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

Scorecard

The analysis

Findings

1. Answer to the practice manager: No—patients overall do not prefer online-first, and the system is only working well for under-45s. Once adjusted for the practice's adult age profile, preference for phone booking (45.0%) outweighs preference for the online form (40.7%), even before accounting for the 42% of adults without a mobile number on record who could not receive this SMS survey.

   High confidenceBase 886

   Unweighted Q6 shows 46.2% prefer online vs 40.7% phone and 4.6% in person (base 886), only because 18–44s and 45–64s make up 90.1% of respondents vs 76.0% of registered adults. Age-weighted across registered adults (44% 18–44, 32% 45–64, 13% 65–74, 11% 75+), phone preference rises to 45.0% and in-person to 7.0% (52.0% non-online combined), while online falls to 40.7%. Online is preferred by a majority only among 18–44s (58.4%, base 462), falling to 38.0% among 45–64s (base 337), 16.7% among 65–74s (base 54), and 6.1% among 75+s (base 33).

2. Answer to the GP partner: Booking satisfaction is markedly lower than last year's 71%, standing at 50.8% unweighted (±4.2 pp) and 46.3% age-weighted among those who tried to book, driven by severe dissatisfaction among patients aged 65 and over—though the exact percentage-point drop cannot be taken at face value because the survey mode and sample changed completely.

   Medium confidenceBase 549

   At Q2, 50.8% of triers were satisfied and 33.9% dissatisfied (base 549). Satisfaction falls sharply with age: 64.7% in 18–44s (base 272), 44.0% in 45–64s (base 209), 17.8% in 65–74s (60.0% dissatisfied, base 45), and 13.0% in 75+s (73.9% dissatisfied, base 23). However, October 2025's 71% figure (base 412) came from a waiting-room paper survey that captured only patients who had succeeded in getting an in-person appointment, whereas September 2026's SMS survey includes failed booking attempts and excludes patients without mobile phones.

3. An over-75s-only age threshold for phone and reception support would leave behind 65–74-year-olds and a large share of 45–64-year-olds. Patients aged 65–74 struggle almost as severely with online-first as over-75s, and 88% of open-text requests for phone booking came from under-65s.

   High confidenceBase 886

   Among 65–74s, only 17.8% of triers were satisfied (base 45), 77.8% prefer phone (63.0%) or reception (14.8%) over online (16.7%, base 54), and 44.4% of deterred 65–74s said they are not confident going online (base 18)—higher even than 75+s (36.4%, base 11). Among 45–64s, more prefer phone (49.0%) than online (38.0%, base 337). In Q3 open text (base 246), 94 respondents asked for phone booking, of whom 83 were aged under 65 and only 11 were aged 65 or over.

4. Roughly a quarter of adult patients—representing about 4,392 registered adults when age-weighted—needed an appointment in the last three months but did not even try to book, primarily because of slow reply times and perceived lack of appointment availability rather than digital inability among under-65s.

   High confidenceBase 886

   At Q4, 24.3% of all respondents (base 886; 25.7% age-weighted across 17,100 adults = 4,392 patients) did not try to book despite needing an appointment, rising to 33.3% among both 65–74s (base 54) and 75+s (base 33), and 35.1% among those who made no booking attempt at all in the period (base 313). At Q5 (base 215), top barriers were expecting to wait too long for a reply (43.7%; 51.2% in 45–64s) and not thinking they would get an appointment (28.8%), alongside form difficulty (16.7%) and low online confidence (9.3% overall, but 44.4% in 65–74s and 36.4% in 75+s). In Q3, 45 respondents cited waits of 24 hours to 5 days for a reply and 29 criticised the lengthy, repetitive form.

5. Patients with disabilities experience lower booking satisfaction and face diverse physical, sensory, and cognitive barriers that require both non-digital channels (phone and face-to-face reception) and accessibility fixes to the online form itself.

   High confidenceBase 102

   Disabled triers reported 40.0% satisfaction vs 52.3% among non-disabled triers (and only 10.8% 'very satisfied' vs 22.9%, Q2 bases 65 and 484; gap p = 0.063). Across all disabled respondents (Q6 base 102), 50.0% prefer phone and 15.7% prefer in-person reception ( nearly five times the non-disabled rate of 3.2%), while only 23.5% prefer online (vs 49.1% non-disabled). Open-text answers from 21 disabled respondents detail screen-reader unlabelled buttons (JAWS), hand tremors (Parkinson's, MS, stroke, arthritis), sight loss, deafness/BSL needs, dementia, learning disabilities, selective mutism, and chronic fatigue requiring save-and-return or proxy booking.

6. Answer to the PPG chair (part 1—sex): Women who tried to book reported lower satisfaction than men by 7.8 percentage points, but this difference is not statistically significant at the 95% confidence level, and the tables do not show whether women were deterred from trying more often.

   Medium confidenceBase 540

   At Q2, 47.5% of female triers (base 303) vs 55.3% of male triers (base 237) were satisfied (two-proportion z = 1.79, p = 0.074). Q4, Q5, and Q6 were not cross-tabulated by sex, and Q2 was not cross-tabulated by age within sex.

7. Answer to the PPG chair (part 2—interpreters): The survey reached very few patients needing an interpreter and lacks satisfaction crosstabs for them, so overall experience evidence is thin—but even within this tiny group, preference for in-person reception booking is overwhelming.

