In addition to the key points made in the action plan we are pleased to respond to some of the additional comments written on the questionnaire:

'Privacy when booking any sort of test - the desk is too near to the public'
	This issue has been discussed on numerous occasions in the last few years by CASAG. Changes we have already made include altering the way the chairs face in reception (inwards rather than forwards to the desk) and the addition of Castle Mead Radio as background noise. Reception are trained to minimise any personal details commented upon out loud and are always happy to speak to you in a private room if there are confidential or personal matters you wish to discuss. 

Requests for a water machine
	Once again this has been discussed in the past. There is no plumbing available in reception and it has been considered a hazard to have a free standing machine in the reception area where children, if not appropriately supervised, could pull it over and injure themselves. If any patents feel unwell and would benefit from a glass of water please ask reception and they will be happy to assist.

'COPD cliic has gone down the pan since you ceased to have a dedicated practice nurse'
	We now have two dedicated practice nurses who are highly trained in the diagnosis and management of COPD - Anne Turner and Karen Kerr. Every patient is seen annually for spirometry and is sent a written reminder if they do not make an appointment. Mild cases are seen every 12 months, but moderate and serve cases are reviewed every 3 to 6 months, or more often, according to their clinical need. We also aim to review all patients that have been admitted to hospital with COPD within 2 weeks of their discharge. 

'I am disappointed that those patients who do not fulfil their commitments to appointments cannot be reprimanded in any way. I appreciate some missed appointments are unfortunate but the number flashing up on the screen is alarming'
	A regular topic of debate at the CASAG meetings, but unlike other services we cannot charge patients who fail to attend. All we feel we can do is continue to advertise the numbers of wasted appointments and the impact this has on the care of all patients. We hope this will encourage patients to ring and camel when they know they cannot keep their appointment so it can be offered to someone else.

'Too many signs and posters - not clear what doctors are in which room'
	We aim to make this much clearer and will regularly be updating and tidying the posters in the waiting room.

'This practice has treated me very well'
'Very satisfied'
'This is by far a great practice. I owe a lot to the doctors and staff'
'Who could ask for more?'
'I know the staff do their best despite working in difficult circumstances'