Muse Wonder: How Ashgrove patients find online-first 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). The brief and the data →

Verdict: ✓ Sound research
Research score: 100 of 100
Analysis rating: 1,460
Head to head, this task: won 14 of 16

Scorecard

Numbers 11 of 11 right

Question		Its answer	True
Among respondents who tried to book in the last three months, what percentage were satisfied (fairly or very) with the booking process?	✓	50.8%	50.8%
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?	✓	46.3%	46.3%
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?	✓	24.3%	24.3%
Weighted to the age mix of registered adults, what percentage would prefer to book by phone?	✓	45%	45%
What is the 95% margin of error, in percentage points, on the unweighted percentage satisfied among respondents who tried to book?	✓	4.2 points	4.18 points
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)	✓	No	No
How many of the open-text answers ask to be able to book by phone, or for a phone booking line?	✓	97	97
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?	✓	13	13
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?	✓	4,392	4,393
Among respondents aged 18 to 44, what percentage would prefer to book using the online request form?	✓	58.4%	58.4%
What percentage of the patients sent the text message completed the survey?	✓	9%	9%

Traps in the data 7 of 7 handled

✓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.

The analysis

Recommendation

Do not keep online-first as it is, and do not simply restore a universal morning phone line on this evidence. Adopt the targeted option now: keep and improve the online form for the large group it works for, but add a clearly publicised dedicated phone line and in-person reception help for over-75s, patients with a disability and patients with limited English, with staff able to complete the request with/for the patient and arrange interpreter/BSL or other adjustments. Alongside this, fix the two problems affecting all users: shorten/remove repetition in the form and set and meet a same-working-day (ideally hours, not days) response standard. Tell partners: patients do not, overall, prefer online-first; satisfaction among triers is about half, lower after age weighting, and about a quarter of adults report being put off trying.

What would change it

Evidence that would change this to restoring a universal phone line: representative follow-up (including non-mobile and older patients) showing large unmet need or harm outside the targeted groups, assisted-line demand repeatedly exceeding capacity or being hard to access without stigma/gatekeeping, or operational data showing universal phone booking is affordable without worsening response times. Evidence that would change this back toward online-first as-is: representative data showing the targeted groups achieve satisfaction, successful booking and response times on a par with younger online users through the form alone, and that reported deterrence is mainly appointment scarcity rather than booking route.

Findings

Online-first is not the preferred system for the registered population as a whole: weighted to the practice age mix, 45.0% prefer phone and only about 40.7% prefer the online form. The practice manager should not tell partners that patients generally prefer the new system.

Medium confidenceBase 886

Unweighted Q6: online 46.2%, phone 40.7%, in person 4.6% (n=886). Age-weighting reverses the plurality because older patients, who are under-represented in the sample, strongly prefer phone: phone preference rises from 29.9% at 18-44 to 72.7% at 75+.
Current satisfaction among people who managed to try booking is modest, and is much lower in older age groups.

Medium confidenceBase 549

50.8% of triers were fairly/very satisfied (n=549; 95% margin of error +/-4.2 points). Age-weighted satisfaction is 46.3%. By age: 64.7% at 18-44 (n=272), 44.0% at 45-64 (n=209), 17.8% at 65-74 (n=45) and 13.0% at 75+ (n=23).
The apparent fall from 71% satisfied last year to 50.8% now cannot be interpreted as a measured 20-point decline, because the surveys are not comparable.

High confidenceBase 549

Last year: paper questionnaire handed out in the waiting room, 412 returns, October 2025. This year: text-message survey to patients with a mobile number, 886 completes from 9,840 sent (9.0% completion), September 2026. Mode, coverage, setting, season and respondent mix all changed. The current figure is a warning signal, not a like-for-like trend estimate.
A substantial minority were put off even trying, so satisfaction among triers overstates how well access is working.

Medium confidenceBase 886

24.3% of all respondents (215/886) said there was a time in the last 3 months when they needed an appointment but did not try to book. Age-weighted this is 25.7%, about 4,392 of 17,100 registered adults. Even among people who did try at some point, 17.1% also reported a time they did not try (n=549).
The main stated deterrent was expected delay, not only difficulty with the form; form difficulty and lack of online confidence are concentrated in older non-triers.

Medium confidenceBase 215

Among the 215 who did not try: expected too long for a reply 43.7%, did not think they would get an appointment 28.8%, got help elsewhere 22.8%, problem went away 17.7%, form difficult 16.7%, not confident online 9.3%. Among 65-74 non-triers (n=18), 44.4% cited lack of online confidence and 27.8% form difficulty; at 75+ (n=11), 36.4% and 27.3%. Small bases require caution.
There is no statistically reliable evidence here that women found booking harder than men, on the satisfaction measure.

