Cost per qualified enquiry versus paid treatment

Why cost per lead misleads

Cost per lead divides what you spent by everything that came in: genuine new patients, wrong numbers, spam forms, people outside your area, and existing patients who found the phone number on an advert. It is easy to lower by attracting more of the wrong contacts, and a cheap lead source can be the most expensive way to fill the diary. It also rewards the ad platforms for the wrong thing. If the only result they are told about is a form fill, that is what they will look for.

Defining qualified

A qualified enquiry is one your team would be glad to book. Write the test down so everyone applies it the same way. Mine has four parts:

1. A real person you managed to speak to or message back.
2. Not already a patient of the practice.
3. Within reasonable travelling distance.
4. Asking about a treatment you offer, at a type of care (NHS or private) you can provide.

The person who handles the enquiry marks it qualified or not in the enquiry log, with a short reason when it is not. Keep the reasons to a fixed list (unreachable, existing patient, out of area, treatment not offered, spam) so you can count them. A rising share of "out of area" points to targeting. A rising share of "unreachable" points to how fast enquiries are answered.

Cost per qualified enquiry is then total marketing cost divided by qualified enquiries. It arrives within days, long before treatment starts, which makes it the best early signal of whether spend is working.

Following enquiries to started treatment

Qualified is still not paid. To get to cost per started patient, each enquiry in the log needs to be followed to its outcome: booked, attended, plan accepted, treatment started, or lost (with a reason). In practice that means one row per enquiry, with the date of each stage added as it happens, matched to the practice management system once a month.

The same outcomes can be reported back to Google Ads. With auto-tagging on, each ad click carries a Google click identifier, and Google notes it is required to track offline conversions ^[1]. Enhanced conversions for leads lets you import later outcomes and match them to the original lead using hashed details such as an email address, which Google says improves accuracy and bidding ^[2]. Report a stage name and, if you choose, a value; never anything clinical. How to set this up is covered in tracking source to CRM outcome.

An illustrative worked example

These are round figures chosen to make the arithmetic easy to follow. They are not averages or benchmarks. Two lead sources each cost £1,500 in a month.

On cost per lead, Source A looks twice as good. On cost per qualified enquiry they are level. On started patients and contribution, Source B is clearly better. A report that stopped at cost per lead would have moved budget the wrong way.

You can run the same sums on your own figures with the KPI and contribution calculator, and the full set of definitions is in the KPI guide.