey and would value your views on new services and how these may be changed for the better. Please go to the Patient Participation Group page to take this survey or click here to take survey..

Whooping cough vaccine offered to pregnant women in their last trimester

There has been a resurgence in the numbers of cases of whooping cough over the last few months. New born babies are particularly at risk before they begin their vaccinations. Therefore a booster dose of vaccine will be offered to pregnant women at around 32 weeks which will be administered by the practice nurse. This will be discussed by the Doctor or midwife at a routine antenatal appointment. The vaccine will help in two ways. Firstly by passing on some passive immunity from mother to baby whilst in utero. Additionally will prevent the baby catching the disease by preventing the mother catching the diseaase. It is for this reason that those who have just delivered may also opt to be vaccinated.

One survey Results March 2012

Gade Surgery is pleased to announce the results of its first survey the results of which can be seen by following this link.


Online survey

Gade Surgery Online Survey

Gade Survey in collaboration with its Patient Participation Group has produced its first survey to involve patients in the shaping of services. Go to our dedicated Patient Participation Group web page for more information or click here to take survey.


Dr Rick Bennett – Retirement

Dr Rick Bennett has dedicated more than 30 years of service to the patients of Gade Surgery. It is with great regret, therefore, that we have to announce that he has decided to retire from the practice at the end of March 2012.

Dr Bennett will be replaced by Dr Matthew Jennings who joins the practice team on 1st April. Dr Jennings is familiar with the local area and brings with him a wealth of experience gained from working in a number of diverse communities. We hope he will bring with him many new ideas to benefit his patients and their families and fully expect that he will maintain the standards of care established by Dr Bennett. We look forward to the challenges of working with a new partner and to supporting him as he integrates within the practice community. We are confident of his success and are sure that patients will offer their own invaluable support in welcoming him to the practice.

Dr Bennett has asked us to thank those patients who have already expressed their appreciation and good wishes; their cards and letters are most welcome.

Telephone Booking

24-hour telephone appointment booking

Our clinical computer system is called Vision and they have developed an automated telephone system that integrates with Vision’s appointments, allowing patients to manage their appointments at any time. It frees up administrative time and reduces the number of patients calling the practice at peak periods.


  • Allows patients to book new appointments, choosing from either the first available or with a specific clinician
  • Patients can change booked appointments
  • Patients can cancel appointments
  • Fully integrated with Vision appointments, with all telephone bookings shown within Vision’s appointments books
  • Patients can choose to receive a text message confirmation of the appointment
  • Patients can choose to receive a text message reminder 24 hours before the appointment
Benefits to the practice
  • Fewer calls at peak times, freeing up administration time
  • Provides a ‘live’ reception area that works continuously for 365 days a year
  • Makes it easier for patients to cancel or re-arrange their appointments, helping to reduce DNAs
Benefits to Patients
  • Provides flexibility to book, re-arrange or cancel appointments at any time of the day
  • Not limited to practice opening hours
  • Provides a timely reminder of appointments by text message, so they do not forget the appointment

If you become unwell or are injured make sure you choose the right NHS service to make sure you get the best treatment

If you become unwell or are injured make sure you choose the right NHS service to make sure you get the best treatment.Use this link. to get advice about when and how to use these NHS services.

Speech and Language Drop-In Clinic sessions

Pre-school children are invited to come along to the Speech and Language Drop-In Clinic sessions which are open sessions for parents/carers who have concerns regarding their child’s speech and language skills.Full information can be found by following this link.

Health Protection Services advise to returning travellers from Japan

The Health Protection Services have issued medical advice on travellers returning from Japan which can be viewed at this link.

Watford General launches self pay skin service

Watford General Hospital has started a self pay skin service for those skins lesions which are deemed to be benign and cosmetic.This guidance can be viewed from this link. Further information about this service including pricing please follow this link.

Herts on Sight

Herts on Sight provides links and helpful advice for those suffering with visual impairment living in or around Hertfordshire. In particular it is aimed at those who do not just want to accept there fate and let life take its course, but rather want to enjoy life to the full.Further information can be found by following this link

Out of hours dental service

Hertfordshire now has a dedicated out of hours dental service; further information can be found by following this link

Self Pay Skin Surgery

Amersham Hospital has a self pay service for benign skin lesions that are deemed to be 'low priority' and so will not be carried out as a NHS procedure. This linked information sheet from Amersham Hospital gives further details.Those procedures which are likely not to be funded by the NHS are given here.

New Anger Management Course

Hertfordshire Anger Management Association have launched an individual anger management course which is on a wone to one basis over 15 weeks and based in Hatfield. There is more detail on this flyer .

New recommended groups for flu vaccination

The 2010/11 flu vaccination season kicks off with new recommended groups. These are as follows:
  • All over 65 year old
  • All under 65 year old (including children) with chronic illnesses
  • Pregnant women
  • Carers
  • Longstay patients
  • Poultry workers
  • Immunocompromised
  • Health and social care workers
The vaccination scheduling is different for different groups.A flow chart can be seen at this link.

This year the vaccine contains the swine flu strain as this is thought to again become a significant strain this coming winter.

Start booking your appointments for the first clinics starting at the end of September.

Carers on line breaks booking

A new service has been launched to allow on line booking of breaks by carers within Herfordshire. This allows the carer to go out in the knowledge that a vetted and trained care worker is in control. Please contact Debra on 02028 238 7798 or on for further information. Further information is also available on their website at

Summary Care record rolled out

During 2010 the NHS Summary Care Record (SCR) is being introduced to help deliver better, safer care.

