Domhnall Macauley: A tongue in cheek letter to consultant colleagues

Domhnall MacauleyDear consultant colleague,

The standard of consultant letters is very variable so we have decided to introduce a new proforma for consultant letters to GPs.

Patients attend many different outpatient departments and we intend to introduce a different proforma for every department in each of the hospitals to whom we refer.

Our clinical team have different information needs and, in order to improve clinical care, we ask you to complete the different sections supplied by the doctors, practice nurse, district nurse, practice manager, and receptionist.  In future, if we deem your letter to be inadequate we will return it to enable you to add the appropriate information.

If we do not receive a letter within an appropriate timescale following an appointment or discharge, we will request that you see the patient again to update your letter.

Finding out what actually happened to patients in hospital is critical so we have decided to introduce a red flag category.  Red flags are for patients who are ill and for whom it would be helpful to have information within two weeks. We do not feel it is sufficient to delay the letter until all the results are back or dictate the letter at the time, only for the letter be typed a number of weeks or months later.

We require some important core information. In your letter, please include the reason for admission, how the patient was managed in the hospital. and a list of the diagnostic conditions and codes on discharge. If you wish the patient to be seen by one of your other consultant colleagues, we do not feel it is appropriate to add a note to this effect in the last line to a three page letter that might arrive 3-4 weeks after discharge. If you are missing a blood test, or would like us to follow up on a test that you or one of your staff have forgotten to take, it would be helpful if you could contact the patient and our nursing staff rather than add a handwritten squiggle at the bottom of a letter.

Information like blood pressure, respiratory function, blood tests etc would be useful. It saves the patient further appointments and investigations at the surgery. We appreciate that some of your colleagues seem reluctant to do this as GPs are paid for having good data recording.

We are introducing this with immediate effect and without prior consultation and look forward to your continuing cooperation.

Dictated but not signed by.

Domhnall MacAuley is primary care editor, BMJ