Quality improvement: best practice for clinical letters

Write ‘to’, not ‘about’

Good written communication is essential to good clinical care. For a doctor looking for a suitable quality improvement activity, an appraiser may consider suggesting a review of clinical letter-writing practice.

The Academy of Medical Royal Colleges has published guidance on this topic: Please write to me: Writing outpatient clinic letters to patients. It promotes the practice of writing to the patient, copying in the receiving clinician, compared with the traditional habit of writing to the clinician and copying in the patient.

For an individual clinician, this may be a more challenging adaptation than it at first appears. However, it can have a big effect on the way the doctor communicates with patients in the clinic and afterwards.

As an example of turning this into a quality improvement activity, a doctor might create a PDP item to read the guidance, adapt their letter-writing practice accordingly and report back on their experience and learning at their next appraisal.

Highlights from the Academy guidance include:

  • Most patients and GPs prefer outpatient letters to be written directly to patients.
  • Letters written to patients can contain as much information and need not be longer than those written to GPs.
  • Follow the advice about content, clarity and style.
  • It is good practice to ask the patient’s permission before sending them a printed letter, and gain written consent if sending the letter to the patient electronically.
  • For adults who lack the capacity to give consent, write to the clinician and, where it is in the patient’s best interests, copy the letter to relatives or carers.
  • Children under age 16 years can give permission if you judge that they fully understand and appreciate what is involved. Otherwise, you should usually write to the parents or guardians, perhaps with a separate simplified letter to the child.
  • Invite feedback from patients and clinicians about your letters to drive improvement. Include this in your appraisal portfolio.

Further information

This information sheet is relevant to all designated bodies in England.