When a practice tells us their ads “aren’t working,” the account almost always has the same three problems. None of them require a bigger budget to fix. They require a tighter one.
The three leaks
1. Broad match with no guardrails
Broad keywords let Google show your ad against searches that have nothing to do with what you sell. You pay for the click either way. Without a strong list of negative keywords, a chunk of every budget goes to traffic that was never going to book.
2. No conversion tracking past the click
If the account only counts clicks, you are flying blind. You can’t tell which campaigns produce calls and which just produce noise, so you can’t move money toward what works.
3. One campaign for every intent
Lumping “emergency dentist” in with “teeth whitening cost” means one budget, one bid, and one message for two completely different buyers. The high-intent searches get starved; the browsing searches get fed.
The rebuild
- Separate campaigns by intent. Emergency, implants, cosmetic, and general care each get their own structure, bid, and message, so budget follows the searches most likely to book.
- Add negatives, then keep adding them. We build a starting negative list and refine it from the real search-terms report every week.
- Track real conversions. We connect conversions back to actual enquiries, not just clicks, including offline imports from a practice management system where it fits.
- Report on cost per acquisition. Every month, against last month, from your own account.
What it looked like for London Dental Specialists
This practice had run ads internally for two years with no conversion tracking beyond phone calls, broad keywords pulling irrelevant traffic, and no separation by procedure intent. We rebuilt the account from scratch around intent, added more than 400 negative keywords, and connected offline conversion import to their patient system.
The result, from their own ad account: a 40% lower cost per acquisition, search impression share up from 34% to 61%, and a 15% budget cut with lead volume held. Fewer wasted clicks, more booked intent, less spend.
The point
Lower ad costs rarely come from a clever bid trick. They come from refusing to pay for searches that were never going to convert, and pointing the budget at the ones that do. If you want to know where your account is leaking, that is the first thing we look at.
