Shier Ziser Dawood is a GP registrar piloting the first integrated training post in ‘AI applications in General Practice’ as part of University College London Hospital’s GP training programme.
Recently I had the pleasure of attending the Accurx Connects conference, where a hotly anticipated announcement was made that Swedish automated scribe company Tandem had partnered up with Accurx to provide an integrated AI ambient scribe solution for GPs, compatible with electronic patient records systems (EPRs) System1 and EMIS. Unlike current solutions, which require GP users to manually copy and paste scribe outputs into their system, their solution utilises existing Accurx capabilities to directly integrate AI manufactured consultation notes into the patient note platform (after critical review by a clinician), as well as the ability to create a text to the patient summarising key information, and referral letters.
…the lack of transparency surrounding ongoing costs and the uncertainty of where the funding will come from was a big elephant in the shiny conference room.
Having used some other popular scribes I was very impressed with the functionality of the product, particularly in terms of reduced hallucinations and inferences, and of course with the integration. For example, when using another scribe I had a simulated patient describe, ‘Low mood for three weeks,’ and neither clinician or patient used the word depression, yet the scribe coded him as such. With the Accurx scribe I used the same consultation simulation and this did not happen. The risk of pasting into the wrong patient’s notes was also eliminated, something that always worried me with other non-integrated scribes.
A few things however made me feel a bit uncomfortable and no one on either Accurx or Tandem teams was able to fully allay these concerns. The first was a question on every attendee’s mind, what’s this going to cost? Until August it will be run as a free trial, but after that there is no information on what the cost will be. As it currently stands ICB funding in England has been cut by 50%.¹ It is unclear where the extra funding will come from for the scribes. Reassuringly, the government has published recent promises to put scribes at the forefront of NHS innovation, and hopefully that promise will be backed up with some cash. Accurx also indicates they will be in talks with key players to try negotiate that funding at scale. However, as things currently stand, I worry we will get hooked on this fantastic product only to have it taken away as the summer comes to a close. This was vaguely reminiscent for me in a melodramatic way of the Nestle baby formula scandal.² In the 1970s, Nestle aggressively marketed infant formula in developing countries, offering free samples until mothers’ breast milk dried up, then charging for the formula which many couldn’t afford or safely prepare—leading to malnutrition and infant deaths. Whilst on the face of it this seems far less harmful, the approach of offering a free product to establish dependence before introducing costs feels uncomfortably familiar.
Granted, Accurx scribe is arguably a much superior solution than contaminated/watered down formula compared to breast milk, but the lack of transparency surrounding ongoing costs and the uncertainty of where the funding will come from was a big elephant in the shiny conference room.
I also still have some reservations about the onboarding process and clinical governance surrounding the use of this new product. My understanding based on some very expert opinions and NHS guidance is that practices need a few crucial documents to use any new clinical health tech. The DCB0129 and DCB0160 are two of these. The former should be provided by the vendor of a health tech solution outlining risks and mitigations for organisations using its product, and the latter should be created based off those risks and other more local personalised risks by the practice or other service utilising the solution.
Here is a fun limerick I created to help remember this using Anthropic’s Claude.ai:
There are standards for health IT care,
DCB0129 makes makers aware,
Their software must be safe,
With risks well displayed.
While DCB0160 helps users prepare.
The first guides manufacturers to show
That their systems are clinically sound, you know.
The second ensures that healthcare sites
Deploy IT with safety insights,
Both standards help patient safety grow.
Poetry aside, these two documents have been legal requirements for NHS institutions implementing new health tech for over 15 years,³ but as the rate of change increased exponentially with this AI boom, their implementation seems to be left behind more and more. I was told other documentation covers a practice and that these specific documents aren’t required for doctors to start using the scribe solution ‘right away’, but again expert opinion has emphasised that is not the case. For a vendor this isn’t so much of an issue, as with all AI health tech solutions the doctors themselves are taking ultimate responsibility for any medicolegal risk associated with its use, acting as a ‘risk sponge’ in this new and exciting and arguably high-risk field. It is such a new field that there is not much existing knowledge of the law to fully inform doctors of the risks they’re taking through its use.
