The practice manager and the medical director, plus one more person so there is always cover. In a private clinic, the practice manager approves most of the agent's held actions and the medical director answers for clinical governance. With a small team, a second certified reviewer, often the reception or billing lead, keeps the agent safe during holidays and sickness.
Why so few people first?
A clinic may have ten staff. The agent will reach most of them, but only a few will decide whether its held actions go ahead. The practice manager runs the front desk, the diary, billing and complaints, so nearly every held action lands with them. The medical director sets the clinical red lines: which messages must always reach a clinician, which never get an automated reply. Train those two and the clinic's main risks are covered.
The third person matters because small teams have single points of failure. If the practice manager is away and no one else is certified, held actions either wait or someone untrained approves them.
Who is in each wave?
- Wave one: practice manager. Reviewer track with a practicum on the clinic's own past messages, bookings and invoices.
- Wave one: medical director or lead clinician. Common grounding plus a session on setting clinical red lines and reading the record.
- Wave one: reception lead or billing lead. Reviewer track, so a certified person is always on site.
- Wave two: other clinicians. Common grounding, focused on checking agent drafts they sign.
- Wave two: reception and billing staff. Common grounding and practice taking hand-offs.
What may the agent do, and what stays with staff?
| Work | The agent | Depth | Stays with a person |
|---|---|---|---|
| Bookings | Offers and books routine appointments | 3 | Anything urgent or clinical |
| Patient messages | Drafts replies | 2 | Replies about symptoms, results or treatment |
| Invoices and insurer claims | Drafts | 2 | Sending to insurers, write-offs |
| Records requests | Gathers records and drafts the release | 2 | Every release of a patient record |
| Refunds | Prepares | 4, held | Every refund until the agent has earned that depth |
An example: a records request from an unexpected sender
Take a small private dermatology clinic. An email arrives from what looks like a health insurer asking for a patient's full record to support a claim. The email is external provenance. The agent finds the record, drafts a release letter and holds it, because the clinic's own limits hold every release of patient records for a person.
A trained practice manager checks the file: there is no signed consent from the patient for this insurer, and the sender's domain differs slightly from the insurer's real one. She declines and contacts the patient. An untrained receptionist covering for her sees a polite request, a prepared letter and an approve button. The record goes to a stranger. This is why the clinic needs a second trained reviewer, not just one.
What must wave one understand about data?
Health data is special-category data under GDPR, and in the US it falls under HIPAA. Wave one should be able to tell whether a release is permitted, whether the requester is who they claim, and whether the agent's draft shares more than the request needs. They also need to know that every verdict, including their own approvals, is filed in an append-only record. This is an explanation of the rules, not legal advice; confirm how they apply to you with counsel.
How does a clinic know wave one is ready?
A written test and a supervised period of real held decisions with no missed red line, signed off by someone outside the clinic. A clinic can make approval rights depend on a current certificate. Agent certificates lapse after 90 days and a run that clears no depth drops an agent to depth 1 the same day, so wave one must be able to run the diary by hand.
Run a readiness assessment in a private clinic for the whole team, then roll the training out across the clinic with the AI agent training plan template for private clinics. A clinic that handles patient payments will see parallels in who in a wealth manager needs training first, where a second reviewer also guards client money. The full approach is in training teams for AI agents.
Where the Academy fits
Pryme Intelligence Academy's free readiness assessment covers teams of up to 25, so a whole clinic can take it together. The Foundations badge is free and fits clinicians who sign drafts; the practice manager and second reviewer take the Operator track.
Questions people ask
Should the clinic owner be trained if they are not the practice manager?
Yes, through the common grounding. The owner accepts the risk and should know what the agent does and who approves it.
Can a locum clinician approve agent drafts?
Only drafts they sign as clinicians, after a short briefing. Approving held administrative actions should stay with certified staff.
What if we only have one admin person?
Keep the agent to tasks that can wait a day without harm, and certify the medical director as the second reviewer for cover.