Scottish National Users' Group (SNUG) Podcast

Rediscovering GP innovation with Professor George Crooks

In this episode, we speak with Professor George Crooks OBE,  Chief Executive of Scotland's Digital Health and Care Innovation Centre and a former GP of 23 years in Aberdeen. He reflects on changes over the years  and how the quiet disappearance of proactive home visiting in general practice has contributed to some of today's system pressures, and argues that technology - from passive monitoring to citizen data access - can help restore some of what was lost. He offers a measured take on AI in healthcare, warning against off-the-shelf clinical AI trained on unrepresentative datasets, while advocating for its immediate use in administrative tasks and patient-facing data tools.

We discuss the barriers holding back innovation in Scottish healthcare. Prof Crooks is forthright about information governance being "an absolute nightmare of our own making" and describes a system where excessive layers of risk-averse governance have become a disabler rather than an enabler. He introduces the idea of innovation as a three-legged stool - technical, service, and commercial - and explains why neglecting any one leg leads to failure. He closes with a frank assessment of Scotland's international standing, arguing that while still commanding respect, the country may still be trading on a reputation from decades ago, and issues a direct challenge: stop waiting for excellence and start deploying good.

Digital Health and Care Scotland Innovation centre DHI Scotland

Better health through citizen empowerment TEDx Talk by Professor George Crooks

SCOTCAP

SNUG Annual Members Day and AGM 2026 Wednesday May 20. 2026 Registration link

Orkney needs IT... that works!

In this episode, we speak with Dr Iain Cromarty about life as a GP on the island of Hoy in Orkney. Iain shares how he came to work in one of Scotland's most remote practices, the realities of providing care to a population of around 400 on an island steeped in wartime history, and the unique clinical challenges of island medicine - from catching ferries for acute admissions to managing patients when no transport is available. He also reflects on how continuity of care is changing now that the islands rely entirely on itinerant doctors working shorter shifts.

We discuss digital health and connectivity, a subject close to Iain's heart. He describes the frustrations of working without facilities like Order Comms, relying on Word documents and scanned emails for processes that were fully digital in his Norfolk practice 15 years ago, and the ongoing challenges of unreliable broadband and telephony that can sometimes cut doctors and patients off entirely. But it's not all frustration - Iain highlights how Near Me video consultations have transformed outpatient access to Aberdeen specialists, and how a WhatsApp group connecting clinicians across 10 islands has become a lifeline for clinical support, including one memorable case of a video-guided consultation with a patient still trapped in a car.

A beginner’s guide to Orkney’s history

10 Amazing Things to Do in Orkney

What to see and do on Orkney Mainland

Travelling The Orkney Islands For 7 Days (Ruth Aisling YouTube video)

How Did Orkney Change Scottish History? (Scottish History YouTube video)

Can AI help reduce polypharmacy? (Part 2)

In this second part of our polypharmacy discussion with Steve Williams, we continue to explore whether large language models like Microsoft Copilot could play a practical role in supporting medication reviews. We consider a real case from a duty day in general practice where Copilot was used to assess prescribing safety and generate a summary of deprescribing opportunities.

This prompt was used: “Review the following medication list using the latest British Geriatrics Society (BGS) guidance and the Scottish Polypharmacy Guidance (7-step approach). For each medicine, identify:

1. Indication and whether it is still appropriate
2. Clinical risks (frailty, falls, anticholinergic burden, renal function, interactions)
3. Deprescribing opportunities
4. Safer alternatives if applicable
5. Monitoring requirements

Then provide a concise summary of priority actions and any safety red flags that need urgent review. Here is the medication list: [PASTE MEDICATIONS HERE]  Include references to the relevant guideline steps where appropriate.”

The conversation also covers a new study led by Professor Tony Avery, which tested an LLM against an expert clinician to assess medication safety in nearly 300 anonymised GP patient records. While the model achieved 100% sensitivity in detecting clinical issues, it matched the expert's full assessment in under half of cases, with failures arising from overconfidence, lack of contextual reasoning, and occasional hallucinations such as misidentifying medications.

