View from the ground, by Dr James Thambyrajah

Last year I qualified as a new GP and was offered a salaried job, due to start in January 2017, in a different CCG from where I had trained. It was one of the hardest decisions I have ever had to make but after debating the pros and cons I decided to make the move and leave a practice I adored in leafy Hampshire, and accept a job 32.6 miles away via the A3 in leafy Surrey to be closer to my wife and two children.

My initial thoughts on moving to a different CCG were mixed at best: I was apprehensive about leaving an area and group of people that I had grown to love; fearful about what lay ahead for me as a new GP in a completely different CCG; but at the same time excited about a fresh start.

On my first day, I was shocked to find out that the processes for requesting blood tests, ECGs, and 2-week referrals were completely different from what I was accustomed to. My head was spinning and I knew I had to adapt fast if I wanted to survive in the jungle that is Cheam village, Surrey! As doctors, we have to adapt to suit our surroundings; this Bruce Lee quote sums up our role perfectly:

Empty your mind, be formless, shapeless—like water. Now you put water in a cup, it becomes the cup, you put water into a bottle it becomes the bottle, you put it in a teapot it becomes the teapot. Now water can flow or it can crash. Be water, my friend.

One of the major differences at my new practice is how much they have embraced technology in the day-to-day running of the surgery. One example that I have found particularly useful is a web-based program that enables GPs to send direct messages to consultants and specialists. The shift away from posted and faxed letters and towards email and instant screen messaging seems to be an inevitable trend and one that I find both fascinating and futuristic. The ability to have quick, (almost) instant communication with a consultant is invaluable; at 4pm on a Monday afternoon I saw a patient with 2-week history of unilateral eyelid twitching and after a thorough history and normal examination I was unsure about how to manage this patient. I told him I would contact a consultant using this messaging system and phone him as soon as I received a reply. I managed to send a message to a neurology consultant straightaway as my next patient was running late. The consultant replied to my message almost instantly, and what’s more, I received a handy text message notification because the web-based software is linked to my phone. I phoned the patient and informed him of the consultant-recommended management plan just 15 minutes after our initial consultation ended! 

Recently, I read an excellent and moving opinion piece by Dr Helgi Johannsson,1 in which he reflects on his involvement in caring for victims of the tragic fire at Grenfell Tower. He describes being woken on the morning of the fire to find numerous messages on his mobile phone. He had recently set up a group message board that he and his consultant colleagues intended for use at the time of a major incident such as this one. He goes on to describe the importance of effective communication, particularly when such tragic events occur, so that healthcare professionals can coordinate care effectively and efficiently. 

On the subject of end-to-end encrypted phone messaging he writes:

It is widely used in communication within NHS teams already, yet officially it is prohibited on information governance grounds. Is it time for the NHS to take the opportunities that this kind of technology offers and incorporate it into our everyday practice?

I could not agree more with Dr Johannsson. As GPs we need to embrace new technology; we are on the front line of healthcare and in order to look after our patients to the best of our ability we need to communicate with our NHS colleagues quickly and effectively. Surely web-based software and end-to-end encrypted messaging is the next logical step. On a personal level, using the web-based software to contact consultants has revolutionised my practice and I am thrilled and proud to tell my patients that rather than waiting a few weeks for a posted reply, I have a detailed management plan in my virtual inbox within hours or in some cases, minutes.

Change is often difficult within the NHS but to quote Stephen Hawking: ‘Intelligence is the ability to adapt to change.


  1. Johannsson, H. I am a better doctor for allowing myself to stop, reflect, and grieve. BMJ Opinion, June 2017. Available at: