181 consultations in 20 days at a £26 cost per booking

The client is a healthcare provider running three genuinely different services through one business: a high-volume consumer service, a lower-volume service aimed at a different audience at a higher acceptable cost, and a recruitment funnel for practitioners. All three ran through the same ad accounts, on Meta and Google Search.

The obvious way to report that account is one blended cost-per-booking. It is also the wrong way, and it is the reason accounts like this get mismanaged: the three services have acceptable costs that differ by a factor of four. A blend that looks healthy can hide one service line quietly running at double its ceiling while another subsidises it.

The first decision was structural, not tactical: every report on this account splits by service line and never blends. Each line carries its own cost target, agreed with the client up front, and is judged only against that target. This is unglamorous and it is the single highest-value thing we do on the account.

The second was a measurement fix. One Google Search campaign was configured to count two separate events as conversions for the same customer journey, which made its reported cost per acquisition look far better than reality. We identified it, documented the specific double-count, and switched that campaign to be benchmarked on return on ad spend instead, with an explicit conversion threshold that maps back to the real per-booking value. The campaign was not paused and the budget was not cut. The number it was being judged by was simply wrong, and we fixed the number.

The third was a set of guardrails against false alarms: a minimum conversion volume before any cost-per-acquisition alert is allowed to fire, and hard boundaries at known measurement-regime change dates so that no report ever compares performance across a period where the platform changed how it counted.

Over a 20-day measured window the account produced 181 booked consultations at a £26 average cost per booking, against a £25 target on the primary service line.

The number worth paying attention to is not 181. It is that the figure is reported per service line, on a stated window, against a stated target, with a known measurement caveat documented on the one campaign that has one. That is what makes it checkable rather than a marketing claim.