2026 updated guidance from Academy of Royal Medical Colleges “Please write to me” – highlights frequent complaints about poor communication in the NHS, how communication issues will disproportionately affect people with lower levels of health literacy. Now includes discharge summaries.
- No nasty surprises – should repeat and add information but not give new or upsetting information
- Tailored to individual patient – record patient preferences about how they can best read/process
- Include questions asked by patient and GP, and answers
- Explanation of new or changed treatments
- Problem/diagnosis list is optional!
- Section aimed directly at GP optional
- Links to other sources of information and decision aids should ideally be from Patient information forum “Trusted information creator database”
- Break up text with paragraphs and bullet points
- Aim for Flesch reading ease score of 70 or above (UK reading age 9-11)
- Provide technical information in short sentences
2020 interview study with GPs in the Midlands –
Giving letters to patients has benefits of a sense of patient inclusion, increased patient understanding, patient autonomy, enhanced communication transparency. The letter can act as a memory-aid (for example, medication). Paper-held summary may also act as a physical record of the admission for future encounters and communications, particularly if the patient sees a team who do not have access to the letter (for example, out-of-hours GP).
But if discharge letter is no longer simple summary, but exercise in patient education. GP then has to wade through a lot of excess information.
Letter to patient can alarm patients (especially if inaccuracies), language barriers and patient low literacy lead to health inequalities. GP may be asked to explain letters to patients. Ethics of cases where the diagnosis had not been disclosed, confidentiality breaching if the letter contains third-party information or if patient loses the letter. Patient can be upset by sensitive issues (eg, obesity).
Tips therefore include:
- Give patient choice regarding getting letter (AoRMC says check how they like to be communicated with) – some people are sensitive about information being posted out.
- Give patient an abbreviated/edited version
- Include simple interpretations of results (“normal”, “satisfactory”)
- Insert a patient information section
- Hidden Actions: Critical requests (e.g., ordering blood tests or prescribing new drugs) are often buried in paragraphs rather than clearly itemized.
- Missing Information: Letters frequently omit the specific rationale for medication changes or leave out essential physical measurements or mental health assessments.
- Jargon and Acronyms: Traditional letters are often written with heavy medical terminology. This confuses patients who then book GP appointments just to have the letter explained.
- Delays: Administrative backlogs and IT glitches often mean letters arrive too late to safely guide a patient’s ongoing primary care.
What GPs Actually Want:
- A Dedicated Action Section: GPs overwhelmingly prefer structured letters that feature a bolded “GP Action” or “Please Consider” section at the very beginning or end.
- Concise Formatting: Because GPs spend less than a minute reading most routine letters, they favor bullet points and standardized headings for diagnoses, management plans, and required investigations.
- Direct Communication with Patients: Academy of Medical Royal Colleges “Please write to me” guidance promotes writing clinic letters directly to the patient (in plain English) while copying in the GP. This saves GPs time and boosts patient understanding
Shetland improvement project highlights that letters are processed by admin and pharmacy staff and often they need to involve clinical staff or contact the patient themselves to help understand what is being requested of them. Patient feedback included “it helped me understand the journey I was on”, “quite a lot of jargon and medical terms I didn’t understand”, “didn’t feel I needed it as I trust relevant information has been given”.