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Aipedia: Doctors and medical practices
A doctor who signs an AI-generated fit note or fit-to-fly letter is certifying it personally, so an adequate assessment of the patient is still required. Paid private letters fall outside NHS indemnity, so the doctor's own cover has to respond.
Part of: AI in doctors and medical practices
In short
Online services and some practices now use AI questionnaires that gather a patient's answers and draft a fit note, fit-to-fly letter or other fitness certificate for a doctor to sign. Defence organisation guidance is clear that doctors must still assess the patient properly before issuing these documents. GMP Domain 4 requires information to be accurate, not false or misleading, and checked first. If a passenger falls ill on a flight or an employer relies on a wrong certificate, the claim falls on the signing doctor, and paid private letters are not covered by CNSGP or NHS indemnity.
Certificates are an obvious target for automation because they are repetitive and time-consuming. Common set-ups include an online questionnaire that asks about symptoms, pregnancy, recent surgery or travel plans and then drafts a fit-to-fly letter; tools that pre-populate fit notes from the record and the patient's request; and generative AI used to draft fitness letters for gyms, sports events, employers or schools. Some private online services offer these letters for a fee with fast turnaround, and the doctor may approve dozens in a session.
The GMC's AI resource confirms that professional judgement remains with the doctor, whatever tool drafted the document.
Illustrative scenario: a patient completes an online questionnaire for a fit-to-fly letter, answering no to a question about recent surgery because they do not count a recent procedure as surgery. The AI drafts a standard letter, which the doctor signs after a glance at the answers. The patient develops a serious complication in flight. The airline and the patient question how the doctor could certify fitness without speaking to them.
Other risks include fit notes stating a condition the doctor never assessed, letters that overstate fitness for an employer, and certificates issued in a patient's favour because the questionnaire was easy to game. A pattern of certificates that were not properly assessed could also raise probity concerns with the GMC, not just negligence claims.
Volume is part of the risk. Services that promise letters within the hour put pressure on doctors to approve quickly, and an AI draft that reads well makes it easy to sign without engaging with the answers. Confidentiality matters too: questionnaire data is health data, so the service needs proper data protection arrangements, and the doctor should be satisfied that patient answers are not being passed to a public generative AI tool.
Where a fit note is issued as part of NHS general practice, it generally sits within NHS work covered by CNSGP. Paid private letters are different. The CNSGP scope table excludes private work, and the NHS Indemnity arrangements for employed staff exclude private practice and "Category 2" work such as reports for insurers. A fit-to-fly or fitness letter sold privately therefore needs the doctor's own medical malpractice cover or defence organisation membership. That cover may require a human to remain the decision maker and compliance with national guidance, as one defence organisation's published position does, so a letter issued without a real assessment may be hard to defend and could test the cover. A regulatory complaint about certification needs regulatory costs cover.
See also where NHS indemnity stops, AI triage and online consultation, private GP indemnity and the doctors AI hub.
Apex arranges indemnity for doctors and clinics, including private work outside NHS schemes. A broker reviews your cover for private certification and online work, and how your policy treats AI-assisted letters.
Only if that amounts to an adequate assessment for the patient in question. Defence organisation guidance says doctors must still assess the patient properly, and GMP Domain 4 requires information to be accurate and checked. Where answers are unclear or the history is relevant, speak to the patient.
No. CNSGP excludes private work, and NHS indemnity for employed staff excludes private practice and Category 2 work such as reports for insurers. A paid letter needs your own medical malpractice cover or defence organisation membership.
Yes. Certificates are statements of professional opinion, and GMP Domain 4 requires them not to be false or misleading. Repeated certification without proper assessment could raise probity concerns as well as negligence claims.
Tell us about your practice and the work you do. A broker will review how your current cover treats AI-assisted work, or arrange new cover. No fee for a quote. Or call 0117 325 0027.
Start an indemnity quote Request a callbackApex Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales, company number 07014570. This page is general information about how AI is used in the profession and how insurance may respond. It is not legal, regulatory or insurance advice on your circumstances, and it does not guarantee that cover will be available or on what terms.
