Why does written communication matter so much in the NHS?
A large share of clinical communication happens in writing: clinic letters, discharge summaries, referrals, handover notes, emails and messages. A written message travels without you. The reader cannot ask what you meant, and they may be reading it at speed between other tasks.
Unclear writing can harm patients. A stopped medicine that is not clearly flagged, a referral that does not say what is being asked, or an urgent action hidden in paragraph four can all lead to mistakes. Written records are also permanent. Patients can request copies, and letters and emails may be read later in a complaint, an inquest or a regulator's investigation.
Every UK regulator, including the GMC, NMC, HCPC and GPhC, expects registrants to communicate clearly and keep accurate records. If English is not your first language, the expectation is clarity and accuracy, not elaborate prose. Short, simple sentences are usually best.
How do you structure a clinic letter?
Readers scan. A GP may receive many letters a day, so put what matters at the top and use a predictable order. Your organisation's template takes priority, but most good letters follow this pattern.
- Identifiers and context: Patient identifiers required by your template, date of the appointment, who saw the patient, who the letter is to and who is copied in.
- Diagnoses, medicine changes and actions: A short summary at the top. Each action should have an owner and a time frame, for example 'GP: please repeat kidney function in two weeks'.
- History and findings: Only what supports your assessment. Results with dates.
- Assessment and plan: Your impression, the options discussed, what the patient chose and the follow-up arrangements.
- Safety-netting: What the patient has been told to look out for and what to do if it happens.
Should clinic letters be written to the patient?
The Academy of Medical Royal Colleges guidance Please, write to me (2018) encourages doctors to write outpatient letters directly to the patient, copying in the GP, rather than writing to the GP about the patient. Many NHS organisations now do this, and NHS England's revalidation guidance for responsible officers points appraisers to it as best practice.
- Ask the patient whether they want a copy and where it should go, and follow local policy on consent for sending letters, especially electronically.
- For adults who lack capacity, the letter usually goes to the clinician, with relatives or carers copied in where that is in the patient's best interests.
- For children, think about whether the child, the parents or both should receive it, and whether a simpler separate letter would help.
- Be careful with sensitive information. Someone else at home may open the post. Safeguarding concerns may need to be shared another way.
Pt seen re: recurrent abdo pain. Bloods unremarkable, USS NAD. ?IBS. Trial mebeverine. R/V 3/12 PRN.
Dear Mrs Okafor, thank you for coming to clinic on 14 October. You told me about tummy pain that comes and goes, often with bloating. Your blood tests and ultrasound scan were normal, which is reassuring. I think the most likely cause is irritable bowel syndrome (IBS). We agreed you will try a medicine called mebeverine, which can ease bowel spasms. I will see you again in three months. Please contact your GP sooner if you notice blood in your stool, lose weight without trying, or the pain becomes severe. Copy to: Dr Hughes, GP.
Plain English does not mean less information. Explain medical terms the first time you use them, avoid abbreviations, use short sentences and active verbs, and be specific about numbers and times. Patient letters do not need to be longer than clinician letters.
How do you write a good referral?
The commonest weakness in referrals is that they do not ask a question. 'Please see and advise' gives the receiving team nothing to triage. State what you want and why, and give the information needed to judge urgency.
- The question: diagnosis, treatment advice, a procedure, or transfer of care.
- Why now, and how urgent you think it is.
- Relevant history, examination and results, with dates.
- Current medicines and allergies.
- Anything the team needs to know to see the patient, such as an interpreter or access needs.
- Confirmation that the patient knows about and agrees to the referral.
SBAR (Situation, Background, Assessment, Recommendation) is widely used for phone escalation, and it works just as well for written referrals and urgent messages.
How do you write a professional email at work?
Email is fast and convenient, but it is easy to misread, easy to forward and easy to send to the wrong person. Treat every work email as a document that your manager, the patient or a regulator could read.
| Part | What good looks like |
|---|---|
| Subject line | Specific and action-focused, for example 'Decision needed by Thursday: clinic cover 20 November' |
| Greeting | 'Dear' for first contact or formal matters; 'Hi' is normally fine with colleagues you know. Use the name and title they use. |
| First line | Your purpose in one sentence |
| Body | Brief background, then short paragraphs or numbered points |
| Request | Exactly what you need, from whom and by when |
| Sign-off | Name, role, team, and a phone number or bleep |
Getting the tone right
Tone is harder to judge in writing. Messages written when tired or annoyed can read as rude even when that is not meant. Avoid capitals for emphasis, rows of question marks, sarcasm and blame. If the subject is sensitive or you disagree with someone, a conversation is often better, followed by a short email confirming what was agreed. If you are angry, write a draft, leave it, and reread it before sending.
Subject: Discharge. Why is the TTO for bed 7 STILL not done?? Pharmacy have been waiting since this morning. This keeps happening.
Subject: Bed 7 discharge medicines needed by 3 pm. Hi Sam, the patient in bed 7 is ready to go home, but the discharge prescription has not been written yet and transport is booked for 4 pm. Could you or another member of the team complete it by 3 pm? I've noticed a few delays like this recently, so I'll add it to Friday's ward meeting to see whether there's a process problem. Thanks, Priya, Ward Pharmacist, ext 4412.
What are the confidentiality rules for clinical emails and messages?
UK GDPR, the Data Protection Act 2018, the common law duty of confidentiality and the Caldicott Principles all apply to what you write. You do not need to be an expert, but a few habits prevent most problems.
- Use only secure, organisation-approved systems for identifiable patient information, such as your organisation's secure email or approved clinical messaging.
- Share the minimum necessary. Often an NHS number or hospital number is enough without a name and address in the subject line.
- Check every recipient before sending, especially with auto-complete and reply-all.
