Month: October 2025

From Lloyd George Envelopes to Artificial Intelligence: The Evolution of Medical Records in Primary Care

I spoke to GP Registrars on the Imperial College GP Training Scheme about the evolution of medical records in primary care. This is a journey that mirrors the broader transformation of healthcare itself.

The story begins in 1911, with the introduction of the Lloyd George Envelope following the National Insurance Act. These brown paper envelopes (named after the then Chancellor and future Prime Minister, David Lloyd George), each containing a patient’s handwritten medical notes and printed correspondence, became the standard for decades. They were simple, portable, and remarkably durable but also limited by their physical nature. Searching for information meant literally leafing through these paper records, and continuity of care relied on legibility and the clinician’s diligence in recording.

The late 20th century brought a revolution: the computerisation of general practice. Early adopters in the 1980s and 1990s began using systems like EMIS and Vision, digitising the record and transforming how we document, code, and retrieve information on people’s healthcare. Over time, these systems became essential clinical tools by enabling prescribing safety checks, audit, population health management as well as research and quality improvement.

Today, almost every consultation, prescription, and referral is logged electronically. The electronic health record (EHR) has become the backbone of primary care. Yet, despite these advances, challenges remain: data fragmentation across systems, burdensome data entry, and limited interoperability between sectors.

Looking ahead, I believe we are on the verge of another major transformation. Artificial intelligence (AI) and machine learning have the potential to redefine how we record, understand, and act on health information. In the coming years, we can expect:

  • AI-assisted consultation notes, automatically generated from clinician–patient conversations.

  • Predictive analytics, helping us identify patients at risk of deterioration or with unmet health needs.

  • Natural language processing, allowing clinicians to query records using plain English.

  • Integrated patient data, linking information from hospitals, social care, and personal devices.

The shift from the Lloyd George envelope to intelligent digital systems represents more than just technological progress. It also reflects an ongoing effort to improve care, enhance safety, and make information work for both clinicians and patients.

As we look to the future, the challenge will be ensuring that these innovations support, rather than replace, the human connection that is at the heart of general practice. The tools may change rapidly, but our purpose remains the same: delivering compassionate, person-centred care grounded in good records and good professional relationships.

Rethinking NICE Cost-Effectiveness Thresholds: Implications for the NHS and UK Industrial Strategy

There has been recent discussion about the need to revise drug pricing frameworks within the United Kingdom’s National Health Service (NHS), particularly amid the ongoing transatlantic trade frictions involving potential tariffs from the United States administration.

Elevating the cost-effectiveness threshold applied by the National Institute for Health and Care Excellence (NICE) by 25 percent from its established range of £20,000 to £30,000 per quality-adjusted life year (QALY) would increase access for NHS patients to innovative treatments that were previously excluded on grounds of excessive cost relative to their clinical benefits.

However, this change would also put increased pressure on the NHS budget. It is difficult to quantify the extra spending that might result from a wider range of drugs becoming available for use in the NHS through this change but any extra spending on these treatments would have to be matched by reductions in spending on other health services. Effective implementation would therefore require not only additional funding but also robust mechanisms for monitoring real-world effectiveness and ensuring that new treatments deliver value commensurate with their higher costs.

The government would also need to consider any benefits that might occur from increased investment in research and development in the UK by global pharmaceutical companies. From a trade and industrial policy perspective, revising the NICE cost-effectiveness threshold would have broader implications for the UK’s position in global pharmaceutical markets. A more permissive pricing environment may enhance the attractiveness of the UK as a destination for clinical trials, research, and early market access, reinforcing the government’s ambition to establish the UK as a “science superpower.”

But it could also be perceived internationally as a shift towards higher healthcare costs, potentially complicating trade negotiations that involve intellectual property protections, market access, and pricing transparency. The Department for Business and Trade would need to balance these considerations carefully, ensuring that any change supports the competitiveness of the UK life sciences sector while maintaining affordability and equity within the NHS.

Hence, this is not a straightforward issue and the Department of Health and Social Care, the Department for Business and Trade, and the Treasury may all have differing views about the relative costs and benefits of the change. Ultimately, the decision will depend on the government’s political and economic priorities and its assessment of the relative importance of the competing costs and benefits.