What is the Summary Care Record?

Your Summary Care Record is a secure electronic record of important information about your health. It will be available to healthcare staff providing your NHS care in England. This means if you ever have an accident or become ill and need urgent or out of hours advice or treatment, the people treating you can have immediate access to important information to help with your care.

What information is included in your Summary Care Record?

It will initially have information about your current medications, any allergies you suffer from and any bad reactions to medicines that you experience. Over time it will build to include information about other health issues considered important to your wellbeing.

Why should I have a Summary Care Record?

Your record will provide health care staff with immediate information if you need treatment. Healthcare staff will be able to view important information such as diagnoses, test results, prescriptions and allergies when necessary, giving a more complete and accurate picture of your health history. This will help them provide you with more effective care.

Who will be able to access my Summary Care Record?

Authorised healthcare staff delivering your NHS care will be the only people allowed to access your Summary Care Record if they are involved in treating you, and there are strict security measures in place to protect your information. If a healthcare professional needs to view your Summary Care Record, your permission will be asked beforehand unless it is an emergency, for example if you are unconscious.
Further information is available at If you wish to opt out you can do so by returning this optout form . Equally you can optback in by returning this form.

NHS market reforms are damaging our health service

The British Medical Association is running a campaign to raise public awareness about the current and potential damage of market reforms inside our health service. The BMA would like the NHS to uphold the following principles:
  • Provides high quality comprehensive health care for all, free at the point of use.
  • Is publicly funded through central taxes publically provided and publically accountable
  • Significantly reduces commercial involvement
  • Uses public money for quality healthcare, not profits for shareholders
  • Cares for patients through co-operation, not competition
  • Is led by medical professionals working in partnership with patients and the public
  • Seeks value for money but puts the care of patients before financial targets
  • Is fully committed to training future generations of medical professionals
For further information and how to support your NHS go to

GP Guidance on Referral Thresholds for Low Priority Procedures

West Hert Primary Care Trust have issued to GP's a list of treatments which they consider to be low priority and by way of their guidelines have imposed stict referral criteria for certain conditions.These conditions include hip and knee pain, ganglion, need for tonsillectomy or grommets, skin lesions, inguinal hernia, varicose veins, cataracts etc. As part of this guidance is a letter which GP's are expected to give to their patients explaining why it is not necessary to refer for hospital treatment. This guidance has been produced because the local health economy is running at a considerable deficit and by all means available economies on spending are being sought. The Local Medical Committee has yet to produce its official view but suggested that patients may wish to inform their local MP if these measures directly affect them. Please follow this link to see this guidance. When a GP refers a patient and it the consultant feels that treatment is indicated then further authority has to be sought for funding before any treatment can be undertaken. Although it is clear that in times of limited budgets that cost effective treatment must be undertaken in our view it is demeaning the role of the specialist to have to seek such authority.



New Access Ramp at Chorleywood

With a view to improving patient access at Witton House, our Chorleywood surgery there is a new ramp available to enable easy access from the carpark side of the entrance area. The front access is less than ideal for wheelchair access and so the surgery can be accessed on the flat from the carpark. Unfortunately the ramp cannot be left in position as it impedes an emergency access from an upper floor and so if needed please liase with the receptionist beforehand.

Local Patient Group

Watcom which is the local Health Services commissioning group for our local area is looking to use patient input so that the patient perspective is fully considered in local health services. For further information including how to apply please click here.

Chlamydial screening programme at Gade

There is a national programme to detect and treat chlamydial infections in asymptomatic 15 to 24 yr olds. This target population has been found to be testing positive for chlamydia in one in ten cases tested. This disease which may produce few symptoms and if left untreated can cause infertiility in women. Treatment is simply a single of dose of antibiotics.

The testing service is available in schools and other institutions on an infrequent basis. Patients of Gade in the target age group may avail themselves of this test at any time simply by collecting a kit from reception to collect a specimen of urine which is sent off to a central lab. The result will be sent to you by text or other preferred method. If tested positive you will be invited to ring a central office who advise you on treatment centres and contact trace. Gade Surgery can provide this treatment. Re-testing is available as often as is necessary.

We would recommend this service to our patients.

New Booking In System at Gade

At Gade surgery only there is a new booking in system. Just inside the door is a touch screen which on entering your name and date of birth registers your arrival for your pre-booked appointment. You then wait in the designated waiting room until you are called. Your name will appear on the screen in the waiting room to let you know when your doctor or nurse can see you. This automated system has been introduced to allow the receptionists to deal more promptly with patients who need personal contact and equally prevent patients from having to wait to book in. We hope this will improve the service we offer our patients.

New Doctor Schedules

From the beginning of January 2009 Dr Hinton is working Monday and not Friday and Dr Slade is working Friday and not Monday. This can be viewed on the schedules page.

Vaccination Update

MMR catch up

The DOH has called for urgent action to prevent a measles epidemic as the vaccination uptake has been low enough to risk 100,000 catching this illness which can cause death. Those children and teenagers who have never been vaccinated will be targeted first.

HPV Vaccination programme to start

Vaccination will start in schools to vaccinate 12 and 13 year old girls and also a catch up group of 18 year old girls. The vaccine will markedly reduce the risk of cervical cancer in the vaccinated group. The vaccination programme consists of three injections that will be given outside of General Practice. For further details please refer to the Public Health Department at your local PCT.

