Paying bookings are up 78% on the pre-ads baseline, and every £1 of ad spend books £5.63.

Total appointment counts look flat because the diary has changed shape, not shrunk. Pre-ads, 132 Pharmacy First bookings (NHS, £0) padded the Feb–Apr numbers; Jun–Sep had 1. Strip the zero-value NHS work out and paying bookings have gone from 78 to 139 a month, at a higher average ticket. That is the uplift ads paid for. Baseline uses Feb–Apr rather than April alone (the weakest pre-ads month) to keep the comparison conservative.

Pre-ads weeks ran at £600–£1,300 of value. Since launch no full week has dipped below £1,100, and the two July peak weeks each booked more than the whole of April. Late August and September have settled into a £1,100–£1,800 band as summer travel tails off.

*May spend covers 25–31 May only, so May ROAS and MER are not shown. July remains the record month at £9,926. September is the month to watch: spend is running +74% on August while value is tracking -14%, which pulls ROAS down to 3.3x from 6.7x. Summer travel demand has eased and the extra budget has not yet found an equally valuable audience. See the recommendations.

Travel clinic (navy) carried the summer. Vaccinations (blue) are climbing into September as flu season opens, and weight loss (light blue) is a steady £900–£1,800 a month.

Last column compares the monthly average value in this window with the Feb–Apr monthly average for the same group.

NHS services (Pharmacy First, contraception) and most blood tests carry no private service value in the booking system but still take clinic time. NHS work is funded separately and is not counted in ROAS or MER.

High-ticket travel vaccines dominate. Meningitis B, yellow fever and rabies alone are £11,781, and the £15 travel consult is the front door to most of them.

Travel clinic peaked at 39 bookings in w/c 6 Jul. Vaccinations are the line to watch into October: the last three weeks averaged £408 a week against £357 over the six weeks before, as flu season opens.

NHS bookings carry no private value and are left out. The two July peak weeks each booked more travel clinic value than the whole of April.

The “conv. value” Google Ads reports (238 for the whole period) bears no relation to the £34,926 the booking system recorded, because the account still tracks book-button clicks rather than confirmed bookings with values. All ROAS and MER figures in this report therefore use booking-system value, which is the number that matters. Fixing the conversion feed remains recommendation two. †Total ROAS is Jun–Sep only, because May spend covers a single week against a full month of bookings.

*Incremental value = net booked value above the Feb–Apr monthly baseline of £3,909 (pro-rated for September).

At the new fee and the Jun–Sep average ad spend, total monthly cost is £2,370. The clinic has been booking that much every 9 days. The scenarios below show what MER looks like at the new fee across the range of months already seen, plus last year's Q4 with no ads at all.

Q4 2025 (Oct–Dec) booked £21,032 across 952 appointments with no paid media, £13,147 of it flu and COVID vaccinations. Even a repeat of that quarter, with ads simply protecting it, clears the new fee comfortably. The job for October to December is to add a travel and weight loss layer on top of the seasonal vaccination peak rather than let it displace them.

The national site is the visibility engine: 24,592 impressions, the widest spread of service searches (954 non-brand queries) and the second listing on most local terms. The location sites own their towns: Ottershaw, Ashford and Bagshot rank #1–6 for “[town] pharmacy” and outrank the national site on every one of those terms, so the group takes two results instead of one. Woking is the service workhorse: 534 non-brand queries in the top 3, and it is the site that ranks page 1 for the town-specific service searches: travel clinic, yellow fever and ear wax removal in Woking. The gap is that the national site is seen for travel, weight loss and blood test searches (6,531 impressions) but sits on page 3–4 for them (17 clicks). Lifting those pages onto page 1 is the biggest organic lever, and the location sites already give it the internal links and local signals to do it.

Average Google position for non-brand searches in each service group, weighted by impressions, with the impressions and clicks behind it. Green = top 3, blue = page 1, amber = page 2, grey = page 3 or beyond. Local pharmacy searches are page 1 on every site. For the service groups, Woking is page 1 on the town-specific searches (travel clinic woking #2.8, yellow fever vaccine woking #2.1) but the impression-weighted averages sit on page 2–4 everywhere, which is exactly the headroom the network is set up to close.

Position on each site for the searches that matter locally. On “[town] pharmacy” the location site wins and the national site takes a second slot, so the group is not competing with itself. On service-plus-town searches the Woking site is already page 1; Bagshot and Ashford have the impressions but not yet the rank.

Of the 208 local-intent searches where the national site and a location site both appear, the location site ranks higher on 154 and the national site on 54. That is the intended shape: local sites win local, national backs them up and carries the non-geographic service searches. These exports are a single Search Console window; a month-on-month ranking trend needs the comparison export and will be added next report.