Tim James is laboratory manager and head BMS in Clinical Biochemistry at Oxford University Hospitals NHS Foundation Trust, a post he has held for the last 20 years. Within this role he manages three laboratory sites including a large teaching hospital service. Working with clinical departments to better understand testing and to ensure optimal utilisation are key aims of the service. He has worked with many clinical teams to evaluate current testing and where possible introduce new diagnostics and/or change where there are clear benefits for patients. In 2018 Oxford introduced testing for angiogenic markers into routine practice following an outcome-based study of benefit – the INSPIRE study. He has published over 100 peer reviewed papers in all areas of clinical chemistry and in the last five years developed a strong collaboration with the Oxford Obstetric team which has led to a series of publications encompassing diagnosis of pre-eclampsia, developing pregnancy specific reference intervals and identifying newer markers of obstetric disease.