🚀 AI in the NHS Newsletter #16
Issue #16 | 13-20 September 2025
📊 Executive Summary
The week witnessed a collision of high aspirations and ground realities. Albania's appointment of an AI minister contrasted sharply with NHS clinicians unable to secure basic RAM upgrades. Critical infrastructure debates dominated, from ICE/LIMS systems that still refuse to communicate after two decades, to billion-pound Virtual Wards investments with questionable returns. Regulatory discussions intensified around Population Health Management tools skirting medical device thresholds. Bright spots emerged with Accurx's exemplary response to community feedback and robust preparation for the upcoming GIANT NHS AI Conference. The "8am rush" became a political flashpoint in GP contract negotiations, whilst DoximityGPT's launch triggered immediate legal action, revealing Silicon Valley's lawsuit-as-strategy playbook dating to 1989.
📊 Weekly Activity Analytics
Dashboard Metrics
📬 Total Messages: 283
📈 Peak Day: Wed 17 Sept (68 messages)
🔥 Most Active Period: 09:00-10:00 weekdays
💬 Average/Active Day:40.4 messages
🏖️ Weekend Activity: 8% (23/283)
💼 Weekday Activity: 92% (260/283)
Activity Heatmap
Time | Sat | Sun | Mon | Tue | Wed | Thu | Fri | Sat |
---------|-----|-----|-----|-----|-----|-----|-----|-----|
Morning | 🟡 | ⚪ | ⚪ | 🟢 | 🟠 | 🟠 | 🟡 | 🟠 |
Afternoon| 🟢 | 🟢 | ⚪ | 🟡 | 🟡 | 🟢 | 🟢 | 🟢 |
Evening | 🟢 | ⚪ | 🟢 | 🟢 | 🟡 | 🟡 | 🟢 | ⚪ |
Night | 🟢 | ⚪ | ⚪ | ⚪ | 🟢 | ⚪ | ⚪ | ⚪ |
Legend: 🟠 High (15-30) 🟡 Medium (5-15) 🟢 Low (1-5) ⚪ None
Key Insights
Peak engagement: Tuesday mornings for technical infrastructure debates
Weekend quiet zones: Only 8% activity, primarily link sharing
Response patterns: Average 3-minute response time during peak discussions
Newsletter effect: 15% activity spike following Issue #15 release
🏥 Major Themes
1. The Interoperability Crisis: Two Decades of Failure
The week's most heated exchange centred on laboratory systems and their persistent inability to communicate. A senior infrastructure architect revealed the shocking history: ICE was created solely because EPRs and lab systems couldn't speak common standards - and remains necessary twenty years later.
A primary care innovator shared their PowerAutomate attempt to automate blood test ordering for chronic disease management: "Could potentially save hundreds of admin hours each practice. However ICE slowed down locally and gave errors and hence had to abandon it."
A digital health strategist cut through complexity: eliminating ICE would enable direct EPR-to-Lab communication, but legacy architecture and upgrade slot scarcity create insurmountable barriers.
The consensus emerged through a procurement specialist's observation: "NHS pays so much for stuff like this when a tech admin with Power BI can make something prettier and built around local requirements."
2. Regulatory Grey Zones: Medical Device or Analytics Tool?
Intense debate erupted over Optum's Population Health Management tool's regulatory status, with clinical safety officers warning of potential for harm at scale through misconfigured search parameters.
A London implementation lead clarified: "More analytics which gets round the regulation - soon as we rely on it for patient care then it will hit MHRA threshold."
A risk management expert highlighted uncomfortable precedents: United Healthcare's history of algorithmic bias in patient stratification raised red flags about deployment without proper oversight.
The safety net, as one contributor darkly noted: "They keep 'Human In The Loop' GPs with unlimited liability."
3. Virtual Wards: The Billion-Pound Question
Revelation that Virtual Wards consumed nearly £1 billion triggered fundamental questions about NHS investment priorities and accountability.
A federation director's local assessment: "Simply a way of bailing out the acute deficit and pumping a load of cash into VCs."
