Scottish National Users' Group (SNUG) Podcast

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:

SNUG podcast on Apple podcasts      SNUG podcast on Spotify

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

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

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

 

In this episode we hear from some system suppliers who were exhibiting at the recent SNUG Members’ day.

Numed’s Simon Healy explains how their ECG, spirometry and blood-pressure devices can integrate with a GP system, Caitlin Collins and Elliot Shaw from Microtech discuss Surgery Pod, a self-service computer system that captures blood-pressure, height, weight and lifestyle data in the waiting room. Eleanor Rafe from Accurx reports that some Scottish practices are now using its two-way messaging and booking-link features to cut phone traffic and provide asynchronous chats.

Sharon Hanley and Dani Henderson from X-on Health describe its Surgery Assist chatbot—which begins by texting callers in the phone queue a link to an online symptom-checker and local service sign-posting—with the Surgery Connect cloud telephony platform that shows patients their real-time queue position and offers automated callbacks. And, finally, Rick Thompson from One Advanced describes their new AI agents which could work inside Docman 10: one summarises long discharge letters, another suggests SNOMED codes, and their forthcoming UK-hosted large-language-model (One Advanced AI) which will let clinicians query clinical records in both Docman, and Vision for a summary of entire patient records – once the Information Governance agreements are in place, of course.

Imagine a new world in which practices could use integrated devices, smart telephony and trustworthy AI to relieve the 8 a.m. rush, ease the increasing administrative and cognitive load, provide new and smarter ways of working and reclaim clinical time…

SNUG Members’ Day video links (SNUG Membership needed)

NHS England Guidance on the use of AI-enabled ambient scribing products in health and care settings

Ambient Voice Technology AI checklist for clinicians (Dr Gandalf eGP Learning video)

Feedback or comments are welcome: alex.defranco@phs.scot    www.snughealth.org.uk 

Dr Steve Baguley is a consultant in Sexual Health & HIV and has been Chief Clinical Digital Officer for NHS Grampian since 2010. This episode features a discussion in which he compares Estonia's effective digital health system, which requires providers to submit care summaries to a central repository, enabling seamless data sharing and full transparency for citizens (who can view their records), and Scotland’s NHS, which struggles with fragmented IT systems and unfulfilled promises, failing to meet its 2017 pledge for citizen data access by 2020. There have been significant delays in GP IT Re-provisioning, electronic prescribing  and other digital transformation efforts.

Steve also discusses the role of AI in healthcare. He highlights ambient scribe technology as a major breakthrough for reducing clinician administrative burden while maintaining documentation quality. However, he strongly advises caution regarding AI tools like ChatGPT for direct clinical decision-making. For critical applications, he recommends a dual-AI verification system to enhance safety and reliability. Steve argues for a pragmatic, needs-based deployment strategy for AI tools (such as ambient scribes and Microsoft Copilot), prioritizing specific use cases and user requirements.

Spending time where it counts – an AI strategy for Health & Social Care in the North of Scotland 2023-27

Health and social care - data strategy: 2024 update - progress and priorities

Interesting times for Scottish GP IT (Peter Cairns blog)

There's only one team in Tallinn

To join the NHSS Scottish Digital Health and Care Network, access Teams and use the Join Code b7tk31u. (NHS Scotland M365 account needed).

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

SNUG podcast on Apple podcasts        SNUG podcast on Spotify

We have an interview this month with Dr Margaret McCartney, a Glasgow GP, broadcaster, and writer, who discusses her journey into media, the current challenges faced in general practice, and her views on technology, evidence-based medicine, and contemporary healthcare issues. Margaret shares how her media career began rather unexpectedly and gives some insights into her media engagement. She expresses significant frustration with outdated IT systems in Scottish general practice, in particular the current version of Docman, and argues for improvements and suggests integration of beneficial AI technologies could alleviate some of the administrative burdens.

The conversation also covers broader healthcare themes, including the application of evidence-based medicine, highlighting the necessity for doctors to interpret guidelines flexibly, and consider patient-specific contexts and complexities. Margaret discusses the application of shared decision-making, including some situations when this may not be appropriate, the implications of fragmented healthcare teams for continuity of care, and the ethical dimensions of assisted dying, advocating caution against expanding medical powers without adequately considering vulnerable populations. Additionally, the discussion touches on concerns regarding social media's impact on young people's mental health, recommending evidence-based approaches to address negative influences effectively.

Margaret McCartney Wikipedia page  

MedicsVoices: Holding medicine to account

The Contented Clinician podcast series

BBC Radio 4 Naked Week podcast   BBC Radio 4 Inside Health

Adolescence: what teen boys really think of girls, influencers and porn – Guardian Today in focus podcast

Atul Gawande: Being Mortal   Frontline TV Documentary

Written submission by Dr Margaret McCartney to the UK Parliament's Public Bill Committee regarding the Terminally Ill Adults (End of Life) Bill

Registration and Programme for the 2025 SNUG members’ day on May 29, 2025 at Westerwood Hotel

Lexacom began as a simple audio recorder program created by former GP , Dr Andrew Whiteley, originally devised to save time by sending recordings across a network to a secretary. Over two decades, the company has grown organically, serving over 60% of GPs with its digital dictation, transcription, and speech-recognition solutions. In this episode, Dr. Whiteley describes how this developed. Lexacom is now expanding its feature set beyond traditional dictation, focusing on secure cloud-hosted platforms, sophisticated speech-recognition designed for medical terms, and dynamic workflows that tailor letters, reports, and consultation notes to individual practices.

