Dr David Cooper, GP in Aberdeen, SNUG co-chair, and chair of the NHS Grampian Primary Care IT group, joins us for an update on digital general practice in Scotland. Naturally, we start with the EMIS-to-Vision migration: half of Grampian's practices have already switched, and David talks through the learning curve practices are facing, why the transition has been pushed back at his own practice, and what he's hopeful the "one system for Scotland" approach could eventually deliver, from reduced training needs to better integration with Docman and Adastra.
We briefly ponder some of the recent worries around the future capabilities of AI before returning to use in primary care, where David gives his current take on AVT, Copilot, and where he does and doesn't see AI changing the GP's role, including how his trainees are already using AI tools for both admin and self-directed feedback on their consultations. We close with a look at Microsoft 365 and Copilot more broadly, and a consider whether SNUG has a role to play in helping primary care staff get more out of the M365 tools that remain underused across the health board.
Old Machar Practice, Aberdeen
Adopting new tech and AI in general practice (GPonline podcast)
Microsoft 365 Guided learning Modules (use NHS Scotland account details to log in)
16+ things to do in Aberdeen
The Genesis of Skynet [Terminator 2]
17 Aug 2026
Making decisions: a hat, a haircut or a tattoo?
Jonathan Underhill, pharmacist and long-standing advocate of evidence-informed and shared decision-making, discusses why applying clinical guidelines mechanically does not always produce the best outcome for an individual patient. Drawing on his work at the National Prescribing Centre and NICE, he explains how population-level evidence needs to be balanced against comorbidity, adverse effects, diminishing returns from additional medicines, and, importantly, the patient’s own values and preferences. He describes the “three-talk” model of choice, options and decision. We get into how clinicians actually make decisions, with heavy reliance on rapid pattern recognition and mental “mindlines”, why good practice requires knowing when to switch from intuitive “system one” thinking to slower, more deliberate checking, and ponder whether prescribing decisions are analogous to whether the patient is getting a hat, a haircut or a tattoo, and how more time is usually needed to make a good decision.
We learn about information mastery and the usefulness equation, which states that information is most useful when it is relevant and valid while requiring relatively little work to obtain, and consider how AI could dramatically reduce the effort involved in finding clinical information. While there is considerable potential for AI to compensate for clinicians’ limited ability to remember an ever-expanding evidence base, particularly when it is grounded in trusted sources such as NICE or Cochrane, clinicians must continue to question validity, think critically and retain the human role in complex decisions and reassuring anxious patients. We also discover a shared enthusiasm for Bruce Springsteen, including Jonathan’s memories of seeing him live 44 times and some of his most memorable concerts.
System 1 and System 2 Thinking The Decision Lab.
Muir Gray: Population based and personalised care—two sides of the same coin
Evidence based guidelines or collectively constructed “mindlines?” BMJ Paper by Gabbay and le May
Explainer on Information Mastery
PrescQIPP Talking Meds podcast
Carronbank Medical Search Engine
Brucebase wiki
25 Jul 2026
The experience of migrating to Vision
Practice manager Steven Ebsworth shares Alva Medical Practice's honest experience migrating from EMIS to Vision, detailing preparation, challenges, and ongoing improvements.
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Steven Ebsworth
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