Particle-1: 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: ✗ Not sound
Research score: 92 of 100
Analysis rating: 1,193
Head to head, this task: won 2 of 14

Why it is not sound

The analysis

Made a recommendation that does not follow from the data
Proposed a mistaken next step: Restore a morning phone booking line for every patient on the strength of this survey alone

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?	✓	95	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?	✓	11	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 unchanged. Restore a morning phone booking line for every patient, retain the online request form, and add targeted in-person and phone help for over-75s, disabled patients and patients with limited English. The data do not support telling the partners that patients broadly prefer online-first: phone preference is 45.0% age-weighted vs about 40.7% online, and phone demand is substantial in the open text. A narrow need-only phone line would still leave many 45-74 patients who prefer phone without an option. Pair this with a simpler online form and a same-working-day response standard, because response delay and form burden are recurring complaints.

What would change it

A representative mixed-mode survey, weighted to the registered adult population and including patients without mobiles, showing that online preference clearly outweighs phone and that satisfaction is high across older and disabled groups. Operational data showing that a universal morning phone line would seriously harm access or is unaffordable would also change the recommendation; conversely, evidence that phone demand among 45-74s can be met through targeted support would favour the narrower option.

Findings

The claim that patients prefer online-first booking is not supported overall: online is the largest single preference only before age weighting, while phone preference is higher once weighted to the registered adult population.

Medium confidenceBase 886

Q6: 46.2% prefer online and 40.7% prefer phone unweighted, but age-weighted phone preference is 45.0% versus about 40.7% online. Online is preferred by 58.4% of 18-44s, while phone is preferred by 63.0% of 65-74s and 72.7% of 75+ respondents.
Satisfaction among recent bookers is around half and is substantially lower than the 2025 headline, but the two figures are not directly comparable.

Medium confidenceBase 549

Q2 net satisfied among those who tried to book: 50.8% (base 549); age-weighted to registered adults: 46.3%. Last year's 71% came from a paper waiting-room survey before online-first, whereas this survey was text-message based and unweighted.
Older and disabled patients are much less satisfied with booking and should not be treated as served by the current online-first model.

Medium confidenceBase 549

Q2 satisfaction: 18-44 64.7%, 45-64 44.0%, 65-74 17.8%, 75+ 13.0%; disability yes 40.0% vs no 52.3%. Q6 disability yes: 50.0% prefer phone and 15.7% in person. Bases are small for older and disabled subgroups.
Unmet need is material: about a quarter of respondents needed an appointment but did not try to book, equivalent to roughly 4,400 registered adults when age-weighted.

High confidenceBase 886

Q4 yes: 24.3% overall (base 886); age-weighted 25.7% of 17,100 adults = about 4,392. Among those who did not try, 43.7% expected to wait too long for a reply and 28.8% did not think they would get an appointment.
Phone booking is a major open-text request across ages, not just a small older-patient minority.

Medium confidenceBase 246

95 of 246 open-text answers ask for phone booking or a phone line; 11 of these are from respondents aged 65 or over. The open text is self-selected and cannot be generalised directly.
The apparent sex gap in satisfaction is not statistically significant at the 95% level.

Medium confidenceBase 549

Q2 satisfied: female 47.5% (base 303) vs male 55.3% (base 237); difference 7.8 percentage points, z≈1.81, p≈0.07. Interpreter subgroup is too small for a reliable satisfaction comparison (n=13).
Interpreter and disability needs point to supported access, but interpreter evidence is very thin and should be treated as indicative only.

Low confidenceBase 115

Q6 needs interpreter yes (n=13): 61.5% prefer in person, 23.1% phone, 7.7% online. Q6 disability yes (n=102): 50.0% phone, 23.5% online, 15.7% in person. Open text includes requests for Polish/Urdu forms, BSL/video relay, easy-read, large print, screen-reader compatibility and reception help.
Speed of response and form burden are concrete, actionable drivers of dissatisfaction and non-booking.

Medium confidenceBase 246

Q5 top reason for not trying was expected wait too long for a reply (43.7%). Open text has 45 answers asking for faster response and 26 asking to simplify or shorten the form. Q2: 14.6% very dissatisfied and 19.3% fairly dissatisfied among triers.

Caveats

The survey was text-message only and sent to the 9,840 adults with a mobile number, 58% of registered adults; patients without a mobile, many of whom may be older or more vulnerable, are absent.
Only 886 completed from 9,840 invited (9.0%), so non-response and self-selection are material. The sample is much younger than the registered adult population: 52.1% aged 18-44 vs 44% of adults, and 3.7% aged 75+ vs 11%.
Tables are unweighted. Age-weighted figures change the headline conclusion on online versus phone preference and lower satisfaction.
Last year's 71% satisfaction is not comparable: it used a paper waiting-room questionnaire before online-first, with a different mode, sample and likely different respondent profile.
Several key subgroup bases are very small: 65-74 n=54, 75+ n=33, disability n=102 for Q6 but n=65 for Q2, interpreter n=13. Interpreter findings are especially fragile.
Open-text answers are from 246 respondents only and are not representative; counts indicate salience, not prevalence.
Q2 asks only people who tried to book, so it excludes patients who needed an appointment but did not try, even though Q4 shows this is about a quarter of respondents.
No direct satisfaction measure is available for interpreter users; Q6 preference and open text are the only evidence.

