Gemini 4 Argon: How Ashgrove patients find online-first booking

Scorecard

The analysis

Findings

1. To the Practice Manager ('Patients prefer the new system, don't they? Can I tell the partners online-first is working?'): No. Even in a survey distributed by text message—which heavily over-represents younger, digitally connected patients—only 46.2% prefer the online form, while 40.7% prefer booking by phone and 4.6% in person. When weighted to the actual age profile of registered adults, preference for booking by phone (45.0%) exceeds preference for the online form (40.7%). Furthermore, 24.3% of respondents needed an appointment in the last three months but did not try to book one (an age-weighted equivalent of ~4,412 registered adults), primarily because they expected to wait too long for a reply (43.7% of those put off) or did not think they would get an appointment (28.8%).

   High confidenceBase 886

   Unweighted preference (Q6, n=886): 46.2% online, 40.7% phone, 4.6% in person at reception. Age-weighted preference across the 17,100 adult population (44% 18–44, 32% 45–64, 13% 65–74, 11% 75+): 45.0% phone, 40.7% online, 7.6% in person. Unmet need (Q4, n=886): 24.3% unweighted (25.8% age-weighted, ~4,412 adults) needed an appointment but did not try to book; among those who did not try to book at all in the last 3 months (n=313), 35.1% had an unmet need. Top barriers (Q5, n=215): expected to wait too long for a reply (43.7%), did not think they would get an appointment (28.8%), online form difficult to use (16.7%).

2. To the GP Partner ('Last year 71% were satisfied with booking. Has satisfaction fallen since we went online?'): Yes, satisfaction has fallen substantially, though the exact percentage-point drop must be treated with caution due to a change in survey methodology. Among respondents who tried to book, 50.8% are satisfied (95% CI: 46.6% to 55.0%), down 20.2 percentage points from 71% last year. Because older patients are severely under-represented in this SMS sample (9.8% aged 65+ in the sample vs 24.0% in the practice population), age-weighting reduces overall satisfaction further to 46.3% (or 42.3% if weighted by age and booking incidence). Satisfaction collapses among older adults: just 17.8% of 65–74s and 13.0% of 75+s are satisfied, while 60.0% and 73.9% respectively are dissatisfied.

   High confidenceBase 549

   Q2 satisfaction (n=549 triers): 50.8% net satisfied (29.3% fairly, 21.5% very), 33.9% net dissatisfied (19.3% fairly, 14.6% very). By age: 18–44 is 64.7% satisfied (n=272); 45–64 is 44.0% (n=209); 65–74 is 17.8% (n=45); 75+ is 13.0% (n=23). Last year's survey (n=412, waiting-room paper survey) recorded 71% satisfied. While waiting-room surveys exclude patients who fail to get an appointment and SMS surveys exclude those without mobile phones (42% of practice adults), the severe dissatisfaction among 45+ and disabled patients confirms a genuine operational problem.

3. A restricted phone and reception service (only for over-75s, disabled patients, and limited-English patients) will leave the majority of phone-dependent patients behind. Strong preference for phone booking and low satisfaction with online-first extend heavily into the 45–64 and 65–74 age bands. In the open-text responses, 85% of the requests for phone booking (64 out of 75) came from patients aged under 65.

   High confidenceBase 886

   Among 65–74s (n=54, excluded from an over-75s cutoff), 63.0% prefer phone booking, 14.8% prefer reception, only 16.7% prefer the online form, and 72.2% of those put off from booking (n=18) cited lack of confidence going online (44.4%) or form difficulty (27.8%). Among 45–64s (n=337), more prefer phone (49.0%) than online (38.0%), and satisfaction is only 44.0% (n=209). Even among non-disabled respondents (n=784), 39.5% prefer booking by phone. Open-text Q3: 75 respondents asked for phone booking; only 11 were aged 65+ and 64 were aged 18–64, including several explicitly asking not to restrict phone lines to specific groups (e.g., A039, A583, A659).

4. To the PPG Chair ('Are women, or patients who need an interpreter, finding it harder to book than others?'): For women vs men, the 7.8 percentage-point gap in satisfaction (47.5% female vs 55.3% male) is not statistically significant at the 95% confidence level (p = 0.071), so we cannot be certain women find it harder overall, though it warrants monitoring. For patients needing an interpreter, the sample is very small (n=13) because the survey was sent in English by SMS, but the signal is stark: 61.5% prefer to book in person at reception and only 7.7% (1 person) prefer the online form.