Steve is self-described as a “curious pragmatist” and feels that LLMs are of great interest, and their ability to flag problems with high sensitivity - when guided by good prompts and established clinical frameworks - makes them a genuinely useful preparation tool, provided the clinician still does the thinking. As Steve puts it, the technology looks promising, but "human intelligence is very underrated..."

A Real-World Evaluation of LLM Medication Safety Reviews in NHS Primary Care.

Evidence Based Polypharmacy Reviews and the 7 Step Process: TURAS training

Thinking Critically About AI (Video lecture by Dr Jessica Morley)

How we make decisions – dual process theory and unconscious biases (MeReC Bulletin 2011)

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Can AI help reduce polypharmacy? (Part 1)

Steve Williams is a senior clinical pharmacist with 35 years of NHS experience, and a co-host of the Aural Apothecary Podcast - a show that takes "an authentic yet light-hearted take on the world of medicines and healthcare in the UK". Steve shares his approach to tackling polypharmacy with us, having moved from acute hospital settings to general practice specifically to address the root causes of medication-related hospital admissions. Working with a 21,000-patient practice, he describes a systematic approach to structured medication reviews - stratifying patients by risk (those on 8+ medications, high-risk combinations, or dependence-forming medicines), allocating pharmacist time to proactive reviews, and combining medication reviews with long-term condition management in single 30-minute appointments.

The discussion explores the scale of the problem in the UK: a thousand pills dispensed per second, a million people on 10 or more repeat medicines, and an estimated million hospital admissions annually due to medication issues. Steve advocates for training and empowering "competent prescribers" - whether GPs, pharmacists, or nurses - to confidently review and deprescribe medications, noting that his Dorset system has successfully incentivised practices to reach targets for reviewing high-polypharmacy patients. The big question is - can AI start to help us tackle and reduce polypharmacy?

Scottish polypharmacy guidance (updated) The latest version 2025 - draft version for consultation, loads of detail, examples of using the 7-step approach

British Geriatrics Society: Pragmatic prescribing to reduce harm for older people with moderate to severe frailty  Excellent clear 2-page guidance

Health Innovation Network: The mechanics of tackling overprescribing and problematic polypharmacy  Steve’s comprehensive guide to tackling polypharmacy in primary care

Health Innovation Wessex: project Polypharmacy Links to Steve’s training resources.

Manage my meds – for patients and carers to help patients prepare for a medicines review.

The Aural Apothecary: Dr Jessica Morley. Will Artificial Intelligence save the NHS?

Talking General Practice: AI and the future of general practice – Prof Brendan Delaney

From information overload to actionable knowledge

In this festive episode, we welcome Dr. Chris Weatherburn back for an annual end-of-year chat, reflecting on a year marked by the news that One Advanced have taken over the Vision system and there have also been many AI products starting to make an impact on general practice. Chris outlines three key areas: ambient voice technologies, workflow automation, and decision support. He notes the tension between AI's exciting potential and the necessary caution required in healthcare, referencing the pause on Project Foresight after ethical concerns and the SG guidance urging practices to hold off on ambient voice tools until proper assessments are completed. We consider how GPs are navigating this complex landscape, with SNUG playing a vital role in helping practices implement new technologies correctly.

Chris also shares book recommendations, highlighting John Kotter's work on change management and Ronnie O'Sullivan's Unbreakable, drawing parallels between elite performance and general practice—particularly around maintaining positivity, managing negative thinking, and finding sustainable success. The conversation turns to the challenges facing Scottish general practice, including the recent funding offer by the Scottish Government for general practice and digital access improvements, the loss of SCIMP's independent guidance role, and the upcoming NSS/NES merger. We reflect on the importance of embracing change while learning from others' experiences, with Chris emphasising that SNUG remains well-placed to support practices through the transitions ahead.

Strategy as Change: Kotter’s New Approach

14 Life Lessons from a Snooker Legend - Unbreakable

NotebookLM Guide: Google's AI Study Hack You Need for Faster Research

Chris’s plenary on AI at the 2025 SNUG conferencee

From Information Overload to Actionable Knowledge: NotebookLM’s AI podcast explaining Chris Weatherburn’s websites

The NHS Digital SNOMED CT Browser

Will ye gang tae the Highlands?