Next steps

decisionImplement a morning phone booking line for all patients while retaining online booking.
decisionAdd assisted in-person and phone support at reception for over-75s, disabled patients and patients with limited English.
decisionSimplify the online request form and set a same-working-day response standard.
researchRun a representative mixed-mode survey including paper and telephone completion, especially for patients without mobiles.
monitorMonitor booking route, satisfaction, non-triers and response times by age, sex, disability and interpreter need.

Open-text themes it coded

Phone booking / phone line request 95Faster response / reply 45Simplify or shorten the online form 26Continuity of care / same GP 15No change needed / online form already easy 46Accessibility, interpreter or in-person help 23

The survey it planned

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

S1
What is your age?
One answer
- 18 to 44
- 45 to 64
- 65 to 74
- 75 or over
- Under 18
Continues if 18 to 44; 45 to 64; 65 to 74; 75 or over
S2
Are you registered with Ashgrove Medical Group as a patient?
One answer
- Yes
- No
- Not sure
Continues if Yes
Q1
Since April 2026, how satisfied or dissatisfied are you with the way you book appointments at Ashgrove Medical Group?
Scale

Scale 1-5: Very dissatisfied to Very satisfied

Judges: assumptive
Asked of everyone, it assumes respondents have booking experience since April 2026 on which to base a satisfaction rating. Those who have not tried to book have no applicable response option.
Shown to everyone, yet it assumes the respondent has booked since April 2026. Q11 allows for patients who have not, and Q1 has no 'not applicable' option, so those patients are forced to rate something they have not done.
Q2
Since April 2026, have you used the online request form to ask for an appointment?
One answer
- Yes
- No
- Don't know / can't remember
Q3
How easy or difficult was the online request form to use?
Scale

Scale 1-5: Very difficult to Very easy

Routing Shown only if Q2 is: Yes
Q4
Since April 2026, have you ever needed an appointment but not asked Ashgrove Medical Group for one?
One answer
- Yes
- No
- Prefer not to say
Q5
What made you not ask for an appointment? Please choose all that apply.
Any that apply
- I did not think I would get an appointment
- The online request form was too difficult to use
- I did not have internet or a device
- I had difficulty with English or needed an interpreter
- I did not know how to ask
- I could not get through on the phone
- I prefer to speak to someone face to face
- I did not want to bother the practice
- Another reason
- Prefer not to say
Routing Shown only if Q4 is: Yes
Q6
If you needed a routine appointment in future, how would you prefer to ask for it?
One answer
- By filling in the online request form
- By phoning reception
- By going to reception in person
- No preference
- Another way
Q7
Which of these, if any, would make booking an appointment easier for you? Please choose all that apply.
Any that apply
- A simpler online request form
- Being able to phone reception during a morning booking line
- A phone line for people who need extra help
- In-person help at reception for people who need it
- A reply by text message
- A reply by phone call
- Clearer information on how to book
- Help in my language or an interpreter
- Longer opening hours
- None of these
- Other
Q8
How confident are you using the internet on a phone, tablet or computer to contact a GP practice?
Scale

Scale 1-5: Not at all confident to Very confident
Q9
Do you have a disability or health condition that makes it harder for you to book an appointment?
One answer
- Yes
- No
- Prefer not to say
Q10
Do you need an interpreter or help in a language other than English when contacting the GP practice?
One answer
- Yes
- No
- Prefer not to say
Q11
How did you make your most recent request for an appointment since April 2026?
One answer
- By filling in the online request form
- By phoning reception
- By going to reception in person
- I have not requested an appointment since April 2026
- Don't know / can't remember
Q12
Is there anything else you would like to tell us about booking appointments at Ashgrove Medical Group?
Open text

Sample plan

Invite every registered adult patient aged 18+ with a mobile number on record by SMS containing a link to the online questionnaire; send one reminder only. Target 900 completed questionnaires. Use soft quotas from S1: 18 to 44 = 240, 45 to 64 = 220, 65 to 74 = 220, 75 or over = 220; monitor daily and keep older quotas open until filled. Precision note: for a 50% estimate, 900 completes gives about +/-6.5 percentage points per age band if split evenly, not +/-5. Meeting +/-5 in all four age bands needs about 1,540 completes. The partners must either add completes/boost older groups or accept wider confidence intervals for some bands. Weight results to the registered adult age profile and report unweighted base sizes. Keep all wording and options neutral; do not use leading text that assumes online-first is working.