A broader systemic issue emerged through analysis: "Given £200bn to spend with little accountability" - explaining why solutions are purchased rather than existing capabilities developed.
4. Accurx's Masterclass in Community Response
Following community feedback about their Scribe product, Accurx demonstrated exemplary vendor responsiveness, announcing immediate changes that drew widespread praise.
"Kudos for 'you said, we did'" captured the group's appreciation, whilst a previously concerned clinician admitted: "This is very encouraging. Truth be told, although I held my tongue, I was feeling a bit aggrieved last week."
📈 Enhanced Statistics Section
Top Contributors by Volume
Clinical Safety Lead - 29 messages (infrastructure expertise)
Digital Innovation Specialist - 16 messages (accountability focus)
Implementation Coordinator - 15 messages (reality checking)
Systems Analyst - 15 messages (cost questioning)
Regulatory Expert - 13 messages (legal precedents)
Hottest Topics by Engagement
🔥 ICE/LIMS interoperability (47 messages, 16 participants)
🔥 PHM regulatory status (32 messages, 11 participants)
🔥 Virtual Wards ROI (18 messages, 8 participants)
🔥 8am rush politics (15 messages, 6 participants)
🔥 DoximityGPT lawsuit (12 messages, 7 participants)
Discussion Quality Metrics
Evidence-based contributions: 68%
Cross-expertise engagement: High (clinical/technical/regulatory mix)
Constructive debate rate: 82%
Thread completion rate: 71%
😂 Lighter Moments
Hardware Envy: A consultant's lament about being unable to secure a second 8GB RAM stick prompted helpful suggestions about downloading more RAM, blocked only by NHS firewalls.
Wealth Indicators: Claims of gold-plated Ferraris in vendor videos were debunked: "No Ferrari here... 6 year old Audi... It's fun and fast though!"
Scottish Specifications: Rokid Air glasses critique: "Look like 1980s NHS glasses!" Response: "NHS would jump from 1948 to 1980s!"
Democracy Strikes: Mid-debate poll deployment caused momentary chaos, proving democratic impulses can emerge anywhere.
💬 Quote Wall
"The only reason ICE existed was because EPRs couldn't talk standards. I can't believe it has a need to exist 20 years after I left the lab."
"We spent nearly a billion on VW, and the outcomes?"
"The NHS has a knack of not using what it has and moving onto the next shiny thing."
"Secondary care IT is a wild West"
"All skins welcomed here, any colour and thickness! It's up to them if they last though"
"Suing a company for prompts someone inputted feels somewhat legally dystopian"
"u must be 'aving a laugh! GPs aren't supposed to know about any of this"
📎 Journal Watch
Academic Papers & Key Studies
📎 BMJ Article on AI in NHS - British Medical Journal
https://www.bmj.com/content/390/bmj.r1840
Historical perspective on AI implementation challenges in NHS settings. Shared during newsletter discussions but noted as appearing dated despite recent publication. Connected to broader debates about evidence-based adoption versus innovation pressure.
📎 Kola Tytler Research Pre-print - ResearchSquare
https://www.researchsquare.com/article/rs-7593409/v1
Novel research awaiting peer review, submitted to leading journal August 2025. Shared whilst awaiting arXiv posting, demonstrating group's engagement with cutting-edge research before formal publication.
📎 AI in Surgery Podcast - Royal College of Surgeons
https://bit.ly/AI-Surgery
Comprehensive discussion featuring group member on surgical AI applications. Links practical implementation with regulatory considerations discussed throughout the week.
Industry & News Articles
📎 Albania Appoints AI Minister - POLITICO
https://share.google/weiFndlGQnhw2TyxK
World's first AI-specific ministerial appointment sparking debate about governance structures. Triggered discussions about UK's comparative approach to AI regulation.
📎 DoximityGPT Legal Battle - Business Insider
https://www.businessinsider.com/doximity-openevidence-suing-each-other-as-doctor-ai-war-rages-2025-9
Detailed coverage of lawsuit timing and Silicon Valley litigation strategies. Connected to historical analysis of "sham litigation" practices dating to 1989.
