What is a discharge summary for?
A discharge summary (often called a discharge letter, TTO letter or eDischarge) is the hospital's handover to the GP and community teams. For many patients it is the only record of the admission that the GP practice will ever read. The practice uses it to update the patient's record, change repeat prescriptions, book blood tests and decide whether anything needs urgent attention.
In most NHS hospitals the summary is written by a foundation doctor or another junior doctor, often at the end of a busy ward round while the patient waits to go home. That is exactly when mistakes creep in. The aim of this guide is to help you write a summary that is safe and useful without taking much longer.
Who reads it?
- The GP, and often a practice pharmacist who processes the medicines changes.
- Community pharmacists, district nurses, care home staff and community therapists.
- The patient and their family, who should be offered a copy and may read every word.
- Another hospital team if the patient is readmitted, and sometimes reviewers or a medical examiner if something goes wrong.
What should a discharge summary include?
In England, electronic discharge summaries are built on a national standard first developed by the Professional Record Standards Body (PRSB), now published as the Transfer of Care Acute Inpatient Discharge Standard. Most hospital templates follow its headings, though local layouts differ. The table below covers the parts that matter most to the reader.
| Section | What good looks like |
|---|---|
| Patient and admission details | Correct identifiers (name, date of birth, NHS number), admission and discharge dates, specialty and responsible consultant. |
| Reason for admission | One or two sentences on why the patient came in. |
| Diagnoses | Main diagnosis and important secondary or new problems, numbered and written in full rather than abbreviated. |
| Clinical summary | A short narrative of key events, investigations and treatment that makes sense without the notes. |
| Procedures and key results | Procedures with dates. Results that change management, plus any incidental findings. |
| Medicines | All discharge medicines, each change labelled as started, stopped, changed or withheld, with the reason. |
| Allergies and adverse reactions | Existing allergies and any new reaction found during the admission. |
| Information given | What the patient and family were told, including any uncertainty. |
| Plan and actions | Numbered GP actions with time frames, kept separate from what the hospital will do. |
| Pending results | Each outstanding test and who will check and act on it. |
| Person completing | Your name, grade, specialty and a contact route. |
How should I write the medicines section?
Medicines are where discharge summaries most often cause harm. Many patients leave hospital with at least one change, and a change that is not explained may be reversed by the practice or continued for far longer than intended. The GP needs to know what the patient takes now, what changed and why.
For every change, state
- What changed: started, stopped, increased, reduced or temporarily withheld.
- Why, in plain words.
- How long for, such as a stop date for antibiotics or a review date for a new medicine.
- What monitoring is needed, such as kidney function after starting or restarting certain drugs.
- Whether a withheld medicine should be restarted, when and by whom.
Ramipril stopped.
Ramipril 5 mg once daily WITHHELD because of acute kidney injury (creatinine 190, baseline 85; 105 on discharge). Please recheck U and E in one week. If creatinine is back to baseline, consider restarting at 2.5 mg once daily. Patient told not to take ramipril until the GP review.
Medicines that need extra care
- Anticoagulants: indication, dose, intended duration and who monitors.
- Antibiotics: the indication and the exact stop date.
- Insulin and other diabetes medicines: dose changes and who reviews glucose control.
- Opioids started for acute pain: the reason, expected duration and a plan to reduce and stop.
- Steroids: dose, reducing plan if needed, and whether a steroid emergency card was given.
- Medicines stopped on admission and never restarted, which are easily lost.
How do I write clear actions for the GP?
GP actions should be specific, genuinely needed and possible for the practice to do. 'GP to follow up' tells the reader nothing. In England, the NHS Standard Contract expects hospitals not to hand back work that is theirs, such as chasing results of tests the hospital ordered or arranging follow-up the hospital decided on. Follow your trust's policy on which tasks stay with the hospital.
- Number each action: One task per number, so nothing is lost in a paragraph.
- Say why: Give the reason in a few words, for example 'started spironolactone for heart failure'.
- Give a time frame: 'In 7 days' or 'at 2 weeks' is far more useful than 'soon'.
- Give a threshold: Tell the GP what result should change management, and what to do if it does.