   Low confidenceBase 13

   Only 13 respondents (1.5% of 886) reported needing an interpreter, and Q1, Q2, and Q4 were not broken out for this group. However, at Q6 (base 13), 61.5% (8 of 13) prefer to book in person at reception and 23.1% (3 of 13) by phone, vs just 7.7% (1 of 13) online (compared with 3.8% in-person and 46.7% online among non-interpreter patients, base 873). Open-text comments (A112 Polish, A756 Urdu) highlight fear of miscommunicating symptoms in written English and dependence on family members.

Open-text themes it coded

Restore phone booking / speak to staff by phone 94Faster replies and receipt confirmation for online requests 45Satisfied with the current online form / works well as is 45Shorter, simpler, less repetitive online form 29Accessibility and format adjustments for disabled patients 21Continuity of care / booking with a regular GP 15In-person help at reception or speaking directly to a person 7Language, translated forms, BSL, and interpreter support 3No suggestions / rarely need appointments 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? (If you are helping an adult family member or friend who is registered here to complete this survey, with their permission, please answer every question from their point of view.)

   One answer
   • Yes – I am registered here and answering for myself
   • Yes – I am answering on behalf of an adult patient registered here
   • No – neither I nor the person I am helping is registered here

   Continues if Yes – I am registered here and answering for myself; Yes – I am answering on behalf of an adult patient registered here

2. S2

   Which age group are you in? (If you are answering on behalf of someone else, please select their age group.)

   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

   In April 2026, Ashgrove Medical Group changed how appointments are booked so that most requests start with an online form, with reception phones kept for patients who cannot go online. Since April 2026, have you tried to book or needed an appointment at the practice?

   One answer
   • Yes – I used the online request form
   • Yes – I phoned reception
   • Yes – I asked at the reception desk in person
   • Yes – I used more than one of these ways (online, phone, or in person)
   • Yes – I needed an appointment, but did not end up requesting one
   • No – I have not needed an appointment since April 2026
4. Q2

   Overall, how satisfied or dissatisfied have you been with booking 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 – I used the online request form; Yes – I phoned reception; Yes – I asked at the reception desk in person; Yes – I used more than one of these ways (online, phone, or in person); Yes – I needed an appointment, but did not end up requesting one

5. Q3

   Since April 2026, has there been a time when you needed an appointment at the practice, but were put off trying to book or gave up before completing your request?

   One answer
   • Yes – I needed an appointment and did not try to book at all
   • Yes – I started trying to book, but gave up before completing it
   • No – whenever I needed an appointment, I completed my request

   Routing Shown only if Q1 is: Yes – I used the online request form; Yes – I phoned reception; Yes – I asked at the reception desk in person; Yes – I used more than one of these ways (online, phone, or in person); Yes – I needed an appointment, but did not end up requesting one

6. Q4

   What put you off booking, or caused you to give up? (Please select all that apply.)

   Any that apply
   • The online request form was confusing or had too many questions
   • I do not have internet access, mobile data, or a suitable device
   • The online form was closed or unavailable at the time I needed it
   • I could not get through on the phone or waited too long in the queue
   • Reception staff told me to use the online form, which I could not do
   • A health condition or disability made using the booking system difficult
   • Reading or writing in English on the online form was difficult for me
   • I did not feel comfortable typing private medical details into an online form
   • I was unsure when or how the practice would reply to my request
   • Other reason

   Routing Shown only if Q3 is: Yes – I needed an appointment and did not try to book at all; Yes – I started trying to book, but gave up before completing it

7. Q5

   Without help from someone else, how easy or difficult is it for you to fill in an online form to request a GP appointment?

   One answer
   • Very easy
   • Fairly easy
   • Neither easy nor difficult
   • Fairly difficult
   • Very difficult
   • I cannot use an online form at all without help
8. Q6

   When you need to ask for an appointment at Ashgrove Medical Group in the future, which ONE way would you most prefer to use?

   One answer
   • Fill in the practice's online request form (on a phone, tablet, or computer)
   • Phone the practice reception
   • Speak to a receptionist in person at the practice
   • Book directly through the NHS App
   • I have no preference
9. Q7

   Which of the following would do the most to make booking an appointment easier for you? (Please select up to three.)

   Any that apply
   • A shorter, simpler online request form
   • Keeping the online request form open for longer hours (including evenings and weekends)
   • Clearer updates on when the practice will reply to an online request
   • Being able to choose whether the practice replies by text message or phone call
   • Being able to phone reception in the morning to book an appointment
   • A dedicated phone line reserved for patients who cannot go online, are aged 75 or over, have a disability, or need language support
   • In-person help at the reception desk to book an appointment
   • Online forms in other languages, or an easy way to ask for an interpreter
   • Nothing – booking an appointment is already easy for me
10. Q8

    In your own words, what one change would make the biggest difference to how you book an appointment at Ashgrove Medical Group? (Optional)

    Open text
11. Q9

    Do you have any physical or mental health conditions, disabilities, or illnesses lasting or expected to last 12 months or more?

    One answer
    • Yes
    • No
    • Prefer not to say
12. Q10

    Does your condition or illness reduce your ability to carry out day-to-day activities?

    One answer
    • Yes, a lot
    • Yes, a little
    • No, not at all
    • Prefer not to say

    Routing Shown only if Q9 is: Yes

13. Q11

    Do you ever need an interpreter (including British Sign Language) when speaking with GP practice staff or clinicians?

    One answer
    • Yes – for a spoken language other than English
    • Yes – for British Sign Language (BSL)
    • No
    • Prefer not to say
14. Q12

    Without help from someone else, how easy or difficult is it for you to read and fill in forms written in English?

    One answer
    • Very easy
    • Fairly easy
    • Fairly difficult
    • Very difficult
    • I cannot read or write in English
    • Prefer not to say