📎 Primary Prevention AI Applications - Eric Topol Substack
https://open.substack.com/pub/erictopol/p/dawn-of-a-new-era-of-primary-prevention
Vision for AI-driven preventive medicine. Contrasted with current infrastructure limitations discussed throughout week.
📎 Polluter Pays Principle for AI - Heffernan Substack
https://open.substack.com/pub/heffernanm/p/polluter-pays
Provocative proposal for AI accountability frameworks. Aligned with group concerns about liability distribution in clinical AI deployment.
📎 Epic System Failure Videos - BlueSky Social
https://bsky.app/profile/shacknews.com/post/3lz344mxmb22a
Visual documentation of major EHR failure. Reinforced discussions about over-reliance on complex systems without adequate failsafes.
Technical Resources & Guidelines
📎 Cerebras K2-Think Model - Cerebras AI
https://www.cerebras.ai/press-release/k2-think-pr
Open-source model announcement generating technical interest. Prompted hands-on testing commitments from multiple group members.
📎 Plaud Note Pro Device - Tom's Guide
https://www.tomsguide.com/ai/this-new-ai-voice-recorder-wants-to-be-your-affordable-transcription-device
Hardware review for clinical documentation. Compared against Limitless and other solutions for consultation recording.
📎 Google Learn Your Way - Google
https://learnyourway.withgoogle.com/
Educational platform (US-only) shared for skill development. VPN workarounds discussed for UK access.
Policy Documents & Official Reports
📎 FTC Sham Litigation Report 1989 - Federal Trade Commission
https://www.ftc.gov/sites/default/files/documents/reports/economics-sham-litigation-theory-cases-and-policy/232158_0.pdf
Historical precedent for current lawsuit strategies. Revelation that practices date to 1989 prompted reflection on innovation versus litigation in healthcare technology.
📎 BMA Special Representative Meeting on AI - British Medical Association
https://www.bma.org.uk/what-we-do/special-representative-meeting
Official position development on AI in clinical practice. Group members participating reported "interesting views not heard before."
🔮 Looking Ahead
Upcoming Events
Saudi Global Health Digital Forum - Group coordination underway for attendance
GIANT NHS National AI Conference - 10 December 2024, London
The Fix Conference - Active participation from multiple members
Unresolved Debates
MHRA representatives joining: Will they survive the group's scrutiny?
ICE replacement feasibility with direct EPR-Lab connections
Virtual Wards true ROI calculation methodology
PHM tool regulatory threshold determination
Emerging Themes to Track
"8am rush" contract negotiation outcomes
Local innovation versus commercial procurement patterns
Liability distribution in AI-augmented clinical decisions
Cross-border regulatory harmonisation post-Albania appointment
🌟 Group Personality Snapshot
This week crystallised the community's defining characteristic: unflinching technical expertise coupled with battlefield humour. The group navigates between regulatory frameworks at breakfast, infrastructure failures at lunch, and philosophical debates over evening refreshments.
The simultaneous occurrence of someone attempting to download RAM whilst another excavates 1989 legal precedents, as billion-pound investments are questioned and basic computing resources denied, captures the NHS's peculiar innovation paradox.
Members demonstrate remarkable resilience - celebrating rare vendor responsiveness whilst documenting decades of interoperability failure, maintaining optimism through solidarity and strategic sarcasm. The emergence of "I said what I said" as unofficial motto reflects growing confidence in speaking uncomfortable truths to power, procurement, and PowerBI evangelists alike.
This is neither think tank nor support group, but something more valuable: a reality-checking mechanism for an industry prone to both magical thinking and learned helplessness. Where else would regulatory expertise, clinical wisdom, and technical innovation collide with such productive friction?
The week proved that whilst Albania appoints AI ministers, NHS clinicians would settle for functioning lab connections and sufficient RAM - a gap between aspiration and reality that this group bridges through informed irreverence.
Until next week: Keep questioning the spend, demanding the RAM, and remembering - you're definitely not supposed to know about any of this.
Newsletter compiled with exactly 8GB RAM (download pending)