High confidenceBase 540

Satisfied: female 47.5% (n=303) vs male 55.3% (n=237), a 7.8-point gap. The approximate 95% interval for the difference is about -0.7 to +16.3 points, so it is not significant at the 95% level. This answers 'is there a proven gap?' with no; it does not prove the true gap is zero.
Patients needing an interpreter show a very different preferred route, but the sample is far too small to judge their satisfaction or difficulty reliably.

Low confidenceBase 13

Only 13 respondents said they need an interpreter. Of these, 61.5% prefer in person at reception, 23.1% phone and 7.7% online, vs 46.7% online among those not needing an interpreter (n=873). No Q2 satisfaction breakdown by interpreter need is provided. Open-text A112 asks for a Polish form and A756 for Urdu-speaking help.
Disability is associated with lower online preference and indications of lower satisfaction and specific access barriers, supporting assisted routes.

Medium confidenceBase 886

Preference for online: disability yes 23.5% (n=102) vs no 49.1% (n=784); in person 15.7% vs 3.2%. Satisfied among triers: disability yes 40.0% (n=65) vs no 52.3% (n=484). Open-text answers describe tremor, blindness/screen-reader failure, learning disability, hearing loss, fatigue/brain fog and need for carer or in-person help.
Open-text demand is dominated by human/phone access, faster replies and a shorter form, not by requests to keep the form unchanged.

Medium confidenceBase 246

246 open-text answers. Coded themes: 97 ask for phone booking/speaking to a person to book, including 13 from respondents aged 65+; many also ask for same-day/faster replies and fewer, non-repetitive questions. A minority explicitly say the form is easy and should stay.

Caveats

Non-comparability with last year: paper waiting-room survey (n=412) vs text survey this year. Do not present 71% to 50.8% as a like-for-like fall, and do not use it alone to justify or condemn the change.
Coverage bias: only 9,840 of 17,100 adults (58%) had a mobile number and were sent the survey; 886 completed it (9.0% of those sent). Patients without mobiles, with outdated numbers, or less able to complete a text-linked survey are missing or under-represented - plausibly including some most affected by online-first.
Age skew: sample is 52.1% aged 18-44 vs 44% of registered adults, but only 6.1% aged 65-74 vs 13%, and 3.7% aged 75+ vs 11%. Age weighting corrects the known age mix but rests on very small older bases (Q2: n=45 and n=23; Q6: n=54 and n=33), so older-group estimates are imprecise.
Weighting is age-only and approximate: percentages in the tables are rounded, and no weighting by sex, disability, language, deprivation or digital access was possible. Weighted totals should be read as indicative, not exact population values.
Satisfaction is conditional on trying: Q2 excludes the 24.3% who at some point needed an appointment but did not try, and excludes any patients who never got as far as the survey. It therefore overstates access performance for the whole population in need.
Very small subgroups: interpreter need n=13 overall; Q5 bases for 65-74 and 75+ non-triers are n=18 and n=11. Sex analysis excludes non-binary/another way/prefer-not-to-say respondents because bases are tiny and not shown in Q2. No causal claims can be made - age, disability, language, health need and digital confidence overlap.
Open-text answers came from 246 of 886 respondents and are self-selected; theme counts show what respondents chose to raise, not population prevalence. Coding of short answers such as 'speak to a person' involves judgement.
Stated future preference (Q6) is not observed behaviour, and the survey does not measure clinical urgency, appointment availability, response times in practice systems, safety outcomes, or the cost/staffing impact of each booking model.

Next steps

decisionLaunch the dedicated phone line and in-person assisted booking for over-75s, disabled patients and patients with limited English; publicise it by letter, in practice, by phone message and via carers/support workers, not only by text/online.
monitorSet, publish and monitor a response-time standard for online requests (for example acknowledgement immediately and clinical/booking response within the same working day), and audit actual times from the practice system.
experimentRedesign and usability-test a shorter form: remove repeated symptom/history questions, add save-and-return, larger controls/text, screen-reader fixes, voice input and easy-read/translated versions.
researchRun a representative follow-up in 3-6 months using mixed modes: text plus paper in practice, postal/telephone options and translated/easy-read formats, with deliberate sampling of 75+, disabled and interpreter-needing patients and of patients with no mobile on record.
monitorMonitor equity and safety monthly for the first 6 months: booking route, response time, appointment obtained, DNAs, complaints, and use of pharmacy/111/A&E proxies where available, split by age, disability and language need.

