Outpatients Letter Standard

Outpatient Letter Standard

Due to the rise in the number of specialist services delivered out of hospitals, well-structured outpatient letters have become increasingly important to provide good care. Outpatient letters are the main method of contact and communication between hospital staff and GPs, and are often the sole record of the consultation held by the outpatient department and hospital. Best practice for most outpatient letters is writing directly to patients. 

The PRSB standard for outpatient letters allows clinical information to be recorded, exchanged and accessed consistently across care settings.

On this page

 

Current release

Version: v2.2
> Standard model – Excel
> Supporting documentation (external link to NHS Standards Directory)

From 01 January 2026, this standard will be owned and managed by NHS England and is made available for reuse or amendment under the Open Government Licence v3.0 (OGL 3.0). A review of the ongoing requirement for this standard will be undertaken by NHS England. Details on this and any update to the standard will be published on the NHS Standards Directory. If you have any questions or feedback relating to this standard, please email: england.standards.assurance@nhs.net.

 

Conformant partners

The following Partners have successfully achieved conformance against the Outpatients Letter Standard.

Conformant PartnerConformant SystemVersion conformant withLevel attainedValid until

Epro
https://epro.com/

Epro

Version 2.2315.07.2027

About this standard

The Outpatient Letters Standard is designed to improve and standardise the content of outpatient letters so that professionals, patients and carers receive consistent, reliable, high-quality information that can be shared between them all. 

Potential benefits from having interoperable electronic outpatient letters, which reflect the requirements of patients, carers, people being supported in care services and care professionals, are significant.  Watch our video case study to find out more.

Summary table

The Outpatient Letters Standard operates by ensuring that all relevant information is recorded and shared in a structured and coded format. This facilitates seamless communication and continuity of care across different healthcare settings.

Below is a summary table of the standard which comprises 27 sections, 6 mandatory (must be included), 12 required (should be included where the information is available), 9 optional (local choice whether to include the information):

Section 

Description 

MRO* 

Patient demographics  

 Patient details and contact information.  

mandatory 

GP practice  

 Details of the GP practice where the patient is registered. 

mandatory 

Individual requirements  

 Individual requirements that a person has, e.g. communication, cultural, cognitive or mobility needs.  

required 

Participation in research 

The details of any research studies participated in. 

required 

Attendance details 

 The details of the patient contact.  

mandatory 

Referrer details 

Details of the individual or team who referred the patient. 

required 

History 

Information relating to the development of each presenting complaint, and the patient’s relevant health history. 

required 

Medications and Medical Devices  

The details of and instructions for medications and medical equipment the patient is using. 

optional 

Allergies and adverse reactions 

The details of any known allergies, intolerances or adverse reactions. 

mandatory 

Legal information 

Legal information captured relating to patient care, such as consent to treatment and mental capacity. 

required 

Safety alerts 

The details of any risks the patient poses to themselves or others. 

required 

Social context 

The social setting in which the patient lives, such as their household, occupational history, and lifestyle factors. 

optional 

Family history 

Information on illness in family relations relevant to the health or care of the patient. 

optional 

Clinical review of systems 

Information gathered on symptoms related to physiological systems. 

optional 

Patient and carer concerns, expectations and wishes 

A description of the concerns, expectations or wishes of the patient. 

optional 

Examination finding 

The record of findings from clinical examination. 

optional 

Assessment scales 

A description of any assessment scales used. 

optional 

Diagnoses  

A list of the patient’s diagnoses. 

required 

Problems and issues 

A summary of the problems that require investigation or treatment. 

required 

Case study

Explore our case study to see how the standard is applied in practice. This case study highlights a pilot project with Frimley Health Foundation NHS Trust, in collaboration with Nuance and Epic.

Frimley Health, Nuance and Epic logos

Successful teams have the functional skills to lead a task, benefit from diversity, and are led in a way that creates time and space for reflection; the ability to take stock periodically, of the task and of the way in which the team is engaged in delivering it. Your stakeholder analysis [HYPERLINK] should help you assemble the most appropriate team and identify how the team interacts and relates to other stakeholders like sponsors, services users, etc.

The variation in the size, both in terms of population served and numbers of constituent organisations, and of complexity, between Integrated Care Systems, precludes the possibility of any prescriptive guidance on the way in which this team is assembled.

Engeström’s expansive learning cycle of learning actions explains how there are 7 stages of learning actions;

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”