AI Scribe use in General Practice: Patient consent – a plain English explainer

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 while ignoring 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 AVT is 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 

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

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

No. If you are not comfortable with AVT being used in your care, you can ask for it to be switched off. You should be verbally given the option by GP staff each time it is used during a conversation that involves you or a carer or other representative. 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 with the General Practice staff member who is talking to you and make corrections or additions.

AVT 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, your consent will be obtained but there may be occasions where 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 AVT during your conversation. You can opt out of this by telling the call handler. 

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

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

If a carer, family member, or other third party is present during your consultation or phone call, their voice may also be captured by the AI scribe.

Practice staff will ask for consent from everyone present before activating the AI scribe. If any person present does not consent, the AI scribe will not be used or will be paused for that portion of the conversation. 

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

AVT is 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. 

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

We undertake digital clinical safety work for all our member General Practices. What this means is that we check that the tools being used are relatively safe; that the company which has developed them is meeting its obligations; and that General Practice staff understand how to use the technology safely and responsibly.

We also host regular webinars for GP staff where we discuss any potential risks or ‘hazards’ which arise from using an AI Scribe, and how to minimise or manage them.

We encourage each Practice to create and maintain a hazard log.

We signpost Practices to training to offer to their staff.

We believe that these steps will minimise the risks related to the use of AVT. 

Transcription errors:

AI scribes sometimes miss or misrepresent important information.  

These risks are reduced by using a good quality microphone, minimising background noise, and ensuring that a human carefully checks the notes before they are added to your record , this means reading the full summary against the key points of the consultation and correcting any errors before saving.  

Where a carer or family member is also present, extra care is taken to ensure the notes accurately reflect what was said and by who. 

Hallucinations:  

AI scribes occasionally include information in the notes which was not discussed in the conversation. This is known as a hallucination. Although these occurrences are rare, the potential impact on patient notes is significant, which is why every summary is reviewed by a human. Staff are trained to spot content that doesn't reflect what was discussed, correct it, and report any clinically significant errors through the practice's hazard log. 

Human error:

AI scribes are emerging technology which are unfamiliar to some General Practice staff. It is possible for mistakes to be made 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. These risks are reduced through training for staff. 

Accents and speech impediments:

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

In some situations, it may not be appropriate to use an AI scribe. This can include patient consultations which relate to relatively straightforward problems or in situations where the subject of the conversation is sensitive.

You do not need to give a reason for declining. If you are unsure whether a conversation is likely to cover sensitive topics, you can ask your clinician before the consultation begins whether they intend to use the AI scribe and decide at that point. 

Safety and accuracy:

Having a transcript and note of your conversation helps General Practice staff to more accurately support your health and care needs. This is especially true in conversations where you talk about multiple health problems or other aspects of your life which are relevant – like housing, social care or relationships.

A more ‘human’ conversation:

We know from testing AVT in Bristol, North Somerset and South Gloucestershire that staff who use them are able to spend more time in face-to-face, empathetic conversation with patients and carers. 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, AVT saves time and speed up care. This includes quicker actions after consultations, quicker production of referral letters and more time available to think about how to support patients. It also means that the quality of life of General Practice staff is improved as they are able to complete work more efficiently.

Better admin:

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

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

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

The AI scribe is designed to take notes and temporarily retain them for use in your care. This information is temporarily available to the member of General Practice staff who you spoke to.

It is not designed to be used as a patient record system to permanently store information about you or your health.

In almost every case, Practice staff will immediately use the information captured by the AI scribe to update your patient record.

After 2 weeks, all information created and temporarily stored by the AI scribe is permanently deleted and 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, please refer to your General Practice’s privacy statement. 

If you believe that an error made by the AI scribe has affected your care, or if you have concerns about how your data has been handled, you should make a complaint through your practice's complaints procedure.