Four-fifths of NHS trusts still using pen and paper for record keeping
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Twenty-five years after the government's first push to digitize the NHS, an investigation by The BMJ reveals that only about a fifth of hospital trusts in England are using fully electronic systems for clinical recordkeeping.
Responses to freedom of information (FOI) requests show that just 39 of 184 trusts (21%) reported using paperless systems to document clinical notes, while 145 (79%) said they still rely on pen and paper to some extent. Just a quarter (45) reported using fully electronic systems for prescribing medications.
The figures have not shifted much since a similar BMJ audit of trusts in 2023, suggesting the drive toward digitization in the NHS continues to stagnate.
Transitions measured in decades
Most trusts that reported using a hybrid system of electronic and paper patient notes cited ongoing or future plans to transition to a fully electronic system.
Although shifting from paper to digital systems promises benefits such as easier information sharing, enhanced data security and joined-up care, progress remains slow, with some trusts now nearing their third decade of "digital transition."
For example, patient notes at Salford Royal started going digital in 2000, at Leeds in 2003, and at James Paget and Airedale trusts in 2012. All of the transitions are still ongoing. Even some "fully electronic" trusts say they still use paper to record patient notes in specific departments.
Multiple systems, familiar frustrations
Of 156 trusts that specified the electronic system they used, nearly a third (49) were using two or more programs, with one trust using six. Doctors say navigating multiple systems is a clinical and administrative burden, especially for trainees who rotate every four to six months.
Pritesh Mistry, fellow in digital technologies at public health think tank The King's Fund, notes that funding constraints, complex implementation timelines, insufficient hardware and clunky user interfaces continue to impede progress and force a reliance on paper systems.
However, those working with paper systems don't necessarily have it any easier. Izzie Jordan-Evans, a Foundation Year 1 doctor at University Hospitals Sussex NHS Foundation Trust, says working in this way "feels increasingly archaic" and "can lead to clinical errors."
AI note-taking meets old risks
While past strategies focused on becoming paper-free, the government's new 10 Year Plan for the NHS shifts focus toward AI-powered ambient voice technology (AVT) to automate clinical note-taking by 2035.
A 2025 trial of AVT at Oxford University Hospitals reported reduced documentation time for nearly 87% of users, with more than half saving at least 30 minutes per day.
Oxford's director of innovation, Megan Morys-Carter, emphasizes the need to keep a "human in the loop," but some experts question this approach as a robust safety mechanism, saying it may shift accountability away from makers of AI tools and toward the clinicians who use them.
"The ever-present risks of technology failure or cyberattacks mean paper is likely to remain an essential failsafe option to maintain services even after 2035," adds Mistry.
Spokespeople for both NHS England and the Department for Health and Social Care acknowledged that trusts move at different speeds but reaffirmed their commitment to digital transformation to deliver safer, more joined-up care.
Publication details
Stephanie Santos Paulo, Four fifths of NHS trusts are still using pen and paper for record keeping, 25 years after first digitisation push, BMJ (2026). DOI: 10.1136/bmj-2026-100436
Journal information: British Medical Journal (BMJ)
Provided by British Medical Journal Who's behind this story?
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