AI scribe use by the Students' Health Service

The Students' Health Service uses AI scribe technology in our General Practice. This is also sometimes called Ambient Voice Technology (AVT).

What an AI scribe is

An AI Scribe listens to conversations between people and takes notes. It uses Large Language Model (LLM) technology to create a good quality summary of the conversation with accurate health terminology.

Good quality AI scribes meet NHS data protection standards. They are also designed to listen to medical discussions and identify important information. They will ignore information which is not relevant. The AI-produced notes are then checked by a human, before being used to support your health and care needs.

Examples of how an AI scribes are being used in your General Practice include:

• taking notes during a consultation between a GP and a patient, using notes from a consultation to create a patient referral letter
• taking notes when a clinician conducts a home visit or visits a care home to talk to a resident
• taking notes when a pharmacist calls a patient on the phone to discuss their medication
• taking notes when a patient is called on the phone to discuss their long-term condition(s)
• taking notes during General Practice team meetings to help the staff work more efficiently together
• taking notes during other non-medical conversations with patients such as patient complaints. 

Which AI scribe tools are used?

General Practices are advised to only use AI scribe tools on the NHS AVT Registry. This is the official NHS list of approved AVT suppliers who meet the required NHS data protection and clinical safety standards. 

How AI scribes work

A step-by-step guide

1. The AI scribe listens and creates notes.
2. The clinician checks and edits the notes. 
3. Notes are added to your record.
4. Any further actions are completed.
5. Temporary data is deleted.

Recordings

Two outputs are produced by the AI scribe: a transcript of your conversation and a summary. There is no sound file recorded. 

When an AI scribe is not used

In some situations, it may not be appropriate to use an AI scribe. This can include:

• patient consultations which relate to straightforward problems
• situations where the subject of the conversation is sensitive.
• any time you have asked us not to use an AI scribe.

Consent for AI scribes

We will always verbally ask for your consent to use an AI scribe during a conversation.

If you are not comfortable with an AI scribe being used in your care, you can ask for it to be switched off. You do not have to explain your decision and your care will not be affected.

When an AI scribe is used in your care, you can ask to review the summary and make corrections or additions.

An AI scribe may also be used indirectly to support your health and care needs. For example, it may be used to create a referral letter. Where reasonable and practical, we will ask consent but there may be times when this is not possible.

When you use the phone to contact a GP Practice, there may be an automatic message played to you about the use of an AI scribe. You can opt out of this by telling the call handler. 

If another person is present during your consultation or phone call, the AI scribe may capture their voice as well. This could be a carer, family member, or other third party.

We will ask for consent from everyone present before activating the AI scribe. If any person present does not consent, we will not use the AI scribe or will pause it for that part of the conversation.

Children and vulnerable adults

Consent for the use of an AI scribe for children and for adults who may lack capacity follows the same principles as for any other aspect of their care. This means that we will ask a parent, guardian, or appointed representative to give consent on their behalf where appropriate. This is in line with standard NHS consent procedures.

If you have questions about how this applies to a specific person in your care, speak to your GP Practice directly. 

Benefits of AI scribes

Safety and accuracy

Having a transcript and note of your conversation helps us to support your health and care needs. This is especially true in conversations where you talk about many different health problems or other aspects of your life.

A more ‘human’ conversation

Testing of AI scribes has shown that staff using them are able to spend more time talking to patients and carers face-to-face and with empathy. This usually means better eye contact and more time to talk and listen. This is better for patients and staff. 

Quicker care

In many instances, an AI scribe saves time and speeds up care. This includes:

• quicker actions after consultations
• quicker production of referral letters
• more time available to think about how to support patients.

It also means that the quality of life for staff is improved as they are able to complete work more efficiently.

Better admin

AI scribes can be used to speed up admin in General Practices. This protects more time for work which directly supports patient care. 

Safety of AI scribes

AI scribes are classed as ‘emerging technology’. This means that it is a relatively new tool, and the way it is used in the NHS is relatively untested. Because of this, we have put safeguards in place to reduce the risks as far as possible.

As with any digital tool, there are always risks of mistakes being made or data being mishandled. However, if the safeguards created are used properly, these risks are small. 

Our safeguards

One Care is a GP Federation which support General Practices in Bristol, North Somerset and South Gloucestershire.  

We provide digital clinical safety work for all our member General Practices. We check that:

• the tools used are safe
• the company which has developed them is meeting its obligations
• that General Practice staff understand how to use the technology safely and responsibly.

We also:

• host webinars for GP staff, discussing any potential risks from using an AI scribe, and how to manage them
• encourage each Practice to create and maintain a "hazards log".
• signpost Practices to training to offer to their staff.

We believe that these steps will reduce the risks related to the use of an AI scribe.

Known risks of AI scribes

Transcription errors

AI scribes sometimes miss or misrepresent important information.  

We can reduce these risks by:

• using a good quality microphone
• minimising background noise
• ensuring that a human checks the notes before we add them to your record
  • this means a human reads the full summary and corrects any errors.  
  • where a carer or family member is also present, we also make sure the notes are accurate about what was said and by whom. 

Hallucinations 

AI scribes will sometimes include information which was not discussed in the conversation. This is called as a "hallucination". Although these are rare, the potential impact on patient notes is significant. Our staff are trained to:

• spot content that doesn't reflect what was discussed
• correct hallucinations
• report any significant errors through the practice's hazard log. 

Human error

AI scribes are emerging technology which are unfamiliar to some General Practice staff. Staff may make mistakes to when copying information into your patient record. It is also possible for staff to forget to switch the scribe on, or end recording too early. We reduce these risks through training for staff. 

Accents and speech impediments

AI scribes can be less accurate during conversations between people with regional or national accents or who have a speech impediment. We reduce these risks by paying extra attention during human checks of the summary. 

AI scribes and data protection

No one other than your General Practice has access to any information produced by the AI scribe. Your health information is kept private.

An AI scribe takes notes and temporarily keeps them for use in your care. This information is temporarily available to the member of General Practice staff who you spoke to. They are not designed to be used as a patient record system to permanently store information about you or your health.

In almost every case, staff will immediately use the information captured by the AI scribe to update your patient record. After 2 weeks, all information created and stored by the AI scribe is permanently deleted. It cannot be retrieved under any circumstances.

You have the right to access your patient records. Many patients can now do so via the NHS app. You can also make a subject access request to your General Practice.

If you want to learn more about how your information is used, read our Patient Privacy Notice (Office document, 75kB). 

In tools from the assured supplier list, neither the AI scribe or LLM trains itself using your personal data. 

Make a complaint about AI scribe use

You can make a complaint through our complaints procedure (Office document, 47kB) if:

• you believe that an error made by an AI scribe has affected your care
• you have concerns about how your data has been handled.