Part 1 - Create a patient questionnaire and collect responses
This section will provide you with all the resources you need to create your patient questionnaire including:
- Who is eligible to participate
- A List of questions to include
- Guide on how to set up an online questionnaire/survey
- Guide on how to create a Quick Response (QR) code
- Patient information leaflet
1a) Which patients are eligible to participate?
Child and adult patients that have received an item 2(a) Enhanced preventive advice and treatment (Determination 1) as part of their course of treatment.
Patients receiving a course of treatment that does not include an item 2(a) or those who receive private treatment only are not eligible.
We recommend that a representative proportion of responses from both child and adult patients is obtained.
If patients wish to participate, please allow them to read the information within the patient information leaflet. This can be shared separately or within the questionnaire.
REMEMBER - If you are a referral or specialist practice that does not routinely provide item 2(a) Enhanced preventive advice and treatment (Determination 1) there are an alternative set of questions for your practice which may be more appropriate. These are accessible by contacting qi.hub@nes.scot.nhs.uk
1b) What should I include in the patient questionnaire?
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A service evaluation questionnaire has been designed for dental teams to use for this purpose. The questionnaire has undergone readability testing and has been reviewed for ethical and governance considerations. This project has been classified as service evaluation therefore does not require ethical approval.
The questions have been approved by NES and Scottish Government for the purposes of this QI Activity.
- Patient Questionnaire - Questions ( Download, 24 KB)
1c) How do I create a patient questionnaire based on the questions provided?
You are required to create and host your own questionnaire from the questions provided. This will enable each practice to hold and interpret their own data from patient responses. Practices may opt to host one shared questionnaire for the practice, however, in some cases individual dentist questionnaires may be appropriate.
Dental teams can host and distribute the questionnaire via whatever means is most appropriate to their local requirements. Please see advice for commonly used platforms below:
Tools you may use to create your questionnaire | ||
Google Forms | Requires a personal Google account to access. Survey responses can be viewed as tables or downloaded as a Google Sheet or .csv file. | How to create a Google Form |
MS Forms | NHS dental contractors do not by default have access to MS Forms as part of their Office 365 account. If you do not have access to MS Forms at present, we recommend you use a personal MS Office account. | How to create an MS Form |
Paper | If digital access is not suitable for your patients or you are unable to support digital distribution of the questionnaire you can consider using paper forms. Please consider the environmental impact and requirement for patient response anonymity. | |
| Other Survey Tools are available. Although we don't recommend a specific service, we have created guides for Microsoft Forms and Google Forms to support you and your team if you choose to use these platforms. | ||
As per UK General Data Protection Regulation (GDPR), practices will be required to include a statement on data processing. You may use your own standard GDPR Statement, alternatively you could adapt the following statement:
“The sole purpose of the data you provide via this questionnaire is to inform and improve the service your dental practice and the wider dental service in Scotland delivers. None of your personal information including your name, address, or any personal details will be recorded in this survey in any way. The data you provide via this questionnaire will only be held by this practice, but some results from multiple choice questions will be aggregated and shared with NHS Scotland to help improve dental care.”
1d) Distributing your questionnaire
Dental teams can host and distribute the questionnaire via whatever means is most appropriate to their local requirements. If using an online platform, the questionnaire can be shared via its unique link (Uniform Resource Locator - URL) or by generating a QR code.
URLs or QR codes can be displayed in the dental practice or distributed by reception teams or electronically via practice communication systems (e.g. email. text) to eligible patients.
Here is a simple guide on How to create a QR Code
1e) Adding QR Code to Patient Information Leaflet
A patient information leaflet has been designed to explain the purpose of the questionnaire for your patients. The leaflet has undergone readability testing.
Once you have your QR code, paste this onto the Patient information Leaflet. This is as simple as dragging the QR Code file into your Word Document.
Templates
- Patient Information Leaflet template ( Download, 22 KB)
If digital access is not suitable for your patients or you are unable to support digital distribution of this questionnaire, printed copies with written responses may be used.
1f) How many responses to the questionnaire are required?
A minimum number of 10 patient responses in total per dentist is required across all sites that the dentist provides clinical care. This response number is required for both full time and part time dentists. It is recommended that each dentist aims to achieve 15-20 responses across all sites.
1g) What will happen to the results of this questionnaire?
This questionnaire is designed to be anonymous: your patient cannot be identified. You are responsible for patient response data which should be used for discussion at a dental team meeting within your practice. You are not required to share this outside your own practice and will not be required to hold this data following completion of the structured reflective process.
The purpose of capturing this data is to explore patient perceptions on their experience of receiving preventive advice since Dental Payment Reform. This will allow dental teams to reflect on how best they can deliver preventive advice to align with Values Based Health and Care.
Part 2 provides information on how to use the responses from your questionnaire to conduct a practice team based reflective activity.
1h) When should I invite patients to participate?
The deadline for submission of reflective reports to NES via MS Forms is 31st July 2026. Please plan your data collection window and practice meeting accordingly. If you have personal circumstances that prevent you from participating in this project and submitting the reflective report by this date please contact you NHS Board.