Flu vaccination programme starts this month

This is offered on an annual recurring basis to those over 65 years old, and those over six months old who are in a clinical risk group (serious heart or respiratory conditions, kidney, or liver disease, diabetes, lowered immunity due to disease or treatment, multiple sclerosis, or conditions of the nervous system, and those who have had a stroke), individuals in long stay care facilities and carers of those who need continued hands on care. Pneumococcal vaccination in also offered as one off for those over 65 years old and those over 2 years old with at risk health problems (asplenia, chronic kidney, heart, lung and liver disease, insulin using diabetics, immunosuppressed, cochlear implants and CSF leaks). If you fall in one of these groups please book an appointment in a 'flu clinic'.

Save my Gp

The British Medical Association through its Local Medical Committee structure has started a campaign to inform the general public about the changes occuring in General Practice and thus to enlist their support in trying to save General Practice as we currently know it. The Government is rolling out new large clinics which will be in direct competition with existing General Practice. Independent research quoted in The Times suggests that PCT's who have been ordered to spend £1million (total cost £250 m) in each of their areas to build a polyclinic are going to build them in the wrong areas. This means that they are likely to force current services into closure and not complement current services as is the claim of the DOH. It is likely large corporations will win the bids to run these new clinics and can afford to financially undermine existing Practices. These same corporations are likely to staff these clinics with overseas Doctors and so family medicine as we now know it will be gone forever. Lost will be that special relationship between Doctor and patient which lasts for generations, this will be replaced with shift mentality healthcare with little or no continuity of care. We would hope you will support our campaign and pick up a leaflet from the surgery or go to for further information.
Already 1.3 million people have supported our petition against these clinics; please add your signature
Thank you

Patient Questionaire

At Gade Surgery we are always keen to maintain high standards of patient care and value the opinion of our patients in helping us monitor and improve our performance. To help us do this we will shortly be carrying out a survey among a random selection of patients.
If you visit your doctor during September you may be asked to complete a simple questionnaire about the practice and your treatment on the day of your visit. This is anonymous and your doctor will not be able to identify you from your answers.
Please try to fill in the form on the day of your visit; if this is not convenient, our Reception staff will provide you with a stamped addressed envelope to post the form back to us.
We welcome your comments and appreciate your support.

Increase in IVF treatment

From April 2009 East of England which includes Hertfordshire have anounced they will be funding in full NICE recommendations from 2004 that there will now be subject to eligibility three cycles of IVF available which includes a maximum of six embryo transfers. Please go to the 'IVF Eligibiliy' page for the new criteria.

Choose and Book and Choice in the NHS

The NHS has as part of its 14 billion pound computer system now has the ability to book hospital appointments on line or on the telephone if your GP agrees you need hospital care. When you and your GP agree that you need to be seen at the hospital this can often be done via the web. After agreeing on a short list of hospitals with your GP, he or she submits this list electronically, and then via your computer or telephone at home you can learn more about the hospitals that may influence your choice, and then directly book your appointment date and time. Please go to the 'NHS Choice' website for further information.

New Doctor schedules from the New Year

From the beginning of the New Year 2008 there are changes to the consulting schedules of Drs Hinton, Slade and Sangar. Please go to the 'Doctors Schedules' page for these new schedules.

Dementia Day Centre

Age Concern Hertfordshire is pleased to announce a Dementia Day Centre run by a team of professional, friendly staff from Monday to Friday at Chalmers Court, Scots Hill Rickmansworth. Please phone 01923 774328 for further information.

New Anti-Obesity Drug Rimonant

Rimonabant if used for up to 2 years, in addition to a calorie restricted diet, produces greater weight loss (around 4 to 6kg) than placebo in clinical trials . Most weight loss occurred in the first year and was only maintained if treatment was continued.

The recommendation of the local PCT is therefore as follows:

Rimonabant for the treatment of obesity has NOT been approved for the following reasons:
  • The drug has serious side-effects (psychiatric disorders seen in trial) and long-term effects are unknown
  • The endocannabinoid system is still being explored and the long-term effects of rimonabant over many years are unknown.
  • Benefit of weight loss of 4-6 kg in first year, only sustained if the drug is continued and not incremental.
  • Absence of weight management services available under the NHS.
  • Up to one half of patients in the trials failed to complete one year of study.
  • Other treatments, that have been in use for some time and been approved by NICE, are available


Influenza is a viral disease that usually strikes between November and April. Many people think they have had flu when in fact they have suffered a bad cold. When you have flu you will know the difference. Most people will find it impossible to leave their bed for 3-5 days and feel terrible. It is followed by fatigue which can often last for several weeks.

Pandemic Influenza [Bird Flu]

In most years scientists are able to predict the strain of flu and are able to develop a vaccine which protects at risk people from the illness. However, very occasionally the flu virus changes suddenly and dramatically. The new flu virus is stronger and spreads rapidly. Unfortunately it takes 6 months to develop a vaccine and during this time many people are likely to be seriously ill and may die. Scientists are currently advising that such an outbreak may occur in the near future.

Symptoms of Flu

  • Headache
  • Fever [38-40*C]
  • Aching muscles and joints
  • Chest pain
  • Fatigue and weakness
  • A runny nose and sore throat
  • Dry cough
  • Restless sleep
  • Indigestion
  • Vomiting or diarrhoea


  • Stay at home
  • Drink plenty of fluids
  • Take symptom relief:
    • Paracetamol
    • Ibuprofen
    • Aspirin [ but not in children or teenagers]
  • If you are still hot , sponge down with tepid water
  • Await natural recovery.

