Ambient clinical notes

• Patients are told before and at the start of the appointment that a scribe is in use, and can say no without any effect on their care.
• The consultation is transcribed as it happens, and the note is drafted in the specialty's template within a minute of the end.
• The clinic letter is drafted to the patient, copied to the GP, in plain English, ready to edit and sign the same day.
• SNOMED CT codes for problems, findings and procedures are suggested with the words from the transcript that support them, for the clinician to accept or reject.
• Actions said aloud, such as bloods in six weeks or a follow-up in three months, become a checklist for the clinician to confirm. Nothing is ordered or booked automatically.
• The clinician stays the author. Nothing reaches the EPR, the patient or the GP until they have read and signed it.

• NHS EnglandGuidance on AI-enabled ambient scribing products (version 3, updated 29 July 2026)
  →

  Organisations stay accountable for safe use. The guidance expects a DPIA, a clinical safety officer and DCB0160 documentation, integration with the EPR, clear contracts on liability and model updates, monitoring independent of the supplier, and staff trained to review every output. Pilots are time-limited to four months and must not bypass these steps.

• MHRAAmbient voice technology-enabled products (29 July 2026)
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  Products that only transcribe, summarise, draft correspondence or suggest codes for clinician review are generally not medical devices. Products intended to support diagnosis or treatment can be. Write the intended purpose down, keep the tool to documentation, and re-check its status whenever the supplier adds a feature.

• NHS EnglandDCB0129 and DCB0160 clinical safety
  →

  The supplier provides its DCB0129 safety case; the trust, as deployer, needs its own DCB0160 safety case, hazard log and monitoring. Hazards include misheard medicines, invented findings, missed actions and the wrong patient's record. Both standards are under review, so expect revised versions.

• ICO and the National Data GuardianUK GDPR, the common law duty of confidentiality and the Caldicott principles
  →

  Consultation audio is special category health data. Update privacy notices before go-live, tell patients what is recorded and how long it is kept, and give them a real chance to object. Keep audio only as long as needed to produce and check the note, under a retention period set in the DPIA.

• NHS EnglandData Security and Protection Toolkit and Cyber Essentials
  →

  The guidance expects both the trust and the supplier to meet the DSPT and hold Cyber Essentials. The new service, its supplier and its data flows go into the trust's CAF-aligned DSPT submission and information asset register.

• GMC, NMC and HCPCProfessional standards for records
  →

  The clinician who signs the note is responsible for it, whoever or whatever drafted it. Training and the sign-off step make that explicit, and the audit trail records who checked what.

On a phone, the table shows the platform you pick. Sovereign / on-prem means open, portable components you can run in your own data centre or with a UK or European provider; IONOS is shown as one example, and others exist. What sovereign cloud means →

• A consent script, patient information before the appointment, and a recorded note in the EPR that AVT was used and the patient was told.
• Clear rules on when not to record, such as safeguarding disclosures, some sexual health and mental health consultations, and whenever the patient or clinician prefers not.
• A clinical safety officer owns the hazard log, and every model, template or product update is re-tested before it goes live.
• A weekly audit of signed notes against the source, by clinicians, with results reported by specialty.
• Medical secretaries' work redesigned with them, not around them: checking, routing and patient contact rather than typing.
• Clinicians trained before go-live, including how the tool fails: mishearing, inventing and leaving things out.

1. 3–4 weeks

   Discovery

   Map today's note and letter process, measure the baseline, agree the EPR integration route, shortlist products from the registry or a framework, and engage the ICB and regional team.

2. Gate · must be true to passBaseline agreed, EPR route confirmed, clinical safety officer named, DPIA and hazard log started, intended purpose written down.

3. Up to 4 months

   Pilot

   Two or three specialties with willing clinicians. Drafts are generated, clinicians sign as usual, and quality is audited against the source every week.

4. Gate · must be true to passError rate and edit rate within agreed limits, no group of patients worse off, DCB0160 safety case and CCIO sign-off.

5. 6–8 weeks

   Production

   Go live in the pilot specialties with monitoring, support, contract terms for model updates, and a rollback plan.

6. Gate · must be true to passMonitoring, support model, rollback plan, training and patient information in place.

7. Ongoing

   Scale

   Add specialties in waves, then emergency and inpatient settings, then community services.

8. Gate · must be true to passEach new specialty passes the same pilot gate, with its own template and accent and noise testing.

R ResponsibleA AccountableC ConsultedI Informed· not involved

Where I'd fit

1. 1

   Goes wrong

   The demo was one clear voice in a quiet room. Real clinics have accents, interpreters, children and corridor noise.

   How the design avoids it

   Test on your own clinics, every specialty and voice, and report accuracy by group, not as one average.

2. 2

   Goes wrong

   Clinicians sign fluent drafts without reading them, and an invented finding enters the record.

   How the design avoids it

   A draft checker that flags unsupported statements, short drafts, an edit-rate measure and a weekly audit against the source.

3. 3

   Goes wrong

   Drafts sit beside the EPR, so clinicians copy and paste and the time saved disappears.

   How the design avoids it

   Agree the EPR integration route in discovery, before choosing a product.

4. 4

   Goes wrong

   A supplier update adds a 'suggested diagnosis' feature, and the tool becomes a medical device without anyone deciding it should.

   How the design avoids it

   A written intended purpose, contract terms on change notice, and a re-check of device status and the hazard log at every update.

5. 5

   Goes wrong

   Patients aren't told properly, and trust is lost after one complaint.

   How the design avoids it

   Information before the appointment, a consent script, an easy no, and opt-outs tracked and listened to.

1. Under way
   NHS England's national AVT rollout, funded through its Frontline Productivity programme and starting in outpatients, with a national centre of excellence and a benefits framework planned.

   Talk to your regional digital transformation team early, and collect baseline measures now so you can show benefits in the national format.

2. To 30 September 2027
   A national NHS procurement framework for dictation, speech recognition and AVT runs from October 2025 to September 2027.

   If you buy through it, plan contract length and exit terms around its end date, and keep your integration independent of one product.

3. Late 2026 and 2027
   The review of DCB0129 and DCB0160 (consultation closed 11 September 2026) is expected to bring revised clinical safety standards.

   Keep the hazard log and safety case structured and current, so moving to the new versions is an update, not a rewrite.

4. 2027
   After the national commission on regulating AI in healthcare, the MHRA plans a 2027 consultation on how AI devices are qualified and classified, and a full roadmap in spring 2027.

   Keep the intended purpose written down and narrow, and review it against the new rules as they land.

5. By December 2028
   The Single Patient Record in the NHS App, with the Health Bill (going through Parliament) as its legal basis.

   Make sure signed notes and codes go into the EPR as structured, coded data, so they can flow into the shared record when it arrives.