   Medium confidenceBase 549

   Sex difference on Q2: Female 47.5% satisfied (n=303) vs Male 55.3% satisfied (n=237); z = -1.80, p = 0.071 (two-tailed). Interpreter needed on Q6 (n=13): 61.5% (8/13) prefer in-person at reception (vs 3.8% of those not needing an interpreter, n=873), 23.1% (3/13) prefer phone, 7.7% (1/13) prefer online. Open-text answers (A112, A756) highlight fear of making medical errors in English on the form and reliance on family members to translate.

5. Patients with disabilities experience major usability, sensory, cognitive, and motor barriers with the online-first system, driving high demand for both phone (50.0%) and in-person reception booking (15.7%).

   High confidenceBase 102

   Q6 preference among disabled respondents (n=102): 50.0% phone, 15.7% in person at reception, 23.5% online (compared to 49.1% online and 3.2% in person among non-disabled respondents, n=784). Q2 satisfaction among disabled triers (n=65): 40.0% satisfied vs 52.3% non-disabled (n=484); only 10.8% of disabled triers are 'very satisfied' vs 22.9% of non-disabled. Open-text Q3 responses from 21 disabled patients detail specific barriers: screen reader/JAWS compatibility failure (A237), visual impairment/small grey text (A334, A565, A713, A742), tremors/Parkinson's/MS/stroke affecting fine motor control (A193, A221, A228, A258, A443), hearing impairment/BSL needs requiring face-to-face or video relay (A265, A375, A789), and dementia/stroke memory loss/learning disabilities/ME brain fog requiring human assistance or save-and-return functionality (A017, A189, A262, A320, A339, A358, A437, A512).

6. For patients willing to book online, the primary failure is not the concept of online booking, but slow practice turnaround times (waiting 24 hours to 5 days for a reply) and an overly long, repetitive form.

   High confidenceBase 246

   Among all respondents put off from booking (Q5, n=215), 'I expected to wait too long for a reply' is the #1 barrier at 43.7% (rising to 51.2% among 45–64s). 'The online form is difficult to use' was cited by 16.7% (rising to 27.8% of 65–74s and 27.3% of 75+s). In Q3 open-text (n=246), 37 respondents complained about slow response times (citing waits of 24 hours to 5 days and wanting same-day or within-hours confirmation) and 23 criticized the form's length, repetition, or complexity.

Open-text themes it coded

Restore phone booking / speak to a person on the phone 97Faster response / same-day turnaround to online requests 45Shorten and simplify the online form (fewer, less repetitive questions) 29Accessibility, digital inclusion, and language adaptations (disability, sensory/motor/cognitive, interpreter/translation, proxy, in-person help) 24Continuity of care / seeing the same or regular GP 15Satisfied with the online form / works well as it is 45No suggestions / rarely use the practice 32

The survey it planned

2 screening questions and 12 questions, as the model wrote them.

1. S1

   Are you currently registered as a patient at Ashgrove Medical Group?

   One answer
   • Yes, I am a registered patient
   • Yes, I am answering on behalf of a registered patient (for example, as a carer or family member)
   • No

   Continues if Yes, I am a registered patient; Yes, I am answering on behalf of a registered patient (for example, as a carer or family member)

2. S2

   Which age group is the patient in? (If you are answering for someone else, please give their age.)

   One answer
   • Under 18
   • 18 to 44
   • 45 to 64
   • 65 to 74
   • 75 or over

   Continues if 18 to 44; 45 to 64; 65 to 74; 75 or over

3. Q1

   Since April 2026, have you tried to book or request an appointment at Ashgrove Medical Group?

   One answer
   • Yes
   • No, I have not needed an appointment since April 2026
   • No, I needed an appointment since April 2026, but I did not try to book one
4. Q2

   The last time you tried to book or request an appointment since April 2026, how did you contact the practice?

   Any that apply
   • Filled in the online request form on the practice website or NHS App
   • Phoned reception
   • Went into the practice in person to speak to reception
   • Someone else (such as a family member or carer) contacted the practice for me
   • Other

   Routing Shown only if Q1 is: Yes

5. Q3

   Overall, how satisfied or dissatisfied were you with your experience of booking or requesting an appointment at Ashgrove Medical Group since April 2026?