When to consult the Doctor

You should telephone and ask to speak to the nurse or doctor in the following situations:
  • If you have returned from a malaria zone in the last 6 months
  • If you have any urinary symptoms [burning or frequency]
  • If your symptoms are not improving after a week
  • If you develop severe chest pain or altered/clouded consciousness
  • If you experience increasing breathlessness
  • If you seem to be improving for a few days and then get worse again
Try not to call because of the temperature, aches and pains and cough, as there is nothing your doctor can do to help and the doctor is likely to be extremely busy dealing with those who do have serious complications.

Child immunisation update.

Child immunisations for pre-school children and babies.

The government has recently introduced a new vaccine ,the pneumococcal vaccine to protect children against the third form of bacterial meningitis caused by pneumococcal bacteria. This now means that 3 forms of bacterial meningitis(meningococcal, haemophilus type b,& pneumococcal), which is especially dangerous for babies and children, can be protected against by vaccination. We strongly recommend that all children are vaccinated, and the addition of this vaccine does not lead to additional side effects from vaccination.
This has meant a change in the schedule of when vaccinations are given.
Children born after 04/07/06 will be on the new ,revised schedule.
Children born before 04/07/06 will be notified when to have a 'catch-up' vaccination of pneumococcal vaccine.
The new schedule is:-
At 2months old - Diphtheria,Tetanus,Pertussis(whooping cough),Polio & Haemophilius influenzae type b (Hib) & Pneumococcal vaccinations .
3 months old- Diphtheria, Tetanus, Pertussis, Polio & Hib &Meningitis C (meningococcal group C )
4 months old- Diphtheria , Tetanus,Pertussis, Polio, & Hib & Meningitis C & Pneumococcal vaccine.
At 12months old- A booster dose of Hib & 3rd. Meningitis C is given.
At 13months old - MMR (Measles, Mumps &Rubella) & 3rd Pneumococcal vaccine.
Pre-school booster( around 4 years old) -Diphtheria, Tetanus , Pertussis & Polio; & MMR.
Girls aged 12 to 13 years old -HPV vaccine; course of three.
13 to 18 years old -A booster dose of Diphtheria, Tetanus and Polio.

Clinics at Gade surgery at Witton House ,Chorleywood will resume weekly instead of fortnightly to allow for these changes from 8th.November.
Additional information can be found on the the following websites:

Patient survey from Dr F.Bennett & Partners, Gade Surgery, using the General Practice Assessment Questionnaire (GPAQ) 2007

Standard report and analysis for GPAQ Consultation Version 2.0a



How the survey was carried out
Summary of results
  • GPAQ evaluation questions
  • GPAQ report questions
  • Demographics
Appendix 1. Background to the GPAQ questionnaire
Appendix 2. Guidance on how to use the results of the questionnaire to improve care in your practice
Appendix 3. Frequency distribution tables for all GPAQ questions not included in the main body of the report
Appendix 4. Comparison of survey results 2005-06 and 2006-07

Date: 26 March 2007

How the survey was carried out

The patient survey was carried out during two weeks commencing 17th September 2007. The doctors handed the survey forms to consecutive patients attending the surgery for consultation during this period in order to gain a random sample of patient views. Patients were invited to complete the questionnaire on the premises immediately after their consultation or, if not convenient, were provided with stamped addressed envelopes to return the forms at a later date. The majority of patients elected to complete the forms immediately after attending the surgery. Of the questionnaires issued, 69.91% were returned, achieving the minimum requirement of 50 per GP,although this represented a slight drop in responses over the previous year.


  • Very understanding Doctor.
  • Completely satisfied with health care received.
  • My Doctor always makes me feel at ease and he listens.
  • It is excellent that I have had the same GP for 15 years.
  • Overall, very satisfied with the service provided.
  • My Doctor is very caring and is always available to speak to on the phone.
  • The Doctors are always good at listening.
  • Friendly receptionists.
  • The care I receive from this Practice is always excellent.
  • Continuity. Very happy with the service.
  • I am very happy with the surgery. They provide excellent service always.
  • I feel confident in my Doctor and how he works in the "team "that manage my illness.
  • Friendly and helpful staff.
  • This is an excellent Practice.
  • I always get appointments. Out of hours very good too.
  • I get the best care from my Doctor, he is so understanding.
  • Able to have a blood test at the surgery instead of visiting the hospital.
  • Having been with my previous Doctor for 20 years, I was very anxious regarding a new Doctor, but I have been very impressed with my new Doctor.
  • Everything is excellent.
  • I feel that the medical diagnoses are good.
  • As a family we are very pleased with our Doctor.
  • At the edge of a diabetic condition, the comprehensive attention and treatment was very helpful.
  • My Doctor is a credit to the Practice.
  • Any concerns I had in my GP retiring and new GP joining have been dispelled. My new GP has an excellent way of explaining why/how illnesses are caused.
  • GP provides excellent support and understanding to my family.
  • I have always been able to see my Doctor when I really needed to.
  • I am happy with the efficiency and concern for patients of staff and doctors at this surgery.
  • The ease of getting to the Doctor who listens and explains what he thinks might be wrong and takes action.
  • My Doctor is cool, definitely keep him!
  • Wonderful Doctors.
  • It is always possible to get an appointment at fairly short notice.
  • I have always been seen almost straight away.
  • I have always received excellent care. Well done and thank you.
  • I have found everyone calm and well organised.
  • Very skilled and competent, providing an excellent service to the community.
  • The Doctors are very caring and completely professional.
  • I am completely satisfied with my Doctor who takes time to listen to my needs and helps as best he can.
  • I am particularly impressed with the courtesy of reception staff and cleanliness of the waiting and consulting rooms.
  • Bloods are always gently taken.
  • It is good that my Doctor acknowledges my complex medical history and gives me credit for that.
  • Excellent response whatever the situation.
  • Seeing the same Doctor helps.
  • A very efficient Practice.
  • Excellent access to services.
  • Testing from surgery and notification of results.
  • Service with a smile, the ladies at the front desk are offering admirable response.
  • Being able to talk to/discuss with GP on the phone.
  • Nice Practice, nice building, pleasant environment.
  • Ability to get appointments.
  • The Doctors are knowledgeable and willing to discuss the ailment in a helpful manner.
  • Good Doctors, more time to talk than my previous Practice.
  • My Doctor makes me feel so much better after seeing her, she really listens to what I have to say.
  • Whenever I have an emergency, the Practice has always bent over backwards to fit me in.
  • It's been good to see own Doctor to enable understanding and continuity of care.
  • Welcoming Practice. Always helpful.
  • I like that I feel that I am heard and listened to.
  • I am very happy with the courtesy of the receptionists and the care from my Doctor.
  • My GP is the best I have had.
  • I trust it and it is reliable.
  • I cannot fault the Practice.
  • I was pleased to switch GP without question.
  • Being able to see your own Doctor.
  • Always seen promptly, receptionists polite.
  • Very satisfied with the treatment I have had from my Doctor and the nursing staff too.
  • Good access to Doctors. Good Doctor/Nurse liaison. Excellent record keeping and up to date information.
  • Great Practice 10/10.
  • New doctor much improved to predecessor.
  • Availability of Doctor when required. Good attitude of receptionists and Nursing staff.
  • My Doctor makes a difference by caring "genuinely".