A key new focus is the integration of ambient AI, which captures and processes everything said during a GP consultation, then automatically produces a structured note. This enables clinicians to focus on patients rather than data entry. Additional modes can transform dictated text into patient-friendly wording or code it into existing clinical systems. Dr. Whiteley emphasizes patient confidentiality and data security, noting that all data remains encrypted on UK-based servers. The latest version of Lexacom also offers mobile app functionality for home visits, offline work, and seamless syncing, reflecting the company’s continued commitment to developing efficient, user-driven solutions for clinicians.

Lexacom website

Video demo of Lexacom Echo (GP Templates YouTube video)

Lexacom Guide: Brief Review for General Practice (Dr Gandalf YouTube video)

Star Trek Voice First Computer

In this episode, we have the privilege of speaking with Professor Roger Neighbour, former GP and past president of the Royal College of General Practitioners (RCGP). We discuss how AI-powered tools like Heidi Health and Clinitalk are providing new opportunities for GPs and GP trainees. We discuss:

• The impact of AI scribes on GP consultations - are they are a game-changer?
• The benefits and risks of increased use of AI in consultations – will this enhance clinical decisions or deskill doctors?
• Training implications – can AI provide useful real-time feedback to trainees?
• The balance between transactional (efficiency-focused) and relational (patient-focused) medicine.

“There’s a kind of schism developing between the transactional ways of conducting general practice and the relational ways. I can see that AI could be extremely useful in a transactional consultation to make sure that the actual clinical business got transacted efficiently and effectively …but if we have too great a reliance on that, it could potentially lead to an erosion or possibly an abandoning of some of the other human values, things like kindness, empathy, thoughtfulness, and the cultivating of a personal relationship with patients. And, if AI is sold on the basis of it will save you time, you don't need to write notes anymore, then something is at risk there…”

Our conclusions?

• AI scribes can reduce the administrative burden, but we must ensure they do not remove the “thinking” process in consultations.
• AI may help reduce clinical errors and help standardize best practices but must be integrated carefully into workflows.
• AI tools like Clinitalk offer real-time educational feedback, helping trainees develop consultation skills.
• A significant risk for the future of GP consulting may be an over-reliance on AI, leading to a loss of skills like empathy, intuition, and relationship-building.

BJGP Editorial: yesterday’s man? (By Prof Roger Neighbour)

Consulting in a Nutshell: A practical guide to successful general practice consultations before, during and beyond the MRCGP

AI Scribe compared in General Practice eGPlearning YouTube video comparing  Kiwipen Tortus Anima and Heidi Health.

Clinitalk Website

Clinitalk: AI Empowered GP Training (Prof Anwar Khan)  WilmslowGP YouTube video

Clinitalk: Demo, Security & Pricing  (Dr Nic Boeckx)  WilmslowGP YouTube video

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

Dr Chris Weatherburn discusses his productive year, focusing on maintaining a work-life balance and the value of effective habits and shares insights on managing innovation responsibly within healthcare, advocating for new technology to be implemented safely. Reflecting on challenges in the GP IT landscape, he expresses confidence in overcoming uncertainties surrounding the future of the Vision system and emphasizes adaptability to change, citing the resilience and camaraderie of the GP community as key assets in navigating potential transitions.

We discuss resilience, humour, and the satisfaction of patient interactions in general practice. Chris underscores the joy and impact of face-to-face consultations compared to remote methods, advocating for person-centred care despite rising pressures in Primary care. Sharing book recommendations like A Path Through the Jungle by Steve Peters, Unlock Charisma by Vanessa Van Edwards and Feel Good Productivity by Ali Abdaal, he offers insights into managing stress, maintaining curiosity, and achieving intrinsic motivation. Chris also touches on AI tools like Storm Genie and their implications for accuracy and truth in knowledge sharing. He concludes with personal reflections on avoiding news for well-being, recommending podcasts like Sliced Bread, and recounting his enjoyment of dancing!

Chris Weatherburn’s website

Feel-Good Productivity: Ali Abdaal - Summary

Unlock Charisma: Vanessa Van Edwards Cues Book Summary

Storm LLM: Putting AI to the Test—Is It Accurate?

Sliced Bread podcast on BBC Sounds

Chris and Caroline salsa in Blackpool

Storm Eowyn: Glasgow shuts down due to red weather warnings

We ponder the dramatic news that INPS has gone into administration and catch up on First Minister’s questions before our main discussion with Dr Colin Brown, a retired GP and now Healthcare Informatics Consultant.

Colin takes us through the evolution of GP computing systems and reflects on the challenges of implementing technology in healthcare, recounting the early adoption of Gpass, the main GP system in the 1980s and 90s. He highlights its limitations, including frequent breakdowns and outdated infrastructure, and the attempts to modernise it in the F3 group’s efforts to redesign it with dual databases and a central server, which ultimately faced technical and logistical hurdles. The shift to off-the-shelf commercial systems in Scotland, the complexity of integrating systems across NHS sectors, and the overarching challenges of interoperability are key themes.

In the latter part of the discussion, the potential of wearable health devices is explored, focusing on their utility for monitoring activity levels, sleep patterns, and even early disease detection. Colin highlights a German national initiative using over half a million wearable devices to gather public health data. He advocates for leveraging this type of data for predictive analytics and better clinical insights, emphasizing the need for accuracy and meaningful interpretation. The conversation also touches on the cautious adoption of AI, with specific examples like digital scribes for consultations, and raises concerns about over-reliance on technology without adequate supervision. Colin concludes by expressing optimism for modular, interoperable platforms to address these longstanding issues, stressing the importance of veracity and utility in health data.

First Minister’s questions from Thursday, 19/12/24 (at 46:34) from Broadcasting Scotland

Everyday data for COVID-19 from mHealth devices: The PAIDUR framework by Colin Brown.

How many steps a day are enough? Preliminary pedometer indices for public health

The history of Gpass

Inside a Santa Claus academy