- List hospital actions separately: Clinics, scans and results the hospital owns go under their own heading marked 'no GP action needed'.
Results still pending at discharge
Results that return after the patient has gone are a well-known source of harm because nobody feels responsible for them. For every pending test, write who will check it and what will happen next. If your team requested it, your team should usually follow it up. Put it in the summary and in your handover.
Worked example: from weak to strong
Amara is an FY1 on a care of older people ward. Mrs K was admitted confused and found to have a urinary tract infection and acute kidney injury. Her ramipril was withheld and furosemide reduced. A CT head showed no acute change but reported an incidental lung nodule on the included images. She started calcium and vitamin D after a fall on the ward. A ReSPECT form was completed with her and her daughter, and she is going home with a new care package.
Dx: UTI, AKI. Treated with abx, improved. Meds as per TTO. GP to f/u bloods. CT head NAD.
Diagnoses: 1) Urinary tract infection with delirium, resolved. 2) Acute kidney injury, improving (creatinine 170 on admission, baseline 80, 96 on discharge). 3) Fall on ward, no injury. 4) Incidental lung nodule on CT head. Medicines: ramipril 2.5 mg WITHHELD (kidney injury); furosemide REDUCED from 40 mg to 20 mg daily; calcium and vitamin D STARTED (falls risk). Antibiotic course completed in hospital. Actions for GP: 1) U and E in 1 week; if creatinine at baseline, consider restarting ramipril at a low dose with repeat bloods. 2) Review furosemide at the same time. Hospital actions (no GP action needed): lung nodule referred to the respiratory team, who will arrange imaging and write to the patient and GP. ReSPECT form completed with Mrs K and her daughter; original is with the patient. Care package: carers twice daily from today. [Name, grade, specialty, contact]
The strong version numbers the diagnoses and includes the incidental finding, labels and explains each medicine change, gives the GP a time frame and a decision point, keeps the hospital responsible for the nodule it found, and records the escalation plan. The figures here are illustrative; always use the patient's actual results and follow local prescribing guidance.
What are the most common discharge summary mistakes?
| Mistake | Why it is unsafe | Fix |
|---|---|---|
| Unexplained abbreviations | Readers may not know them, and some have more than one meaning | Write diagnoses and medicines in full |
| No reason for a medicine change | The practice may restart a drug stopped for a good reason | State the reason for every change |
| 'GP to follow up' | Nobody knows what to do or when | Specific, numbered actions with time frames |
| Pasting ward round entries | Long, unstructured and hard to scan | Summarise key events in a few sentences |
| Incidental findings left out | A possible cancer may be missed | List them and say who will follow up |
| Copied text from an old summary | Outdated medicines or the wrong diagnosis | Check every copied line, or do not copy |
| Summary sent late | The GP has nothing when the patient attends | Finish it on or before the day of discharge |
Discharge summary checklist before you sign
- Right patient: name, date of birth and NHS number checked.
- Main diagnosis stated in plain words, with secondary and incidental findings.
- Every medicine change labelled and explained, and matched against the reconciliation.
- Allergies, including any new reaction, recorded.
- GP actions numbered, specific and time-limited; hospital actions listed separately.
- Each pending result has a named owner.
- Escalation decisions such as ReSPECT or DNACPR recorded.
- Information given to the patient and family recorded.
- Your name, grade and contact details included.
- Readable by a GP in about a minute.
How quickly should it be sent?
In England, the NHS Standard Contract has for several years required discharge summaries for inpatient, day case and emergency department care to reach the GP within 24 hours, by electronic transmission. NICE guidance on transitions from hospital to community settings also expects the summary to reach the GP within 24 hours and a copy to go to the patient. Check your trust's policy, and the arrangements in Scotland, Wales and Northern Ireland if you work there.
Special situations: care homes, self-discharge and transfers
Some discharges need extra thought because they happen quickly, out of hours or to somewhere other than home.
- Discharge to a care home or with a new care package: carers may not be registered professionals. Say in plain words what the person can do for themselves, changes in mobility, eating, drinking and continence, any new equipment, and which signs should prompt them to seek help.