  • Evening/weekend cover.
  • Being able to see a practice nurse quicker.
  • During a visit to the nurse, the consultation room door was left open - I would have preferred it to be closed.
  • Home visits could be more easily arranged when necessary.
  • Waiting times to see the nurse for routine injections or blood tests could be reduced.
  • Faster referral times for physio on the NHS.
  • Reduced prescription fees.
  • There were delays to other practice organised services - especially physiotherapy.
  • Receptionists appear quite rude some of the time.
  • As a full time employee who works in London with 1 hour travel time to and from Chorleywood it would be beneficial to have an evening or weekend surgery.
  • Baby check and 6 week maternal check could be carried out in one appointment.
  • The telephone service is dreadful. Impossible to get through most of the time and then unable to make appointments if I call at lunchtime.
  • Receptionists aren't that friendly over the phone
  • Longer opening hours - evenings. Phones to be operating during lunch hour.
  • Early appointment would be very good i.e from 7:30am
  • Longer opening hours.
  • Ability to make appointments between 12:00 and 2:00pm.
  • My daughter was advised by a chiropodist that she needed her ingrowing toe nails treated but due to your politics where you can't be bothered I have had to pay to go private as this has been going on for a year. Why should we pay for a service you should provide. You should have referred her but you can't be bothered. Have you any comments on this.
  • Personally I do not like the out of hours service so would prefer to return to doctors from the surgery being available at weekends or evenings.
  • Evening appointments please.
  • More parking - seems to be congested.
  • Phoning in - sometimes engaged constantly.
  • Would prefer to see a female doctor sometimes but it appears to be quite difficult.
  • Doctor's manner when dealing with me. I am nervous and need to be put at my ease - not good at dealing with grief.
  • Open more hours.
  • I understand it is because the practice is busy, but it would be better to have more opportunity to see our own doctor (although it is obviously better to see any doctor than no doctor!)
  • Saturday surgery.
  • Practice doctor on call at weekends if required, the current system does not give me any confidence.
  • Emergency appointments at the practice on Saturday mornings.
  • Waiting times.
  • Happy receptionists?
  • I am sad that there is no doctor available at weekends for those with a problem arising at that time. Sometimes advice on medication might avert a crisis for that patient.
  • The reception staff (in the main) can only be described as unhelpful and inflexible often to the point of rudeness. Their entire attitude is to make you feel as if you are a nuisance and obstruct access to the doctors.
  • Office equipment! (I once waited for weeks for a letter to a cardiologist as the printer didn't work/not enough printers (I forget!).
  • I understand that much of the situation is out of the practice's control, but the situation re health visitor's clinics and injections has gotten very poor since my older daughter was born 4 yrs ago. Not being able to see the HV or weigh babies during their frequent injection visits means my second daughter has only seen the HV once. The waiting times during injection visits have also become very long.
  • Main problem is trying to park.
  • It can sometimes take a while to get through on the phones as they are engaged quite often.
  • The attitude of some of the receptionists is very curt at times.
  • Car parking at surgery.
  • Out of hours attendance.
  • Maybe some men's newspapers to read in the waiting room. Seems to cater for women and children.
  • Receptionist's politeness on the phone.
  • Better availability of receptionists over the phone when trying to make an appointment.
  • Phone - can't get through until 2:00pm - is really frustrating.
  • Weekend surgery.
  • At the weekend, would prefer to speak to a Doctor at the practice who has all my notes to hand rather than a locum.
  • Getting through to reception can be hard. The attitude of the reception staff could be improved also.
  • Evening surgery hours could help as it is sometimes difficult to take time off work.
  • I'd like annual check ups to assess my overall health as I do become concerned about the long term effects of lifestyle (drinking alcohol) and strenuous exercise which result in frequent injuries. I often feel that this itself does not warrant making a normal appointment.
  • Weekends - local hospital care often a bit patchy with out of hours service.
  • Child care - my 12 month baby is still waiting for his 8 month check.
  • Difficulty seeing Health Visitor - limited time and days.
  • I think for people working who cannot take time off work, that there should be other times to get to see a Doctor if possible.
  • I would like to have my repeat prescriptions for longer than a month at a time.
  • Answering calls over lunch.
  • Receptionists often lack patience/can be quite "sharp" on the phone.
  • Receptionists have a tendency to make me feel nervous and unwanted.
  • There should be more information/advice on male health issues particularly things like prostate cancer.
  • Answer the phone - it is sometimes very hard to get through to a receptionist to make an appointment and that can be quite frustrating.
  • Blood tests - often a long time to wait.
  • To explain or discuss problem with Doctor over telephone would be good before making appointment.
  • Health Visitor service reduced recently which is a huge shame.
  • I have not been satisfied with out of hours doctor service.
  • I never seem to be able to get through to the surgery before 9:30am. The line is always engaged.
  • Out of hours surgery.
  • Doctors that come out to young children and elderly.
  • Parking.
  • More lady doctors.
  • Weekend surgery.
  • The practice being open over the lunch period.
  • Health Visitor situation.
  • Waiting times.
  • Reduction in bureaucratic changes - Mount Vernon is now not connected with Watford General - only with Hillingdon?
  • Being given the choice to see another doctor if I feel the wait is too long to see my own.
  • More parking spaces.
  • Out of hours attention.
  • Do not like the weekend cover arrangements.
  • The surgery is closed for lunch - this is annoying as this is just when you need to make an appointment!
  • Sometimes I can only manage to come on a certain day & my own GP might not be working - receptionists won't allow me to see another doctor, even if they saw me a few weeks before when covering for my GP's holiday.

