Unity Health Appointment Changes

This report examined patients’ experiences of a new appointment booking system introduced by Unity Health in September 2016. The change followed concerns about poor access to appointments, with Unity Health’s own survey finding that 89% of patients were dissatisfied with access arrangements. The practice replaced traditional appointment booking methods with an online consultation form through which patients submitted details of their health issue and were then contacted by the practice. Healthwatch York investigated the impact of the change after concerns were raised that some people might struggle to access appointments under the new system. 

Healthwatch York conducted a survey that received 782 responses, including 767 online and 15 paper submissions. The findings showed that most respondents preferred the previous appointment system, which allowed bookings by phone, in person, online through Patient Access, and via a daily “stay and wait” clinic. Many patients felt that the new system was more complicated and less flexible. 

A major concern was accessibility. Respondents reported difficulties for people without internet access, those who were not confident using technology, and individuals who were too unwell to complete an online form. People with disabilities, learning difficulties, dexterity problems, or mental health conditions often found the system challenging. Some respondents said that completing lengthy forms increased anxiety, while others felt it was difficult to navigate when experiencing illness or distress. 

Many patients were also concerned about the suitability of the online consultation form for different types of appointments. Respondents reported confusion about whether it should be used for repeat appointments, long-term conditions, medication reviews, or mental health issues. Some felt the form did not adequately reflect the complexity of their health needs or their existing medical conditions. 

Confidentiality was another recurring theme. Some patients were uncomfortable having to explain the reasons for wanting an appointment through an online system and questioned why they had to provide detailed information before speaking to a clinician. Others worried that patients might be discouraged from seeking medical help altogether. 

Despite these concerns, the report also identified positive experiences. Many patients praised the speed of responses they received through the new system, with some reporting that GPs contacted them within hours of completing the online consultation. Several respondents felt that the online process worked efficiently and improved access compared with traditional appointment systems. 

When asked what they would do if they were unable to complete the online form, many respondents said they would telephone or visit the surgery. However, others reported that they might use NHS 111, attend A&E, seek help from friends or family, change practice, or even avoid seeking treatment altogether. A small number stated that they might provide misleading information on the form in order to secure an appointment. These responses suggested potential risks if patients were unable to access the system effectively. 

The survey also found uncertainty about alternatives to GP services. Many people were unsure whether York had a Minor Injuries Unit, and some respondents expressed confusion about when they should use services such as pharmacies, NHS 111, or A&E. 

Patient Participation Groups (PPGs) were poorly understood by respondents. Most people were either unaware of the PPG or had never been invited to join. Many respondents suggested they would be willing to participate if they knew more about the group and its role.

The report identified gaps in awareness about NHS flu vaccinations, with around 30% of survey respondents unsure whether they were eligible for a flu jab. 

Additional feedback gathered from University of York students highlighted specific concerns about the length and complexity of the online form, difficulties discussing sensitive health issues through a digital system, and challenges for students with long-term conditions or medication needs. Students wanted more flexibility around appointment times, routine reviews, contraception services, and communication about progress after submitting forms. However, some students reported very positive experiences and felt the new system was faster than services they had used elsewhere. 

The report concluded that Unity Health was one of the first practices locally to adopt a largely online appointment model and that the change represented part of a wider shift towards new ways of managing demand in general practice. While the system had improved access for some patients, significant concerns remained around accessibility, communication, flexibility, and patient understanding. 

Healthwatch York recommended extending the hours during which the online form could be used, improving communication about alternative booking options, providing support for patients unable to use the internet, increasing awareness of Patient Access and Patient Participation Groups, improving privacy and confidentiality arrangements, refining the online form for people with complex needs and mental health conditions, and continuing to monitor the impact of the changes through further patient surveys. 

The report noted that Unity Health had already begun responding to feedback. Actions included extending the online portal’s opening hours, improving communication with patients, employing a pharmacist within the triage team, providing devices in surgeries, training reception staff to support patients and act as care navigators, and establishing regular reviews of the new system. The practice also reported that missed GP appointments had fallen significantly, effectively making more appointments available for patients.