In the coming years there will be more case law to base caution and clinical governance decisions on, but for now especially with the new government announcement to prioritise AI in the NHS, there is a wild-west vibe. The feeling is that caution has very much been thrown to the wind, and the fear is that the earliest clinical adopters and biggest proponents of AI might end up being the ones burnt the most.
There were some other more minor issues that came to mind that weren’t specific to this scribe’s rollout but nonetheless could not be answered. One is the issue of trainees using scribes, which some might argue is deskilling them in note-taking, whilst others say it is the future and essential that they get on board to remain competitive especially in a difficult jobs market. When the EPR inevitably crashes however it might be a skill worth having, and the process of note taking manually to consolidate one’s thoughts and process information in a more engaged way might be overlooked in the Scribe revolution. I eagerly await a position statement from the RCGP on use of scribes during training, for now it’s each to their own and some trainees are already exclusively using scribes for note taking which leaves me with a sense of unease, perhaps misplaced in this forward-looking time in medical training.
My final reservation was just an existing issue with the EPR platforms we use. Across the board GPs are not always so thrilled with how they work and report frequent glitches and slowed working associated with these softwares. The Accurx scribe was fantastic overall, with the potential to really change one’s working day off the better, but still limited by the existing slow tech it is integrated with, which often is significant enough to negate any time-saving offered by the scribe itself. It will be interesting to see if new solutions such as Medicus⁴ take off and provide viable alternatives to the existing ‘duopolies’ these businesses have.
I eagerly await a position statement from the RCGP on use of scribes during training…
Overall I was very impressed by the Scribe offering and I do think it has the potential to reduce burnout, increase operational efficiency and ‘face to face’ time with patients, all key government benefits touted for Ambient scribes. The integrated nature is a big plus, but there are also some drawbacks when compared to more established scribes such as Heidi which offer a lot more options for different templates and personalisations one can make to their note form. Tortus as well, a home-grown UK based scribe has also announced an exciting partnership with GP telecommunication provider X-on for another integrated scribe,⁵ and their offering is arguably most advanced in terms of clinical governance having been registered as a class I medical device for a while now and working towards class II.
Overall I feel hopeful that funding will materialise as per Wes Streeting’s promises,⁶ clinical governance kinks will be smoothed out, integration integrated, and the Scribe revolution won’t fizzle out with the change of season in August and instead carry us through, Messiah-like, on EPR sunshine rays into September and beyond.
References
1. The King’s Fund. ICB cuts: what does it mean? [Internet]. The King’s Fund; 2024 [cited 2025 May 20]. Available from: https://www.kingsfund.org.uk/insight-and-analysis/blogs/icb-cuts-what-does-it-mean#:~:text=ICBs%20have%20been%20asked%20to,as%20some%20wider%20programme%20costs [accessed 21/5/25]
2. Muller M. The Baby Killer: A War on Want investigation into the promotion and sale of powdered baby milks in the Third World [Internet]. War on Want; 1974 [cited 2025 May 20]. Available from: https://waronwant.org/sites/default/files/THE%20BABY%20KILLER%201974.pdf
3. NHS Digital. DCB0160 Clinical Risk Management: its application in the deployment and use of health IT systems [Internet]. NHS Digital; [cited 2025 May 20]. Available from: https://digital.nhs.uk/data-and-information/information-standards/governance/latest-activity/standards-and-collections/dcb0160-clinical-risk-management-its-application-in-the-deployment-and-use-of-health-it-systems/ [accessed 21/5/25]
4. NHS Digital. Case Study: Medicus [Internet]. NHS Digital Developer Portal; [cited 2025 May 20]. Available from: https://digital.nhs.uk/developer/guides-and-documentation/case-studies/medicus [accessed 21/5/25]
5. Digital Health. Tortus and X-On Health expand AI assistant across primary care [Internet]. Digital Health; 2025 May [cited 2025 May 20]. Available from: https://www.digitalhealth.net/2025/05/tortus-and-x-on-health-expand-ai-assistant-across-primary-care/ [accessed 21/5/25]
6. GOV.UK. AI doctor’s assistant to speed up appointments ‘a gamechanger’ [Internet]. Department of Health and Social Care; [cited 2025 May 20]. Available from: https://www.gov.uk/government/news/ai-doctors-assistant-to-speed-up-appointments-a-gamechanger [accessed 21/5/25]
Featured photo by Steve Johnson on Unsplash.