Summary of results

GPAQ evaluation questions

The following table summarises the individual scores for the evaluation questions in GPAQ, i.e. the ones where patients made a judgment about how good that aspect of care was. Each score is expressed as an average (mean) for all patients who completed the individual question. They are represented as a percentage of the maximum possible score, so the best possible score in each case is 100. You will be able to see the areas where your practice scores well and where improvement may be needed, both comparing aspects of care in your own practice and comparing yourself with others.

The figures in the right hand column contain current national GPAQ benchmarks for that question. Once again, these figures are expressed as percentages of the maximum possible score in this table. These are regularly updated on the GPAQ website. Details of how many patients completed each of the individual responses for each of these questions for your practice are given in full in appendix 3.

  Mean Score GPAQ


Q2. Satisfaction with receptionists 73 70
Q3a. Satisfaction with opening hours 68 65
Q4b. Satisfaction with availability of particular  doctor 69 60
Q5b. Satisfaction with availability of any doctor 75 70
Q7b. Satisfaction with waiting times at practice 67 51
Q8a. Satisfaction with phoning through to practice 66 62
Q8b. Satisfaction with phoning through to doctor for advice 67 55
Q9b. Satisfaction with continuity of care 80 68
Q10a. Satisfaction with doctor's questioning 83 74
Q10b. Satisfaction with how well doctor listens 85 75
Q10c. Satisfaction with how well doctor puts patient at ease 86 86
Q10d. Satisfaction with how much doctor involves patient 84 82
Q10e. Satisfaction with doctor's explanations 85 75
Q10f. Satisfaction with time doctor spends 82 70
Q10g. Satisfaction with doctor's patience 86 74
 Q10h. Satisfaction with doctor's caring and concern 86 74
Q11a. Ability to understand problem after visiting doctor 74 73
Q11b. Ability to cope with problem after visiting doctor 71 68
Q11c. Ability to keep healthy after visiting doctor 65 63

Table 1. Mean scores of evaluation questions (as percentages) compared to the GPAQ benchmarks

These benchmark figures are based on data from 232,908 respondents to both the postal and post-consultation versions of GPAQ (combined) collected during the 2004/2005 contract year. Separate benchmarks for the two different versions of GPAQ will be posted in due course if on-going analyses show that mode of administration produces significantly different GPAQ scores after controlling for social and demographic factors known to influence patient evaluations.
Please refer to for further information.

GPAQ report questions


Some GPAQ questions ask about specific experiences, or ask the patient for specific information. The responses to these questions are summarised here

 Q3b. Additional hours requested Number of responses
Mornings 25
Lunchtime 19
Evenings 96
Weekends 155
None 129
Q4a. Availability of particular doctor Number of responses
Same day 72
Next working day 121
Within 2 working days 114
Within 3 working days 43
Within 4 working days 13
 5 or more working days 7
 Does not apply 3


Q5a. Availability of any doctor Number of responses
Same day day 169
Next working 89
Within 2 working days 48
Within 3 working days 9
Within 4 working days 4
5 or more working days 2
Does not apply 32


Q6. Same day urgent availability of doctor Number of responses
 Yes 268
No 18
Don't know/never needed to 71


Q7a. Waiting time at practice Number of responses
5 minutes or less 103
6-10 minutes 175
11-20 minutes 66
21-30 minutes 13
More than 30 minutes 1


Q9a. Continuity for seeing same doctor Number of responses
Always 121
Almost always 179
A lot of the time 31
Some of the time 14
 Almost never 7
Never 1



 The following tables display the demographic data collected in GPAQ.

