How Ashgrove patients find online-first booking

Ashgrove Medical Group, an NHS GP practice in England with about 21,000 registered patients (17,100 adults).

Sound research: 0 of 8 models
Respondents: 886
Set numeric questions: 11
Traps planted: 7

What each model made of it

Part 1: the brief each model planned a survey for

In April 2026 the practice moved to online-first booking: patients ask for an appointment by filling in an online request form, and the practice replies by text or phone; reception phones are kept for patients who cannot go online. Complaints about access have risen since, mostly from older patients, while the partners report that requests are now easier to triage. Last year's practice survey, before the change, found 71% satisfied with booking.

The decision

Whether to keep online-first booking as it is, restore a morning phone booking line for every patient, or add a dedicated phone line and in-person help at reception only for patients who need them (over-75s, patients with a disability, and patients with limited English).

Objectives

How satisfied patients are with booking since the change, and how this differs by age and need
Whether some patients are put off booking when they need an appointment, and why
How patients would prefer to book, overall and among older patients, patients with a disability and patients who need an interpreter
What would make booking easier for patients

Who to survey

Adult patients (aged 18 or over) registered at Ashgrove Medical Group

Limits

At most 12 questions after the screener and 6 minutes; about 900 completes; text message with a link to an online questionnaire, sent to every registered adult patient with a mobile number on record.

Precision asked for

The partners want results for each of four age bands (18 to 44, 45 to 64, 65 to 74, 75 or over) to within plus or minus 5 percentage points at 95% confidence.

A note from the stakeholder

The practice manager believes patients prefer the new online system and wants the survey to show the partners that online-first is working.

Part 2: the fielded survey every model analysed

Every model analyses the same survey and the same simulated responses, so every true number is known. This is what they were given.

The survey that was fielded (12 questions)

S1
Are you registered as a patient at Ashgrove Medical Group?
One answer
- Yes
- No
- Not sure
Continues if Yes
S2
Are you aged 18 or over?
One answer
- Yes
- No
Continues if Yes
Q1
In the last three months, have you tried to book an appointment for yourself at Ashgrove Medical Group, with a GP, nurse or other member of the practice team?
One answer
- Yes
- No
- Not sure
Q2
Thinking about the last time you tried to book an appointment at the practice, how satisfied or dissatisfied were you with the booking process?
Scale

Scale 1-5: Very dissatisfied to Very satisfied

Routing Shown only if Q1 is: Yes
Q3
What, if anything, would make booking an appointment easier for you?
Open text
Q4
In the last three months, was there a time when you needed an appointment at the practice but did not try to book one?
One answer
- Yes
- No
- Don't know
Q5
Why did you not try to book? If this happened more than once, think about the most recent time. Select all that apply.
Any that apply
- The online form is difficult to use
- I am not confident going online
- I expected not to get through by phone
- I expected to wait too long for a reply
- I did not think I would get an appointment
- The problem went away
- I got help somewhere else, such as a pharmacy or NHS 111
- Another reason
- Don't know
Routing Shown only if Q4 is: Yes
Q6
If you needed to book an appointment at the practice in the next few months, how would you prefer to book it?
One answer
- Using the online request form
- By phone
- In person at reception
- No preference
- Don't know
Q7
Which age group are you in?
One answer
- 18 to 44
- 45 to 64
- 65 to 74
- 75 or over
- Prefer not to say
Q8
Which of the following best describes you?
One answer
- Female
- Male
- Non-binary
- I describe myself in another way
- Prefer not to say
Q9
Do you consider yourself to have a disability?
One answer
- Yes
- No
- Prefer not to say
Q10
Do you need an interpreter when you contact the practice?
One answer
- Yes
- No
- Prefer not to say

Fielding. Sent by text message on 7 September 2026 to the 9,840 registered adult patients with a mobile number on record, with one reminder on 14 September; closed on 21 September 2026. 1,046 started and 886 completed (median 3 minutes 50 seconds). Tables show the 886 completes, unweighted. Percentages are of each column's base. Last year's practice survey (October 2025, before the change to online-first) was a paper questionnaire handed to patients in the waiting room; 412 were returned and 71% of them were satisfied (fairly or very) with booking.

Population. All 17,100 registered adult patients, from the practice list in September 2026: aged 18 to 44 44%, 45 to 64 32%, 65 to 74 13%, 75 or over 11%; female 51%, male 49%. 9,840 of them (58%) have a mobile number on record.

The stakeholders asked:

The practice manager: 'Patients prefer the new system, don't they? Can I tell the partners online-first is working?'
A GP partner: 'Last year 71% were satisfied with booking. Has satisfaction fallen since we went online?'
The chair of the patient participation group: 'Are women, or patients who need an interpreter, finding it harder to book than others?'

The tables (9)

Q1 Tried to book an appointment for yourself in the last three months

	Total	18 to 44	45 to 64	65 to 74	75 or over
Base	886	462	337	54	33
Yes	62.0%	58.9%	62.0%	83.3%	69.7%
No	35.3%	38.7%	34.7%	14.8%	27.3%
Not sure	2.7%	2.4%	3.3%	1.9%	3.0%

Q2 Satisfaction with the booking process, the last time you tried to book

	Total	18 to 44	45 to 64	65 to 74	75 or over	Female	Male	Disability: yes	Disability: no
Base	549	272	209	45	23	303	237	65	484
Very dissatisfied	14.6%	11.4%	17.7%	15.6%	21.7%	15.8%	12.7%	13.8%	14.7%
Fairly dissatisfied	19.3%	12.9%	18.7%	44.4%	52.2%	20.8%	17.3%	26.2%	18.4%
Neither satisfied nor dissatisfied	15.3%	11.0%	19.6%	22.2%	13.0%	15.8%	14.8%	20.0%	14.7%
Fairly satisfied	29.3%	40.4%	22.0%	11.1%	0.0%	25.7%	33.8%	29.2%	29.3%
Very satisfied	21.5%	24.3%	22.0%	6.7%	13.0%	21.8%	21.5%	10.8%	22.9%
Net: satisfied (fairly or very)	50.8%	64.7%	44.0%	17.8%	13.0%	47.5%	55.3%	40.0%	52.3%

Asked only of respondents who tried to book in the last three months (Q1 = Yes).

Q4 In the last three months, needed an appointment but did not try to book one

	Total	Tried to book	Did not try to book	Not sure if tried	18 to 44	45 to 64	65 to 74	75 or over
Base	886	549	313	24	462	337	54	33
Yes	24.3%	17.1%	35.1%	45.8%	22.1%	24.9%	33.3%	33.3%
No	72.9%	79.8%	62.3%	54.2%	74.9%	72.1%	64.8%	66.7%
Don't know	2.8%	3.1%	2.6%	0.0%	3.0%	3.0%	1.9%	0.0%

Q5 Why you did not try to book (all that apply)

	Total	18 to 44	45 to 64	65 to 74	75 or over
Base	215	102	84	18	11
The online form is difficult to use	16.7%	16.7%	13.1%	27.8%	27.3%
I am not confident going online	9.3%	5.9%	2.4%	44.4%	36.4%
I expected not to get through by phone	10.2%	9.8%	10.7%	16.7%	0.0%
I expected to wait too long for a reply	43.7%	41.2%	51.2%	33.3%	27.3%
I did not think I would get an appointment	28.8%	28.4%	34.5%	11.1%	18.2%
The problem went away	17.7%	18.6%	17.9%	16.7%	9.1%
I got help somewhere else, such as a pharmacy or NHS 111	22.8%	24.5%	26.2%	11.1%	0.0%
Another reason	4.7%	3.9%	4.8%	5.6%	9.1%
Don't know	3.3%	5.9%	1.2%	0.0%	0.0%

Asked only of respondents who answered Yes at Q4. Respondents could choose more than one reason, so columns add to more than 100%.

Q6 How you would prefer to book an appointment in future

	Total	18 to 44	45 to 64	65 to 74	75 or over	Disability: yes	Disability: no	Needs an interpreter: yes	Needs an interpreter: no
Base	886	462	337	54	33	102	784	13	873
Using the online request form	46.2%	58.4%	38.0%	16.7%	6.1%	23.5%	49.1%	7.7%	46.7%
By phone	40.7%	29.9%	49.0%	63.0%	72.7%	50.0%	39.5%	23.1%	41.0%
In person at reception	4.6%	2.6%	4.2%	14.8%	21.2%	15.7%	3.2%	61.5%	3.8%
No preference	6.5%	7.4%	6.5%	3.7%	0.0%	7.8%	6.4%	0.0%	6.6%
Don't know	1.9%	1.7%	2.4%	1.9%	0.0%	2.9%	1.8%	7.7%	1.8%

Q7-Q10 Sample profile: age

	Total
Base	886
18 to 44	52.1%
45 to 64	38.0%
65 to 74	6.1%
75 or over	3.7%
Prefer not to say	0.0%

Q7-Q10 Sample profile: sex

	Total
Base	886
Female	54.2%
Male	44.2%
Non-binary	0.2%
I describe myself in another way	0.3%
Prefer not to say	1.0%