- Do not use personal email, personal WhatsApp groups or texts for patient information unless your organisation has approved and governs that use.
- Never forward work emails containing patient data to a personal account.
- If you send something to the wrong person, report it straight away through your incident system. Early reporting limits harm.
Worked example: a discharge summary that prevented an error
Leon is discharging an 82-year-old woman admitted after a fall with acute kidney injury. During the admission her diuretic and blood pressure tablet were stopped, and she was started on an anticoagulant after new atrial fibrillation was found. The team wants her kidney function checked in a week. His first draft says 'meds rationalised, new AF started on DOAC, GP to follow up'. His registrar asks him to imagine being the GP reading it on a busy Monday.
Dx: fall, AKI. Meds rationalised. New AF, DOAC started. Home. GP f/u.
Diagnoses: fall without loss of consciousness; acute kidney injury, improving; new atrial fibrillation. STOPPED: furosemide and ramipril because of kidney injury. Please do not restart until kidney function has been reviewed. STARTED: apixaban for stroke prevention, dose as on the attached medicines list; patient counselled and given an alert card. GP actions: (1) check kidney function in one week; (2) at that review, decide whether to restart either medicine. Patient and daughter informed of all changes.
The second version takes a minute longer to write. It tells the GP exactly what changed, why, and what they need to do. That is the difference between a record and a handover.
Writing statements and complaint responses
Two kinds of writing need particular care. If you are asked for a statement, write only what you personally saw, heard and did, in time order, with times where known. Base it on the clinical record, say where you are relying on memory, and do not speculate about others. If you contribute to a complaint response, be factual, acknowledge the person's experience, apologise where something went wrong, explain in plain language and say what has changed. An apology is not an admission of legal liability.
Improving your written communication
Ask a senior colleague to look at a few of your letters, seek feedback from patients, and reflect on what you change. This makes useful evidence for appraisal or revalidation.
Our course Professional Written Communication in the NHS covers letter structure, referrals, plain English for patients, email tone, confidentiality, record entries and complaint responses, with before-and-after examples. For spoken communication, see Difficult Conversations with Patients and Families and Breaking Bad News Training.
Frequently asked questions
Should NHS clinic letters be addressed to the patient or the GP?
Current best practice, set out in the Academy of Medical Royal Colleges guidance Please, write to me, is to write outpatient letters to the patient and copy in the GP, where the patient agrees. Exceptions include adults who lack capacity, some children, and situations where sensitive information needs to be shared differently. Follow your organisation's policy and template.
How do you start a professional email to a consultant?
Use 'Dear Dr' plus their surname, or 'Dear' plus their first name if you already work with them on first-name terms. In surgery, consultants are often addressed as Mr or Ms. Then state your purpose in the first sentence, give brief background, make a clear request with a deadline, and sign off with your name, role and contact number.
Can I email patient information within the NHS?
Yes, if you use a secure email or messaging system approved by your organisation and share only the minimum information necessary. Check every recipient before sending. Personal email accounts and unapproved messaging apps should not be used for identifiable patient information. If information goes to the wrong person, report it promptly through your incident reporting system.
What should a referral letter include?
A clear question, the reason for referring now and how urgent it is, relevant history and examination, results with dates, current medicines and allergies, any access or communication needs such as an interpreter, and confirmation that the patient knows about and agrees to the referral. Avoid 'please see and advise' without saying what you need.
Can I use abbreviations in clinical letters?
Avoid them in letters a patient will read, and keep them to a minimum in letters to colleagues. Abbreviations can mean different things in different specialties, and some cause errors, for example with medicine doses. If you must use one, write it out in full the first time. Many trusts publish lists of abbreviations that must not be used.
Is it acceptable to use WhatsApp to discuss patients?
Only if your organisation has approved and governs that use. Personal WhatsApp groups and texts are not appropriate for identifiable patient information or clinical photographs. Use your organisation's approved messaging tools, share the minimum necessary, and remember that messages about patients form part of the information they may be entitled to request.
What is the difference between a discharge summary and a clinic letter?
A discharge summary hands over care after a hospital stay. It focuses on diagnoses, treatment given, medicine changes and actions for the GP or community team. A clinic letter records an outpatient consultation: assessment, options discussed, the plan and follow-up. Both should put actions and medicine changes near the top and say who is responsible for each.
Related courses
Professional Written Communication in the NHS
This course teaches you to write clinical letters, emails, referrals and messages that are clear, accurate and professional, following UK…
Breaking Bad News Training (SPIKES)
This course teaches a structured, compassionate approach to breaking bad news using the six-step SPIKES framework. Each step is explained with worked…
Difficult Conversations with Patients and Families
This course gives you practical, published approaches for conversations that involve anger, disagreement, complaints or expectations that cannot be…
Sources and further reading
- Please, write to me: Writing outpatient clinic letters to patients. Academy of Medical Royal Colleges.
- ROAN information sheet: Quality improvement, best practice for clinical letters. NHS England.
- Good Medical Practice (2024). General Medical Council.
- The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- The Caldicott Principles. National Data Guardian.
- Guide to the UK General Data Protection Regulation. Information Commissioner's Office.
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.
More guides
The SPIKES Protocol for Breaking Bad News, With Example Conversations
The SPIKES protocol for breaking bad news explained step by step, with example conversations, useful phrases, common mistakes and what to do afterwards.
How to Handle Difficult Conversations With Patients and Families
How to handle difficult conversations with patients and families: calming anger, the NURSE approach, apologising, complaints, disagreement and safe boundaries.
SBAR Handover: Examples and Template for Nurses and Doctors
SBAR handover explained with a simple template and worked examples for nurses, doctors, physiotherapists, paramedics and community staff, plus read-back tips.