We explore the realities of working in a general practice in a remote rural area of northwest Scotland, highlighting the unique geography, distances from hospital care, and the way these factors shape clinical work, patient access, and continuity of care. Andy Vickerstaff, the practice manager for Aultbea and Gairloch Medical Practice, describes how long travel distances profoundly influence decisions about referrals, out-of-hours provision, and the breadth of services the practice must offer - including roles that extend beyond medicine into social support and immediate care. He contrasts their experience during and after the pandemic with more urban practices, noting how telephone consulting became embedded, while video consulting (NHS Near Me) never fully took off locally. Accessibility remains strong in their setting, avoiding the pressures for access to care seen in larger practices and enabling a high degree of continuity, particularly in palliative and end-of-life care.

The discussion also examines digital systems, AI, and the need for better national guidance. Andy describes using AI tools like Copilot for administrative tasks - including translating and summarising complex foreign medical records - which he sees as transformative. We rue the demise of SCIMP, once a key Scottish body providing authoritative guidance on coding and information management. Andy argues that with all Scottish practices moving to Vision, there is a major opportunity to re-establish centralised, consistent IT and coding guidance to avoid a fragmented approach across 14 health boards. Finally, he reflects on practical IT challenges for independent practices, identifying primary care finance and payroll systems - especially NHS pension processing - as an area urgently in need of a modern digital solution.

Aultbea & Gairloch Medical Practice

Primary Care Informatics – formerly known as SCIMP

Guide to Scotland's North-West Highlands: where to stay, places to visit and great walks

Culture: Beard, sandals, stethoscope

Medics of the Glen (needs STV account)

Will ye gang tae the Highlands, Leezie Lindsay

Donald Where's Your Troosers

Digital Prescribing and Dispensing Pathways… progress?

In this episode, we speak with Dr Sam Patel, National Programme Lead for the Digital Prescribing and Dispensing Pathways (DPDP) Programme, to explore Scotland’s progress toward replacing paper prescriptions with a secure, end-to-end electronic system. Sam explains the legal and technical foundations required to make the transition — from implementing advanced electronic signatures compliant with UK and EU standards, to the key legislative amendments for the programme. We discuss how Scotland’s infrastructure differs from England’s EPS “Spine” system and how the new approach, built on the National Digital Platform, will need to support national identity verification, secure messaging, and audit capability across GP and pharmacy systems.

Looking ahead, Sam outlines the project’s timeline, challenges, and expected benefits. The first pilot sites are targeted for late 2028, following the appointment of a delivery partner and integration with new GPIT and pharmacy systems. We discuss the enormous potential for reducing admin time, improving patient convenience, and creating better repeat-prescribing processes — all while ensuring those who are less digitally enabled aren’t left behind. We also touch on moves towards a consolidated medication record, ECS replacement and the Digital Front Door plans for Scotland.

About the Digital Prescribing and Dispensing Pathways (DPDP)    DPDP Animation

NHS Scotland National Digital Platform (NDP)

Human Medicines Regulations 2012 (legislation.gov.uk)

Electronic Communications Act 2000

Community Pharmacy Scotland

SNUG – Scottish National Users Group  

Queries and comments to: alex.defranco@phs.scot

Agenda for SNUG Virtual Conference        Register here

James McCormack discusses the Scottish Cardiovascular DES

In this episode, we discuss the Scottish Cardiovascular DES designed to reduce adverse cardiovascular events by tackling population-wide risk factors like high blood pressure, raised glucose and cholesterol. Professor James McCormack suggests a greater focus on shared decision making with patients,  arguing that the common 10% risk threshold used to trigger treatment is an arbitrary figure that often fails to clearly define what the risk actually entails. He contends that most guidelines can overlook the individual. With years of experience of teaching how to explain and apply evidence, using humour, he advocates for a foundational shift toward a patient-centred model, where treatment decisions are made with patients, not for them.