Open-text themes it coded

Wants phone booking or to speak to a person by phone to book 97Wants faster response to online requests 43Wants a shorter, simpler, less repetitive online form 25Happy with online form / no change needed 45No suggestion, don't know, or rarely uses the practice 32Wants continuity - same or named GP who knows them 15Needs disability-related adjustment, assisted or in-person booking help 20Needs language or interpreter support 3

The survey it planned

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

S1
Are you currently 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 April 2026, Ashgrove Medical Group changed to online-first booking. Since April 2026, have you requested an appointment for yourself from Ashgrove Medical Group?
One answer
- Yes
- No, but I needed an appointment and did not request one
- No, I have not needed an appointment since April 2026
- I cannot remember
Q2
Thinking about the most recent time you requested an appointment, how did you make that request?
One answer
- I filled in the online request form myself
- Someone else filled in the online request form for me
- I phoned the practice
- I went to the practice in person
- Another way
- I cannot remember
Routing Shown only if Q1 is: Yes
Q3
How satisfied or dissatisfied were you with how you booked that appointment?
Scale

Scale 1-5: Very dissatisfied to Very satisfied

Routing Shown only if Q1 is: Yes
Q4
Since April 2026, have you ever delayed requesting an appointment, or decided not to request one, when you thought you might need one?
One answer
- Yes
- No
- I have not thought I might need an appointment since April 2026
Q5
Why did you delay requesting an appointment, or decide not to request one? Please select all that apply.
Any that apply
- I could not access or use the online form
- I do not have reliable internet access or a suitable device
- The online form was too long or confusing
- I was worried my request would not be seen as urgent enough
- I prefer to explain my problem by speaking to someone
- I find it difficult because of a disability or health condition
- I find it difficult because of language or reading difficulties
- I was concerned about privacy when writing down my problem
- A previous booking experience put me off
- Another reason
Routing Shown only if Q4 is: Yes
Q6
If you needed an appointment in the future, how would you most prefer to request it?
One answer
- By filling in an online request form
- By phoning the practice
- By visiting the practice in person
- With help from a family member, friend or carer
- I have no preference
- Another way
Q7
Which one of the following arrangements would you most prefer Ashgrove Medical Group to use for booking appointments?
One answer
- Keep online-first booking as it is now, with reception phones kept for patients who cannot go online
- Restore a morning phone booking line that any patient can use
- Add a dedicated phone line and in-person help at reception only for patients who need them, such as over-75s, patients with a disability, and patients with limited English
- I have no preference
- I don't know
Q8
Which of the following, if any, would make booking an appointment easier for you? Please select up to three.
Any that apply
- A shorter and simpler online request form
- Help from practice staff to complete the online form
- A phone line that any patient can use
- A dedicated phone line for patients who need extra help
- In-person help at reception
- Support in a language other than English, or from an interpreter
- A text or phone confirmation that my request has been received
- A choice of times for a call back from the practice
- Larger text, screen-reader compatibility or other accessibility improvements
- None of these
- Another improvement
Q9
What one change, if any, would most make booking an appointment easier for you? Please do not include your name, NHS number or details of your medical condition.
Open text
Q10
Which age band are you in?
One answer
- 18 to 44
- 45 to 64
- 65 to 74
- 75 or over
- Prefer not to say
Q11
Do you have a disability or long-term health condition that affects how you book appointments?
One answer
- Yes
- No
- Prefer not to say
Q12
Do you need an interpreter, or help with English, when booking appointments?
One answer
- Yes
- No
- Prefer not to say

Sample plan

Invite by text message every registered adult patient (18+, from the 17,100 adults) with a mobile number on record; wording of invitation and questions stays neutral and does not suggest online-first is preferred. About 900 completes cannot deliver +/-5 percentage points at 95% confidence within each of four age bands: that precision needs about 385 completes per band (n=385 at p=0.5), so target a minimum of 385 completes in each of 18-44, 45-64, 65-74 and 75+ (at least 1,540 completes, aiming for 1,600+). Monitor completes daily against these minimum age-band quotas, send reminders targeted at under-represented bands (especially 75+), and do not close the survey until each band reaches 385 or the shortfall and its wider confidence interval (about +/-6.5 points if only ~225 per band from 900) is explicitly accepted by the partners. Report the SMS/online coverage limit: adults with no mobile on record, and those unable to complete online even via the link, receive no invitation, so results represent mobile-record adults and may understate access problems in the very groups of interest; compare respondent age profile with the register and apply age weighting only as a sensitivity check, not as a substitute for the per-band quotas.