by Dr Rhydian Harris,  25th January 2017


You’re about to insert a chest drain when your bleep fires. Hands tied up, you just about manage to see and memorise the number before a second bleep sounds and a request for yet another call appears.

Gloves off, you start the process of trying to answers the bleeps. Phone at the nurses station is out – pharmacist waiting on a call back from the F1 – so into the office you go.

First number – 3999; line engaged. Onto the second, 4752. “Anyone bleep intensive care?”  you hear yelled down the ward. “Sorry doctor, he’s with the patient, can you call back in 5 minutes?”

Off goes your bleep again – 3999 on the screen – turns out the line was engaged when you called back because they were bleeping you again.

Bleeping is just as frustrating for the caller. Sat by a landline, waiting for a call back, not knowing who is at the other end, or whether the bleep has been heard, unable to carry on with other tasks. It’s a maddeningly out-dated system.

Though reliable at transmitting the need for a discussion, bleeps lack any context, indication of priority, and fail to identify the caller. There is no feedback on whether the message has got through – the bleep could be switched off or have a dead battery, or the holder may not be able to reply due to being scrubbed or otherwise too busy. Sadly, this results in patients suffering adverse outcomes due to delays in contacting clinicians for review.

Little wonder, then, that clinicians have started using their phones to co-ordinate patient care.[1] The rapid dissemination of information, knowing who you will find at the other end, and the ability to know when your message has got through are key draws that bleeps do not offer.

The impact these workarounds can have on patient care are remarkable. WhattsApp groups have been used to control response to major incidents in London.[2]Paramedics in Argentina send WhatsApp photos of ECGs to cardiologists for review to ensure the right patients get to primary coronary intervention (PCI) in a timely fashion. Similarly, we’ve heard anecdotal stories of UK clinicians sharing ECGs with their local PCI centre via WhatsApp because of fax machines being slow and unreliable.[3] Further examples include sharing photos of x-rays, blood gas reports and CT videos with off site consultants; a picture is worth a thousand words, particularly when it’s your half asleep boss at 4am!

WhatsApp is not without major drawbacks, which place the clinician in a difficult position. It’s well-known end-to-end encryption does not prevent data being sent outside the UK. Data is also permanently kept on the handset and is not pin protected, leaving it open to being seen by the wrong eyes.[4] As many will have experienced, it’s all too easy to send a message to the wrong person. Hospitals are tightening up their policies with new General Data Protection Rules coming in May 2018. Breaches of data governance are a huge problem legally, and doctors face disciplinary action if they are responsible.[5]

The work around many use day to day is to anonymize patient data. This is cumbersome and leaves room for error – defeating the purpose of using the messaging platform. A further difficulty is that the clinician is limited to contacting those whose personal numbers they have, resulting in a default to bleeping.

The need for a solution is why we, as junior doctors, have built Forward. Forward is a secure messaging platform, built to feel like WhatsApp, but also allowing patient profiles and images to be shared.[6] Forward provides a searchable “My Hospital” and UK wide directory of users,  QR code scanning to instantly populate a patient list, and simplified workflow with task lists shared and updated by your team in real time. We encourage clinicians to download Forward – to save them frustration, and free up the time to do the things that really matter.

Forward Clinical Ltd is run by a team of NHS junior doctors. If you would like to discuss bringing Forward to your workplace, please email

Forward is free to download and use, and is available on the App and Play stores. It is NHS Information Governance Toolkit Level 2 certified.

More info at