Q7-Q10 Sample profile: disability

	Total
Base	886
Yes	11.5%
No	88.5%
Prefer not to say	0.0%

Q7-Q10 Sample profile: needs an interpreter

	Total
Base	886
Yes	1.5%
No	98.5%
Prefer not to say	0.0%

Open-text answers to Q3. What, if anything, would make booking an appointment easier for you? (12 of 246 shown)

A001 · 45 to 64, Female Less questions on the form
A006 · 75 or over, Female My preference is always to phone and speak to a person, so please make phone booking available to everyone again.
A017 · 45 to 64, Male, Has a disability With early dementia I lose track of what I've started. Someone at reception to help me fill in the request when I come in would be easier.
A018 · 75 or over, Female phone booking back, and a less complicated request form pls
A019 · 18 to 44, Male if the surgery answered my form on the same day, I'd have no complaints at all
A021 · 45 to 64, Male A form that doesn't ask for my symptoms three different ways. Once is enough!
A023 · 18 to 44, Female I'd feel much more confident if the doctor already knew me and my past problems. Seeing different people each time means nothing ever feels followed up.
A026 · 18 to 44, Male No suggestions from me.
A029 · 45 to 64, Prefer not to say, Has a disability Being able to book by calling the surgery. I find talking much quicker and less stressful.
A032 · 18 to 44, Male I'd like one doctor who knows my family history and my long-term conditions, so I don't have to go over everything again every single time I go in.
A034 · 18 to 44, Male Nothing that I can think of right now.
A036 · 18 to 44, Male Honestly I gave up halfway through the form last week because it kept asking things I'd already said. Make it simpler and not so repetitive.

The numeric questions every model answered

Among respondents who tried to book in the last three months, what percentage were satisfied (fairly or very) with the booking process?
Weighting each age band's percentage satisfied (fairly or very, among those who tried to book) by that band's share of registered adults, what is the overall percentage satisfied?
What percentage of all respondents said there was a time in the last three months when they needed an appointment but did not try to book one?
Weighted to the age mix of registered adults, what percentage would prefer to book by phone?
What is the 95% margin of error, in percentage points, on the unweighted percentage satisfied among respondents who tried to book?
Among respondents who tried to book, is the difference in the percentage satisfied (fairly or very) between female and male respondents statistically significant at the 95% level? (1 for yes, 0 for no)
How many of the open-text answers ask to be able to book by phone, or for a phone booking line?
How many of the open-text answers from respondents aged 65 or over ask to be able to book by phone, or for a phone booking line?
Weighted to the age mix of registered adults, about how many of the practice's 17,100 registered adults would say there was a time in the last three months when they needed an appointment but did not try to book one?
Among respondents aged 18 to 44, what percentage would prefer to book using the online request form?
What percentage of the patients sent the text message completed the survey?

What was planted in the data

What a careful analyst notices. The judges check each analysis against these.

Patients aged 65 or over are 24% of registered adults but 9.8% of respondents (text link, online only). They are less satisfied and prefer the phone, so weighting to the age mix lowers satisfaction among those who tried to book from 50.8% to 46.3% and raises the phone preference from 40.7% to 45.0%.
Q2 satisfaction (50.8%) is asked only of the 549 who tried to book. 24.3% of all respondents needed an appointment but did not try to book (35.1% of those who did not try to book); those who did not try are left out of the satisfaction base, which flatters it.
Last year's 71% came from a paper survey handed out in the waiting room before the change, to patients who had got an appointment; this year's 50.8% is from an online survey by text of those who tried to book. Different method and different people.
The practice manager believes patients prefer the new system. Unweighted, the online form leads (46.2% against 40.7% for phone), but only 18-44s prefer it (58.4%); weighted to the age mix, preference is split (40.7% online, 45.0% phone, 6.7% in person).
Only 13 respondents need an interpreter; 61.5% of them would prefer to book in person.
Among those who tried to book, women look less satisfied than men (47.5% against 55.3%, bases 303 and 237), but the difference is not statistically significant at 95%.
Only 886 of 9,840 patients texted completed (about 9%), and the 7,260 registered adults without a mobile number on record were never invited; patients who cannot or do not go online are the least likely to have answered.

Key findings.

Once weighted to the practice's age mix, patients are split between booking online and by phone; only under-45s clearly prefer the online form, and patients aged 65 or over mostly prefer the phone
Satisfaction with booking among those who tried is lower once weighted for age, and a substantial share of patients needed an appointment but did not try to book, so the satisfaction figure flatters online-first
Patients aged 65 or over, the group least served by online-first, are badly under-represented by a text-message survey

A sound recommendation, in substance. Keep online-first for patients who can use it, but add a dedicated phone line and in-person help at reception for patients who need them (older patients, patients with a disability or limited English); do not compare this year's satisfaction with last year's 71%; gather evidence from patients the text survey did not reach before deciding on a phone line for everyone.