   One answer
   • Very satisfied
   • Fairly satisfied
   • Neither satisfied nor dissatisfied
   • Fairly dissatisfied
   • Very dissatisfied

   Routing Shown only if Q1 is: Yes

6. Q4

   Thinking about the last time you contacted the practice since April 2026, how easy or difficult was it to explain what you needed and get a response?

   One answer
   • Very easy
   • Fairly easy
   • Neither easy nor difficult
   • Fairly difficult
   • Very difficult

   Routing Shown only if Q1 is: Yes

   Judges: double-barrelled

   One rating covers both explaining what was needed and getting a response. These could have been very different experiences.

   Asks how easy it was to explain what was needed and how easy it was to get a response, with only one rating for both.

7. Q5

   Since April 2026, has there been a time when you needed an appointment at the practice, but were put off or unable to ask for one?

   One answer
   • Yes
   • No

   Routing Shown only if Q1 is: Yes

8. Q6

   Why were you put off or unable to ask for an appointment? (Please select all that apply.)

   Any that apply
   • I do not have internet access, a smartphone, or a computer
   • I found the online request form too difficult or confusing to use
   • The online request form was closed or unavailable when I tried
   • I tried to phone, but the wait was too long or I could not get through
   • I was told on the phone or at reception that I had to use the online form
   • I find it difficult to explain my health problem in writing or in English
   • I did not know when the practice would call or text me back
   • I felt my privacy was at risk explaining my issue on the form or at the reception desk
   • Another reason

   Routing Shown only if Q1 is: Yes; No, I needed an appointment since April 2026, but I did not try to book one

   Judges: assumptive

   The routing shows this question to everyone who tried booking, including those who answered No to Q5. It assumes they were put off or unable to ask, and provides no option to say this did not happen. Needing an appointment but not trying to book also does not necessarily establish that someone was put off or unable to ask.

   Display logic is keyed to Q1, not Q5. Respondents who answered No at Q5 (never put off) are still asked why they were put off.

9. Q7

   When you need to book or request an appointment at the practice in future, how would you most prefer to do it?

   One answer
   • By filling in an online form (with a text or phone reply from the practice)
   • By phoning the practice to speak to a receptionist
   • In person at the reception desk
   • I have no preference between online and phone
   • Not sure
10. Q8

    How ought Ashgrove Medical Group organise appointment booking for patients in future? Please select the option you think is best overall.

    One answer
    • Keep the current online-first system as it is (most patients use the online form; phone lines are kept for those who cannot go online)
    • Keep the online form, and add a dedicated phone line and in-person help at reception specifically for patients aged 75 and over, disabled patients, and those who need help with English
    • Bring back a morning phone booking line for any patient who wants to call, alongside the online form
    • Not sure
11. Q9

    Which of the following, if any, would make it easier for you to book or request an appointment at Ashgrove Medical Group? (Please select up to three.)

    Any that apply
    • A simpler or shorter online request form
    • Keeping the online request form open for longer hours each day
    • Being able to book routine appointments directly by phone at any time
    • A morning phone line open to all patients to book appointments
    • A priority phone line for older patients, disabled patients, or those who cannot get online
    • Staff or tablets available at the reception desk to help fill in the request in person
    • Clearer information on when the practice will reply to an online request
    • Option to complete the online form in other languages or easily book an interpreter
    • Nothing — booking is already easy for me
12. Q10

    In your own words, what is the one main thing Ashgrove Medical Group could do to improve how you book an appointment?

    Open text
13. Q11

    Do you have any physical or mental health conditions or disabilities that have lasted, or are expected to last, 12 months or more and reduce your ability to carry out day-to-day activities?

    One answer
    • Yes, a lot
    • Yes, a little
    • No
    • Prefer not to say
14. Q12

    How comfortable are you speaking and reading English, and using the internet on a smartphone or computer?

    Any that apply
    • English is not my main language and I sometimes need an interpreter or help with written English
    • I find it difficult or impossible to use the internet on a smartphone, tablet, or computer without help
    • Neither of these applies to me — I am comfortable with English and using the internet
    • Prefer not to say