Dear AI EMMA -You're fired!

GP surgery decides AI receptionist is not up to the job

Picture generated by Google Gemini - one thing AI is good at.

I wrote recently about the problems I had communicating with a hospital and my GP and how the surgery’s new AI receptionist EMMA was not helping. Well, now there has been a major development. Poor EMMA has been given two months’ notice. It’s really not my fault - here’s how it happened.

The Gordon House surgery in West London responded positively when I got in touch saying I wanted to get their side of the story - though I had to use an online patient contact form to bypass EMMA.

I then had a call with a senior GP and the practice manager, followed by a visit to see the reception team in action and ask some questions. What I learned was just how much pressure there is on a busy London practice and how sometimes AI is not the answer, not yet at least.

In my phone call with senior GP Dr. Ravi Ramanathan and the Gordon House practice manager, Fionnuala O’Donnell, it was a tremendous relief to find myself talking to real human beings in a dialogue where I could respond, not just listen. Dr Ramanathan admitted that communication between GPs and hospitals had got more difficult in recent years, perhaps because of the added pressures both faced. He then turned to my frustration with the surgery’s use of AI receptionist EMMA:”To be honest, we are a little bit frustrated as well, because it’s not functioning to the extent that we expected it to function.”

But EMMA was desperately needed - the receptionists were fielding 350 to 400 calls a day and were “under tremendous pressure and stress.” While they had several receptionists who had been with the practice for many years, recruiting and retaining new ones had become very difficult.

Fionnuala O’Donnell told me “since July last year, we’ve lost five out of six receptionists that we’ve recruited.” Training a new receptionist in what is quite a stressful job took six to eight weeks, so the pressure kept on building, especially as the government had decreed that patients should not have to wait more than ten minutes for an answer to a phone call.

EMMA seemed to sort that out quickly - “she” picked up straight away, whether you called at the peak hour of 8am on Monday or mid-afternoon on a Wednesday. What I did not really appreciate until I visited the surgery to see the system in action was how limited the AI receptionist’s role was. She was only available in the surgery’s opening hours, and she certainly was not triaging calls - deciding how urgently a patient needed seeing. Dr. Ramanathan said he didn’t think any AI tool was up to that job just yet.” It might be the case in maybe three to five years time, but not right now.’

In fact, all that EMMA did was put the same questions that are asked in the practice’s online consultation form, which patients can fill in to get an appointment, and then record their answers. When the receptionists started work at 8 am, instead of answering phones they would monitor the EMMA inbox and start fixing appointments. I watched as a senior receptionist read through the transcript of a call from a man in his late 70s, decided he needed seeing relatively soon, called him, and fixed an appointment a couple of days later.

At first, EMMA seemed to be helping. The 8am rush, which saw 25 people calling on the dot of 8 and each having a five-minute phone call and clogging up the system, came to an end. But quickly, the limitations of what was effectively just a transcription service became apparent. First, it wasn’t even very good at transcription.”So, for example, we had a patient whose first name was Peter, and it came through as ”Pizza”, Fionnuala explained. What is more, it did not ask any follow up questions.” If the patient said, ‘I need medication’, it wouldn’t then say, ‘which medication do you need?’ So we just got a questionnaire that said, ‘I want medication’. So then we needed to contact the patient to find out which medication it was”.

But it was the reaction of patients that really made the practice think again: “As we used it, more and more patients got frustrated with it and basically said, ‘I don’t want to speak to you! I don’t want to speak to you! I don’t want to speak to you!’” They learned the trick of forcing EMMA to send them to a real human receptionist. “Then the queues built back up again.” And not just on the phones. People began turning up at the surgery on the off chance they could get an appointment.

I learned on my arrival at the surgery that a decision had been made - this was an experiment that had failed. The Gordon House practice had told the suppliers of EMMA that they were going to trigger a break clause in two months’ time and stop using the AI receptionist. The doctors insist they did plenty of due diligence before spending their money on what is a not inexpensive system. They talked to other major GP practices which had had success with Emma, set up a trial phone number to test her capabilities, and put staff through plenty of training.

So what happens next? Well, a few lessons have been learned, notably the importance of promoting the online consultation form which patients can use instead of a phone call to request an appointment. This was buried so far down the website that I had only recently discovered it when I couldn’t get through on the phone. Now it’s the first thing you see on the site.

The surgery is also keen to get as many patients as possible using the NHS app as a one-stop shop for all their engagements with the health service. There will always be people who can’t cope with the new technology, but the aim is to give the receptionists time to talk to them rather than spending hours on the phone with patients who could have gone online.

Dr Ramanathan is keen to stress that the surgery is still enthusiastic about AI. The GPs have been using a system which listens to appointments and then provides an account of what was said. He says it has been saving the doctors as much as an hour a day: “It’s been incredible. It’s actually a game changer.”

But when it comes to AI chatbots, the doctors have learned to proceed with caution. People may tolerate the idea of talking to a computer when booking a holiday or motor insurance but discussing something as personal as your health is quite a different matter.