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.
Current release
Version: V2.2 | |||
|---|---|---|---|
Release date | April 2023 | ||
Release notes |  |  | 
|
Next release date | December 2024 | ||
Next release type | Scheduled release | ||
The standard | |
|---|---|
Full standard – PRSB viewer | Available with next release (Dec 24) |
Full standard – Excel | 
|
Full standard – Json | Available with next release (Dec 24) |
Supporting documentation | Description/purpose |
|---|---|
| The messaging specification for exchanging information using the NHS standard for messaging, HL7 FHIR. |
| This document includes general implementation guidance for all PRSB standards and detailed guidance, specific to the Outpatient Letters Standard. |
 | Rules for implementation of the standard. |
 | Describes the purpose, methodolgy and stakeholder engagement for developing the standard, along with the findings and recommendations for further work. |
| Summarises the hazards which could result from implementing the standard. |
| Details the potential hazards from implementing the standard with their risk rating and mitigation. |
Need implementation support?
- Online support form
- Support@theprsb.org
- 020 4551 5225 (9-5 Mon-Fri, excl. bank holidays)
Dr Ian Logan, Freeman Hospital, explains how the standard has benefited his patients receiving regular kidney dialysis.
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. This project supports NHS Digital and NHS England’s interoperability efforts. 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. They include:
Improved patient safety by:
- having information which is needed for safe continuity of care to be available on a timely basis.
- avoiding transcription errors when medication information is electronically transferred to the GP record (following clinician review), without the need for re-entry.
Improvements to patient care and patient satisfaction by:
- having consistent and timely information (including medications, diagnoses, procedures and allergies) transferred to all relevant care professionals and their GP practice.
- providing patients with legible up to date information about their outpatient attendance.
Support for new more integrated and person-centred ways of working, including:
- people being able to access to their records online.
- increased efficiency for multidisciplinary teams by providing structured and coded information on diagnoses, procedures and medications which can be reused for new ways of working as teams develop and expand.
Time savings for NHS organisations by:
- removing the need to develop and design content locally, by using national standards
- reducing the duplication of recording.
Information being readily available for use in improving quality of care through:
- re-use in clinical audit and research.
- increased ability to measure and improve actual patient clinical outcomes rather than process outcomes.
A hugely increased opportunity for future development of patient- led care by ensuring interoperability between multiple systems, including personal health records.
Scope
- Adult discharge from outpatient health services;
- Communication back to the GP and patient.
Out of Scope
- Discharge from non-mental health inpatient stay – refer to the eDischarge Summary Standard – PRSB (theprsb.org)
- Discharge from mental health inpatient stay – refer to the Mental Health Inpatient Discharge standard
- Discharge from emergency care – refer to the Emergency Care Discharge Standard – PRSB (theprsb.org)
- Transfer between hospitals – although much of the content may be appropriate
- Information not pertinent to the patient’s outpatient attendance
How it works
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 |
For full implementation the discharge information should be sent as electronic message using the NHS standard for messaging, HL7 FHIR, detailed here: Transfer of Care message specifications – NHS England.
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.
Further resources
- Standards explained
PRSB’s guide to standards which sets out the purpose and benefits of using standards and how to support frontline professionals to adopt them.
- IHRIM record correction guidance
Despite vigilance when filing information in records, mistakes can occur. The Institute of Health Records and Information Management has guidance to support professionals in making corrections following errors. - Transfers of care discovery report
The eDischarge Summary Standard was first published in 2015. Despite significant investment in programme initiatives, the widespread implementation of the standards has been slow.
In this report we identify the challenges that have inhibited the adoption of the standard, make recommendations for improvements and set out the anticipated benefits that this will bring.
Endorsement
- British and Irish Orthoptic Society
- British Psychological Society
- Chartered Society of Physiotherapy
- Institute of Health Records and Information Managers (IHRIM)
- Resuscitation Council UK
- Royal College of General Practitioners
- Royal College of Midwives
- Royal College of Nursing
- Royal College of Obstetricians and Gynaecologists
- Royal College of Occupational Therapists
- Royal College of Physicians
- Royal College of Psychiatrists
- Royal College of Radiologists (Faculty of Clinical Oncology)
- Royal Pharmaceutical Society
- techUK