Q13. Sex Number of responses
 Male  110
Female 256


Q14. Age  Number of responses
Up to 44 years old 162
45 years old and above 199
Mean 48.9


Q15. Long standing illness, disability or infirmity Number of responses
 Yes  143
No 216


Q16. Ethnic group Number of responses
White   341
Black or Black British 4
Asian or Asian British 15
Mixed 4
Chinese 0
Other ethnic group 0


Q17. Accommodation status Number of responses
 Owner-occupied/ mortgaged 282
Rented or other arrangements  75


Q18. Employment status Number of responses
Employed (full/part time, self-employed) 177
Unemployed 4
 School or full time education 20
Long term sickness 7
 Looking after home/family 42
 Retired 100
Other 3


 For all other frequency distribution tables that have not been included in this report, please refer to appendix 3.

Appendix 1

Notes about how the General Practice Assessment Questionnaire (GPAQ) was developed

Some aspects of quality are best assessed by asking patients. We reviewed the literature to identify aspects of GP care which are most highly valued by patients. These include:

  • Availability and accessibility, including: availability of appointments, waiting times, physical access and telephone access.
  • Technical competence, including: the doctor's knowledge and skills, and the effectiveness of his or her treatments.
  • Communication skills, including: providing time, exploring patients' needs, listening, explaining, giving information and sharing decisions.
  • Inter-personal attributes, including: humaneness, caring, supporting and trust.
  • Organisation of care, including: continuity of care, and, the range of services available.

In order to assess these aspects of care we started from what we regarded as the best currently available questionnaire, the Primary Care Assessment Survey (PCAS) [i], [ii], [iii], [iv], which had been extensively validated in the United States. In collaboration with the Health Institute in Boston, we modified PCAS for use in British general practice. The modified questionnaire was called the General Practice Assessment Survey (GPAS). We have used GPAS in large studies in the UK: and detailed research data on GPAS have been published [v] [vi] [vii] [viii] [ix].

For the new GP contract, we were asked to modify our original GPAS questionnaire, and have produced GPAQ. The main differences are that the new questionnaire is shorter. We have also produced two versions, one designed to be sent by post, and one designed to be given to patients after consultations in the surgery.

GPAQ focuses mainly on questions about access, inter-personal aspects of care, and continuity of care. The version designed to be completed after the consultation asks about are given by an individual doctor. These scores will be able to be used by GPs for their appraisals and revalidation folders. The postal version of GPAQ does not allow scores to be calculated for individual doctors. However, it does include questions about the practice nurses.

GPAQ is described in more detail in the manual which can be downloaded from the GPAQ website, .

Appendix 2

Guidance on how to use the results of the questionnaire to improve care in your practice - taking action on GPAQ scores

There is little purpose in doing a survey unless you are prepared to act on the results. In this section, we discuss briefly how you might do this.

GPAQ has been designed so that it is as easy as possible to know how you can use your scores to improve care in your practice. All the questions can be linked directly to some action which you could take. For example, in the communication questions, we have included questions on listening and explaining rather than important but rather nebulous concepts like trust. So for every question in GPAQ, there is some behaviour which you could think about improving.

Some of the work of deciding how to use the results can be done with the practice staff. So, for example, some of the access questions throw up issues which can be addressed through the practice management - e.g. managing the appointment system, phone answering, etc. The access questions form the largest single group of questions.

The next largest group is about communication. This is more difficult to address, but there are well tested methods of improving doctors' communication skills in consultations. These generally rely on critical analysis of videotaped surgeries, usually with a partner or friendly mentor. This is something which all training practices will have had experience of in recent years, as consultation skills training forms an important part of vocational training.

In thinking about who to discuss your survey results with, you should think about:

  • Your partners and other doctors working in the practice
  • Nurses working in the practice
  • Your practice managers and receptionist / admin staff.

Some issues, e.g. scores on the access scale, will need to be discussed with all your staff.

To get level 2 and level 3 payments for the new contract, you will need to do more than this, and will have to have discussed the results of your survey with patients (e.g. a 'critical friends' group, or a patient participation group), and shown that you have done something about the results.

We are aware that most practices have little experience of how to use questionnaires to help them improve care. So, the National Primary Care Research and Development Centre, with the University of Exeter and CFEP are writing a practical handbook on this subject. We expect that it will be published in early 2004, when it will be freely available. Details will be on NPCRDC's website

Appendix 3

Frequency distribution tables not included in the main body of the report

Q1. Number of visits to doctor in last 12 months Number of responses
None 11
Once or twice 79
Three or four times 122
Five or six times 91
Seven times or more 68

Q2. Satisfaction with receptionists Number of responses
Very Poor 1
Poor 6
Fair 50
Good 103
Very Good 129
Excellent 85

Q3a. Satisfaction with opening hours Number of responses
Very Poor 0
Poor 8
Fair 59
Good 134
Very Good 1118
Excellent 51

Q4b. Satisfaction with availability of a particular doctor Number of responses
Very Poor 1
Poor 14
Fair 67
Good 107
Very Good 101
Excellent 78
Does not apply 2

Q5b. Satisfaction with availability of any doctor Number of responses
Very Poor 2
Poor 7
Fair 27
Good 93
Very Good 81
Excellent 102
Does not apply 29

Q7b. Satisfaction with waiting times at the practice Number of responses
Very Poor 3
Poor 7
Fair 74
Good 100
Very Good 96
Excellent 65