- Self-discharge against medical advice: still write a summary. Record the capacity assessment for that decision, the risks explained, treatment offered and declined, medicines supplied and the safety-netting advice given. Follow your local self-discharge policy.
- Transfer to another hospital: the transfer letter needs diagnoses, treatment so far, current medicines with the time of the last dose, pending results and escalation decisions.
- Death in hospital: follow your bereavement office process for notifying the GP, including whether the death was reviewed by a medical examiner or referred to the coroner.
Getting better at discharge summaries
Writing good summaries quickly is a skill that improves with feedback. Ask your registrar or a GP colleague to look at a few of yours, and note which ones GPs in your area find helpful. Many trusts audit discharge summary quality, and joining one is a good quality improvement project for your portfolio. A short anonymised reflection on a summary you improved also makes useful evidence for your ARCP or appraisal.
If you would like a structured way to practise, our course Writing Safe Discharge Summaries works through the national headings, medicines changes, GP actions and common errors with worked examples. It sits alongside Your First NHS Job: Induction and Expectations and Your First Week on the Ward for doctors new to UK practice.
Frequently asked questions
How long should a discharge summary be?
As short as it can be while still being safe. Most routine summaries fit on one screen or one page. The clinical summary should be a few sentences, not a copy of the ward round notes. Complex admissions need more detail, but use headings and numbered lists so a GP can still find the diagnoses, medicine changes and actions in about a minute.
Who writes the discharge summary in the NHS?
Usually a foundation doctor or another junior doctor on the team caring for the patient, though in some services nurses, pharmacists or physician associates contribute. Whoever writes it remains responsible for its accuracy. The responsible consultant oversees the patient's care, so ask a senior if you are unsure about diagnoses, follow-up or escalation decisions.
Should the patient get a copy of the discharge summary?
Yes, patients should normally be offered a copy, and NICE guidance on transitions of care supports sharing it with the person and, with their agreement, their carers. Write with that in mind: avoid jargon and judgemental language, and make sure anything sensitive has been discussed with the patient before they read it on paper.
What does TTO mean on a discharge summary?
TTO stands for 'to take out', the medicines supplied to the patient when they leave hospital. Some hospitals call these TTAs ('to take away'). The TTO list should match the medicines section of the summary. 'Meds as per TTO' is not enough on its own, because the GP needs to know what changed and why.
How soon must a discharge summary be sent to the GP?
In England, the NHS Standard Contract has set an expectation that summaries for inpatient, day case and emergency department care reach the GP within 24 hours, sent electronically. NICE transitions guidance also expects the GP to receive it within 24 hours. Your trust policy sets the local process, so check it and do not leave summaries for the next shift.
What should I do if I find a mistake after the summary was sent?
Correct it promptly. Follow your trust's process for amending or reissuing a discharge summary, tell the GP practice directly if the error could affect care, and let your senior know. If a patient may have come to harm, report it through your local incident system and be open with the patient, in line with the duty of candour.
Can I use abbreviations in a discharge summary?
Keep them to a minimum. Common ones like 'U and E' are widely understood, but many abbreviations mean different things in different specialties, and patients now read these letters. Write diagnoses and medicine names in full. If your trust has an approved abbreviations list, stick to it.
Related courses
Writing Safe Discharge Summaries
This course teaches doctors how to write a discharge summary that a GP can act on safely. It explains what GPs and community teams need, the national…
Your First NHS Job: Induction and Expectations
This course is a practical guide to your first weeks in an NHS job, written for newly qualified staff and for professionals who trained outside the…
Your First Week on the Ward
This course is a practical survival guide for doctors and nurses starting on a UK hospital ward. It explains how ward rounds, jobs lists, bleeps and…
Sources and further reading
- Transfer of Care: Acute Inpatient Discharge Standard (eDischarge Summary Standard). Professional Record Standards Body.
- NHS Standard Contract: requirements on discharge summaries and communication with GPs. NHS England.
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs (NG27). National Institute for Health and Care Excellence.
- Medicines optimisation (NG5). National Institute for Health and Care Excellence.
- Good Medical Practice (2024). General Medical Council.
- Primary and secondary care working together. British Medical Association.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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