Physiotherapy Health Questionnaire (MSK)

If you have been advised by the surgery to do so, please submit this form.

About You

Name

First Last

Date of Birth

Contact Number

Enter Email Confirm Email

MSK-HQ

Please focus on the particular health problem(s) for which you sought treatment from this service.

For each question tick one box to indicate which statement best describes you over the last 2 weeks.

Pain/stiffness during the day: How severe was your usual joint or muscle pain and/or stiffness overall during the day in the last 2 weeks?

Pain/stiffness during the night: How severe was your usual joint or muscle pain and/or stiffness overall during the night in the last 2 weeks?

Walking: How much have your symptoms interfered with your ability to walk in the last 2 weeks?

Washing/Dressing: How much have your symptoms interfered with your ability to wash or dress yourself in the last 2 weeks?

Physical activity levels: How much has it been a problem for you to do physical activities (e.g. going for a walk or jogging) to the level you want because of your joint or muscle symptoms in the last 2 weeks?

Work/daily routine: How much have your joint or muscle symptoms interfered with your work or daily routine in the last 2 weeks (including work and jobs around the house)?

Social activities and hobbies: How much have your joint or muscle symptoms interfered with your social activities and hobbies in the last 2 weeks?

Needing help: How often have you needed help from others (including family, friends or carers) because of your joint or muscle symptoms in the last 2 weeks?

Sleep: How often have you had trouble with either falling asleep or staying asleep because of your joint or muscle symptoms in the last 2 weeks?

Fatigue or low energy: How much fatigue or low energy have you felt in the last 2 weeks?

Emotional well-being: How much have you felt anxious or low in your mood because of your joint or muscle symptoms in the last 2 weeks?

Understanding of your condition and any current treatment: Thinking about your joint or muscle symptoms, how well do you feel you understand your condition and any current treatment (including your diagnosis and medication)?

Confidence in being able to manage your symptoms: How confident have you felt in being able to manage your joint or muscle symptoms by yourself in the last 2 weeks (e.g. medication, changing lifestyle)?

Overall impact: How much have your joint or muscle symptoms bothered you overall in the last 2 weeks?

The MSK-HQ total score is the sum of items 1-14, using the response values provided

© Copyright Oxford University Innovation Limited 2014. All Rights Reserved. The authors have asserted their moral rights. The authors acknowledge the kind support of Versus Arthritis in the development of the MSK-HQ

Physical activity levels In the past week: on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your heart rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that is part of your job.

Maternity Services

Congratulations on your pregnancy. Royal Berkshire Hospital Maternity Services looks forward to helping and supporting you over the next few months as you prepare for the birth of your baby.

The first step in your journey is for you to book an appointment with your Community Midwife by registering your pregnancy on line at the Royal Berkshire Hospital Website: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fforms.office.com%2FPages%2FResponsePage.aspx%3Fid%3D5rOw71yYnUqaO1MQv5y_LnK1TMcN_atCq_RsnJdDFoNUOUU3UE9EN1I3U1gzREM4WDMwUUVEMEhZSS4u&data=05%7C02%7Cjess.lee2%40nhs.net%7C8d947752487e4a8ba79e08dc4356bbac%7C37c354b285b047f5b22207b48d774ee3%7C0%7C0%7C638459286982899670%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=qtFiFP88jxYiIx2sbyNDXsiChVFXChbmu8YDlQHy76U%3D&reserved=0

We will always try our best to arrange this for you at a convenient location, day and time.

Maternity Services runs clinics 7 days week and this may be at your GP practice, a local Children’s Centre or a hospital hubs.

Social Prescribing

Through the Caversham PCN, we now employ a Social Prescribing link worker. This is a relatively new role to the NHS.

Social Prescribing can:

Support patients who present with non-medical issues
Offer non-medical support to patients with health conditions
Identify underlying complex problems that are the root cause of multiple contacts with the practice (e.g. Poor mental health, social isolation & loneliness, financial difficulties etc.) and then connecting patients with non- medical support.

The intervention of a social prescriber can prevent crisis, reduce unnecessary hospital admissions and support sustainable changes in the patient’s life.

Patients aged 16 and over can be referred to the Social Prescriber by their GP.

Our Social Prescribing link worker is Helen Murphy

As an educator, trustee for a mental health charity and volunteer project manager, Helen has come to realise the important role played by voluntary organisations and charities in promoting a healthy community.
As a carer, Helen also values links to many different organisations in the community which provide information and support.
For Helen, social prescribing is a way of improving the connectedness and therefore the health and wellbeing of every individual and promoting a thriving community.
Helen focuses on the Caversham Primary Care Network.

Vaccinations

Shingles

Shingles is caused by the reactivation of the chickenpox virus. Once we have had chickenpox, the virus stays in our bodies. The virus can reactivate when we are older causing shingles which can be painful. For some people the pain can last for months or even years.

Since September 1, 2015, the shingles vaccine has been routinely available to people aged 70 and 78. You become eligible for the vaccine after you’ve turned 70 years of age at any point between September 1, 2013 and September 1, 2018 (inclusive) or aged 78 or 79 years at the point of vaccination.

Further NHS information is available here

Pneumonia

Pneumonia affects about 5-10 people per 1,000 of the adult population – it isn’t seasonal and can affect you at any time of the year.

Adults aged 65 or older tend to suffer more severely and with more complications, so are eligible for a free NHS vaccination (Pneumovax). Younger patients who are particularly susceptible to severe infection or complications may also be eligible.

Your GP may offer you the vaccination if you are eligible or you can book an appointment with the practice nurse. In most circumstances one vaccination will last you the rest of your life, unless you have certain illnesses such as chronic kidney failure or you have had your spleen removed, in which case you need a booster every five years.

Whooping Cough (Pertussis) vaccination for pregnant women

Following an increase in outbreaks of whooping cough, women who are over 16 weeks pregnant are advised to have the whooping cough vaccination. Please telephone the surgery to book an appointment.

Further information from the Department of Health is available here

Non-NHS Work

Detailed below is a list of our current charges for services that are not provided on the NHS.

Please note that in order to complete even the simplest of forms, the doctor might have to check the patient’s entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the Police.

Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time, so many GPs find they have to take some paperwork home at night and weekends, therefore please do not expect your GP to process forms overnight.

Urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this will incur increased charges.

Private Medicals: (Driving/Sports/Employment/Activities/Camps/Taxi/Adoption etc). Medical Examination & Report (Half an Hour Appointment with doctor): £130; Report No Examination £75

BUPA/PPP Form: £45

Private Certificates –

Fitness to Work: £45;

Holiday Cancellation: £45;

Fitness to Travel/Fly/Drive: £45;

Shotgun Licence: £45;

To Whom It May Concern Letter (Straight forward Statement of fact written at the Doctor’s discretion): £45.

Printing/Photocopying (Please remember that results can be viewed online free of charge if you sign up for online access): Per Sheet 50p up to a maximum of £50

Private Prescription: £20

Private Consultation (for 10 minutes): £40

Power of Attorney/ Any Assessment of Capacity – Double Appointment with GP: £160

All Services

About You

MSK-HQ

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