Q8a. Satisfaction with phoning through to the practice Number of responses
Very Poor 3
Poor 11
Fair 68
Good 122
Very Good 102
Excellent 50
Don't know/never tried 5

Q8b. Satisfaction with phoning through to doctor for advice Number of responses
Very Poor 6
Poor 8
Fair 32
Good 72
Very Good 59
Excellent 42
Don't know/never tried 133

Q9b. Satisfaction with continuity of care Number of responses
Very Poor 2
Poor 0
Fair 10
Good 92
Very Good 118
Excellent 128

Q10a. Satisfaction with doctor's questioning Number of responses
Very Poor 2
Poor 1
Fair 10
Good 54
Very Good 130
Excellent 144
Does not apply 8

Q10b. Satisfaction with how well a doctor listens Number of responses
Very Poor 2
Poor 0
Fair 9
Good 52
Very Good 118
Excellent 166
Does not apply 2

Q10c. Satisfaction with how well doctor puts patient at ease Number of responses
Very Poor 2
Poor 0
Fair 7
Good 43
Very Good 90
Excellent 152
Does not apply 53

Q10d. Satisfaction with how much doctor involves patient Number of responses
Very Poor 2
Poor 0
Fair 9
Good 54
Very Good 104
Excellent 146
Does not apply 34

Q10e. Satisfaction with doctor's explanations Number of responses
Very Poor 2
Poor 0
Fair 9
Good 55
Very Good 96
Excellent 171
Does not apply 16

Q10f. Satisfaction with time doctor spends Number of responses
Very Poor 1
Poor 1
Fair 20
Good 64
Very Good 106
Excellent 151
Does not apply 3

Q10g. Satisfaction with doctor's patience Number of responses
Very Poor 1
Poor 1
Fair 7
Good 55
Very Good 97
Excellent 179
Does not apply 9

Q10h. Satisfaction with doctors caring and concern Number of responses
Very Poor 2
Poor 1
Fair 10
Good 51
Very Good 93
Does not apply 5

Q11a.Ability to understanding problem after visiting doctor Number of responses
Much more than before visit 167
A little more than before the visit 96
The same or less than before the visit 27
Does not apply 57

Q11b.Ability to cope with problem after visiting doctor Number of responses
Much more than before visit 155
A little more than before the visit 89
The same or less than before the visit 37
Does not apply 63

Q11c.Ability to keep healthy after visiting doctor Number of responses
Much more than before visit 119
A little more than before the visit 84
The same or less than before the visit 45
Does not apply 95

Appendix 4-Comparison of Survey Results 2006-7 and 2005-6

  Score for 06-07 Score for 05-06
  Mean Score GPAQ


Mean Score GPAQ


Q2. Satisfaction with receptionists 73 7075 75
Q3a. Satisfaction with opening hours 68 6568 67
Q4b. Satisfaction with availability of particular  doctor 69 6072 58
Q5b. Satisfaction with availability of any doctor 75 7080 68
Q7b. Satisfaction with waiting times at practice 67 5170 56
Q8a. Satisfaction with phoning through to practice 66 6270 59
Q8b. Satisfaction with phoning through to doctor for advice 67 5572 59
Q9b. Satisfaction with continuity of care 80 6884 68
Q10a. Satisfaction with doctor's questioning 83 7487 79
Q10b. Satisfaction with how well doctor listens 85 7589 81
Q10c. Satisfaction with how well doctor puts patient at ease 86 8689 82
Q10d. Satisfaction with how much doctor involves patient 84 8286 79
Q10e. Satisfaction with doctor's explanations 85 7587 81
Q10f. Satisfaction with time doctor spends 82 7084 78
Q10g. Satisfaction with doctor's patience 86 7488 81
 Q10h. Satisfaction with doctor's caring and concern 86 7488 82
Q11a. Ability to understand problem after visiting doctor 74 7370 69
Q11b. Ability to cope with problem after visiting doctor 71 6871 66
Q11c. Ability to keep healthy after visiting doctor 65 6366 61



[i] Gelb Safran D et al. The Primary Care Assessment Survey. Tests of data quality and measurement performance. Medical Care 1998; 36: 728-39

[ii] Gelb Safran D et al. Linking primary care performance to outcomes of care. Journal of Family Practice 1998; 47: 213-220.

[iii] Murray A, Gelb Safran D. The Primary Care Assessment Survey: a tool for measuring , monitoring and improving primary care. In: Maruish M (ed) Handbook of Psychological Assessment in Primary Care Settings. 1999. Lawrence Erlbaum Associates.

[iv] Taira DA et al. Asian American patient ratings of physician primary care performance. Journal of General Internal Medicine 1997; 12: 237-242

[v] Ramsay J, Campbell J, Schroter S, Green J, Roland M. The General Practice Assessment Survey (GPAS): tests of data quality and measurement properties. Family Practice 2000; 17: 372-379

[vi] Campbell JL, Ramsay J, Green J. Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care. Qual Health Care. 2001 Jun;10(2):90-5

[vii] Bower P, Mead N, Roland M.What dimensions underlie patient responses to the General Practice Assessment Survey? A factor analytic study.Fam Pract. 2002 Oct;19(5):489-95.

[viii] Bower P, Roland M, Campbell J, Mead N. Setting standards based on patients' views on access and continuity: secondary analysis of data from the general practice assessment survey. British Medical Journal 2003; 236: 258-60.

[ix] Bower P, Roland MO. Bias in patient assessments on general practice: General Practice Assessment Survey scores in surgery and postal responders. British Journal of General Practice 2003; 53: 126-128.

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