Your Google Ads contract is coming up for renewal. The agency sends a report full of impressions and click-through rates. None of it tells you what you actually need to know: did the spend bring in paying patients, and was it worth what you paid for them? Here are the three numbers that answer that question, a worked example you can fill in with your own figures, and the honest reason why the ads are often fine and the phone is the problem.

The three numbers that matter

Everything else in an ads report - impressions, quality score, average position - is machinery. These three are the business:

  • Cost per enquiry. What you paid in ad spend for each person who called, emailed, or filled in your form.
  • Enquiry-to-booking rate. Of every person who made contact, how many actually booked.
  • Value of a booked patient. What a new patient is worth to you - first appointment plus a realistic estimate of what they spend over the following year if they come back.

Multiply the last two together, compare the result to the first, and you have your answer. If the value of a booked patient is higher than what you paid to get the enquiry, divided by your booking rate, the ads are pulling their weight. If it isnt, they arent.

The worked example - fill in your own numbers

Run this on a single month. Pull the figures from your Google Ads account and your diary or practice management system.

Ad spend this month:          £[YOUR_SPEND]
Enquiries from ads:           [ENQUIRY_COUNT]   calls + forms + messages you can attribute to the campaign
New patients booked:          [BOOKED_COUNT]    people who actually attended a first appointment

Cost per enquiry:             £[YOUR_SPEND] / [ENQUIRY_COUNT]
Booking rate:                 [BOOKED_COUNT] / [ENQUIRY_COUNT] x 100 = [RATE]%

Value of a new patient:       £[FIRST_APPT] + (£[AVG_RETURN_APPT] x [AVG_RETURN_VISITS])

Break-even cost per enquiry:  £[PATIENT_VALUE] x ([RATE] / 100)

If your cost per enquiry is below that break-even figure, the campaign is profitable. If it is above it, you are paying more to acquire each patient than they return - and you need to know why before you renew anything.

A quick sense-check on the value figure: a single biomechanics assessment and two follow-ups at typical UK rates is already meaningful. A patient who comes back for nail care every six to eight weeks is worth considerably more over a year. Use your own appointment fees and your own average return rate - do not borrow someone else’s number here, because it is the one figure that changes the maths most.

Where the money usually dies

Here is the part most agencies will not tell you, because it is not their problem to fix.

The ad can be working perfectly - right keywords, right area, right people clicking - and the spend still produces nothing if the enquiry dies before it becomes a booking. The most common place that happens is the phone.

Someone clicks your ad at 11:40 on a Tuesday. You are with a patient. The call rings out. They try the next result. That click cost you real money and returned nothing.

Look at your booking rate figure from the worked example above. A booking rate below 50% is a signal worth investigating before you touch the ad budget. Ask yourself:

  • How many calls went unanswered last month? Most phone systems or your mobile will show missed calls - count them.
  • Of the enquiries that did get through, how many were followed up the same day?
  • Is your booking link easy to find, or does every enquiry require a phone call to complete?

Thameside Podiatry went from launch to first patient in eight days. That speed matters because enquiries are perishable - the longer the gap between contact and confirmation, the more of them quietly disappear.

If your ads are generating enquiries but your booking rate is low, fixing the answering problem will return more than renegotiating the ad spend. Pausing the ads and fixing the phone first is a legitimate option - and a cheaper one.

The five-minute monthly check

You do not need the agency present to run this. On the first working day of each month, open two tabs: your Google Ads account and your diary or PMS, practice management system.

1. Google Ads > Campaigns > last 30 days
   Note: spend, clicks, conversions (if conversion tracking is set up)

2. Your diary or PMS
   Count: new patient first appointments attended this month
   Count: enquiries received (calls + forms + messages)

3. Run the three numbers above

4. Ask one question: is my cost per enquiry below my break-even figure?

If conversion tracking is not set up in your Google Ads account - meaning the campaign is not recording calls or form submissions as goals - that is the first thing to fix. Without it, the agency is optimising for clicks, not patients, and you have no reliable enquiry count to work with. Ask them to show you the conversion actions configured in the account. If they cant, that is a problem worth raising before the renewal conversation.

When the ads are fine

Sometimes the numbers come back clean. Cost per enquiry is well below break-even, booking rate is solid, patients are arriving. In that case, the honest answer is: renew, and look at whether the budget could go higher. A profitable campaign that is capped by budget is money being left on the table.

The point of this check is not to find a reason to cancel. It is to make the renewal decision on your numbers, not the agency’s report.

One thing worth looking at alongside this

Paid ads rent you visibility - the moment you stop paying, the enquiries stop. Search engine optimisation, getting your clinic to rank in Google without paying per click, builds something that compounds over time. The two work well together when the paid side is profitable and the organic side is growing. If you want to understand how that balance looks for a clinic like yours, the local SEO guide for clinics is a good next read.

Or, if you want a second pair of eyes on your actual numbers - not a pitch, just a look at what the data says - tell us what you are working with and we will tell you honestly what we see.