Technical annex Download

Contents

2 Questionnaire and material design

2.1 Questionnaire development for the 2026 survey

The 2024 survey was the start of a new time series for GPPS (see the Technical Annex for the 2024 survey). Since then, changes to the questionnaire have been kept to a minimum to ensure that results can be compared across years.

However, as in every year, the questionnaire content was reviewed to ensure it reflects the primary care context and priorities. While there have been no changes to the core paper questionnaire in 2026, there have been some changes to the questions that are only included online.

In addition, this year some changes were made to the online survey landing page to try to improve engagement. These were graphically designed, using simple messaging and NHS branding as participants login; “Help the NHS” as the survey loads and “Have your say” on the landing page. The progress bar was also removed based on feedback that, for a relatively short questionnaire with very little filtering, it negatively affected engagement. These changes were tested with patients as part of the cogability interviewing (see section 2.5 below).

2.2 Online only questions

In addition to the core (online and paper) questionnaire, a small number of additional questions were added to the online version of the survey. These included:

  • Vaping behaviour (first added to the online survey in 2024).
  • Questions on the NHS Accessible Information Standard (first added in 2025).
  • Permission for recontact, allowing NHS England to find out more about the specific healthcare experiences of participants (first added in 2025). Note that in 2025, the survey also included a question asking permission for ONS to recontact carers. This was not included in 2026.

In addition, some new questions have been included in the 2026 survey:

It was not possible to include these questions in the paper questionnaire due to space constraints. However, given the nature of the questions, anyone requesting an accessible version of the paper questionnaire (large print or Braille) was also sent these questions (including the general recontact question only). They were also asked of anyone taking part with Helpline support.

The full set of online-only questions is available on the website under Latest survey materials. The new questions for 2026 are listed below.

Previous UK armed forces service

Q65 Have you previously served in the UK armed forces?

If you are a current serving member of the regular or reserve UK armed forces, please select ‘No’
  • No
  • Yes, I previously served in regular armed forces
  • Yes, I previously served in the reserve armed forces

 

Referral for specialist care

The next few questions are about your GP practice referring you to hospital for specialist care (for example, as a day patient, for specialist tests or for treatment).

Q70 In the last 12 months, has your GP practice referred you to hospital for specialist care (for example, as a day patient, for specialist tests or for treatment)?

  • Yes
  • No

Q71 When you were referred, were you offered a choice of hospital?

  • Yes
  • No
  • I can't remember

Please think about the last time your GP practice referred you to a hospital for specialist care.

Q72 What information was available to you to help you choose the hospital?

  • Journey times to get to the hospital
  • Current length of waiting lists
  • Quality of care
  • Other patients’ experiences
  • Something else
  • None of these
  • I don’t know or I can’t remember

Q73 Did you have all the information you needed to make an informed decision about which hospital you would prefer to go to?

  • Yes, definitely
  • Yes, to some extent
  • No, not at all
  • I don’t know or I can’t remember

Q74 How would you describe your experience of choosing the hospital for your specialist care?

  • Very good
  • Fairly good
  • Neither good, nor poor
  • Fairly poor
  • Very poor

Q75 Before you were referred for specialist care, did you know about your right to choose the hospital?

  • Yes
  • No
  • I can't remember

Following a review of the online only questions in 2025, NHS England have confirmed that in general these can be published as Official Statistics. However, where a question would benefit from further exploration (for example, 'first of type' for a national survey), it will be labelled as an 'official statistic in development', in line with the standards of trustworthiness, quality, and value in the Code of Practice for Statistics. For the 2026 survey, questions on the NHS Accessible Information Standard will continue to be labelled as ‘in development’ on the basis that they are still under review by NHS England.

As a result, user feedback on the need for these statistics and how they are being used is important. Please share any feedback on the online-only questions with: GPPatientSurvey@ipsos.com.

2.3 The final questionnaire

The final questionnaire (core and online only questions) is available on the website available on the website. Chapter 8: Reporting contains more information on interpretation of trend data.

Below is a list of the topics covered in the 2026 questionnaire:

  • Your GP practice services

  • Your last contact

  • Your last appointment

  • Overall experience

  • When your GP practice is closed

  • Your health

  • Pharmacy

  • Dentistry

  • Some questions about you (demographics) (including vaping and previous armed forces service(online, large print and Braille only))

  • Accessible information (online, large print and Braille only)

  • Referral for specialist care

  • Permission for recontact (online, large print and Braille only)

2.4 Materials development for the 2026 survey

As a result of changes to the contact strategy this year, there were some minor changes to the materials that were used to improve clarity and consistency. In addition, new materials were developed for the experiments, including additional contact via the NHS App. These were all tested with patients as part of the cogability interviewing (see section 2.5 below).

Changes to the existing materials included:

  • Changing ‘access code’ to ‘survey code’ across all materials, following feedback that this was easier to understand.
  • Adding a unique QR code to the printed letters, containing a direct personalised link to the online survey.
  • Developing a set of RCS (Rich Communication Services) text messages, which offer the ability to use branding (NHS logo), more detailed content and interactive features (such as a ‘Take part’ button).

In addition, materials used for the experiments included some changes, including new SMS wording (for those not being sent an e-letter) and content for NHS App notifications. More details on the experiment design can be found in the Appendices.

The initial mailing letter and wording for the first text message (SMS and RCS) are available on the website. All letters and text messages are available on request from the GP Patient Survey team at GPPatientSurvey@ipsos.com.

2.5 Cogability testing: questionnaire and materials

All proposed changes to the questionnaire and materials made before fieldwork were tested with patients using cogability testing. Cogability testing combines cognitive and usability testing, using techniques to help understand how participants process and respond to survey materials. The aim was to understand the processes used by a range of people as they interact with the survey materials, access the online survey and answer the questionnaire. Combining cognitive testing with user-centred design principles, helps to understand user journeys and potential barriers to participation.

A total of 20 interviews were conducted in two separate phases between 1 and 25 September 2025. Participant feedback was used to ensure that the response options and terminology used in the questionnaire and materials were well understood by a range of patients. Since GPPS is sent to a large number of patients, the call to action must be clear and the language used must be accessible and suitable for all patient groups, including those who do not speak English as their first language. Overall, the process aims to reduce the impact of measurement error, maximise comprehension and increase the validity and reliability of the data collected.

In addition, the questionnaire and materials were reviewed by the Plain English Campaign throughout the cognitive testing process. This ensured the changes met Plain English criteria; a set of principles designed to ensure information is presented clearly. In the context of GPPS this has an additional benefit of reducing barriers to participation for patients with language barriers, literacy issues and learning disabilities. The questionnaire was awarded the Campaign’s Crystal Mark, a seal of approval for the clarity of a document.