The conversation explores how to put this philosophy into practice. Risk calculators such as ASSIGN and QRISK should not be used as diagnostic dictators, but as educational tools to start a conversation. He is highly critical of using terms like "pre-diabetes" or "high risk," which can cause patients to vastly overestimate their danger and create unnecessary anxiety. The solution is clear communication: using visual aids and explaining absolute benefits - for instance, a statin might change a 10% risk to 7 or 8% over a decade. By moving away from rigid protocols and chasing fluctuating measurements, clinicians can reduce patient fear, build trust through shared decision-making, and ultimately rediscover a more enjoyable and effective way to practice medicine.

National cardiovascular disease (CVD) prevention and risk factors toolkit

GP Evidence – fantastic site for GPs interested in shared decision making and using patient decision aids, created by Dr Julian Treadwell

Complete BS Medicine podcast list – includes the Contented Clinician podcast

ASSIGN v2 Cardiovascular calculator

PEER simplified Cardiovascular Decision Aid

NICE guidance on shared decision making

James McCormack YouTube videos

The Surrogate Battle - is lower always better?

You can subscribe to the SNUG podcast on the following platforms:

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Any feedback or comments are welcome via email: alex.defranco@phs.scot    www.snughealth.org.uk 

GP IT Re-Provisioning – emergency podcast

In this “emergency” podcast we focus on the major announcement that One Advanced has acquired the Vision system, bringing long-awaited clarity after months of uncertainty following INPS’s administration last December. Dr David Cooper and Dr Bill Martin, co-chairs of SNUG, discuss the relief this brings to Vision practices, staff, and NHS teams who had been left in limbo. They reflect on the resilience shown by Vision’s workforce during this challenging period and explore the practical implications for practices now facing rapid transitions. While some EMIS users had quietly hoped for a different outcome, the contractual and financial reality meant that finding a buyer for Vision was the most feasible path forward.

The conversation also explores the potential benefits and risks of having a single supplier for both Vision and Docman 10, including opportunities for better integration but also concerns about market competition and innovation. While the migration will be demanding, with practices needing strong change management and training, practices will be supported by trainers and facilitators through the process. Ultimately, the mood was one of cautious relief: challenges lie ahead, but GP IT Re-Provisioning can now move forward after a prolonged period of uncertainty.

OneAdvanced completes the purchase of INPS Vision assets

Voltage Control—“Change Management for Dummies

SNUG Registration - SNUG Hints and Tips Day 2025

Changing GP system: the Tollcross experience

At the SNUG Members’ Day, a workshop featured Dr. Keith Mercer discussing his practice’s migration to the Vision IT system, in an interview with National Facilitator Manager Dawn Ellis.

Preparation
The team used checklists, spreadsheets, and searches to prepare for the move from EMIS. Keith and the Practice Manager dedicated around 10–12 hours to data mapping, alongside routine work. Staff completed short e-Learning modules on the Vision training system and benefited from early adopter on-site training.

Migration & Go-Live
During migration, the practice offered urgent appointments only and kept patients informed. EMIS was still used for appointments and prescriptions, while clinical notes went into DACS before transferring to Vision. On go-live day, staff relied on trainer support. Controlled drug prescriptions were quickly added to Vision, and others were scanned into Docman.

Post-Migration & Outcomes
The first few weeks were challenging, with staff adapting to Vision and experiencing mental fatigue. Issues included printing prescriptions and Med3s, learning Vision Tasks, and setting up Mail Manager. However, the practice now appreciates Vision’s efficient search, recalls, and modular layout. Keith advises that practices allocate plenty of time for training and preparation and not to underestimate the effort involved in the transition but concludes Vision does have some good functionality, such as better prescription and record-searching capabilities, and stresses the importance of adequate staffing and additional support during early migration stages.

NSS GP IT site   EMIS to Vision GP Practice toolkit (only accessible via SWAN)

Process and preparation PPT – detailed overview of process at practice level with overview of Vision  (only accessible via SWAN)

Vision 3 Quick Reference Guide for Clinicians

Cegedim Learning Zone

General Practice: Progress since the 2018 General Medical Services contract: Paragraph 50: “The Scottish Government acknowledges that Primary Care data and the infrastructure to support it is inadequate and has said that improving this situation is a priority”.

Johnny Logan: what’s another year