What the Purpose criterion checks
Purpose is scored from 0 to 3. The other five Writing criteria are scored from 0 to 7. A B grade usually comes with 2 out of 3 for Purpose, so on this small scale one missing step can cost you a whole point.
Your reader is busy. Within the first few lines they should know why this letter reached them and what you would like them to do. Later, they should find the details of that request: what exactly, when, and how often.
- State the purpose early: in the first paragraph, ideally in the first sentence.
- Expand the purpose later: usually in the final paragraph, with specific requests linked to this patient.
The first paragraph: who, why, what
A strong opening answers three questions in one or two sentences.
| Question | What to write | Example words |
|---|---|---|
| Who? | The patient's name and a short identifier, such as age or main problem | Mrs Leila Haddad, 67 |
| Why now? | The event that led to this letter | who was discharged home today after treatment for a fractured wrist |
| What do you need? | The action you want from this reader | and to request that you review her pain relief in one week |
Discharge letter from a hospital doctor to a GP
I am writing regarding Mrs Leila Haddad, who was in our hospital recently.
I am writing to update you on Mrs Leila Haddad, 67, who was discharged home today after treatment for a fractured wrist, and to request that you review her pain relief in one week.
Why: The weak version names the patient but gives no reason and no request. The reader still does not know what to do.
Choose a verb that matches the task
Not every letter is a referral. Choose the verb that describes what is really happening. The wrong verb can confuse the reader about who is now responsible for the patient.
| Situation | Useful verbs | Example opening |
|---|---|---|
| You want a specialist to assess or treat | refer, request assessment | I am writing to refer Mr Daniel Osei for assessment of his persistent hoarseness. |
| The patient moves to another facility or team that will take over care | transfer | I am writing to transfer the care of Mrs Ana Lima, who will move to Riverside Rehabilitation Unit tomorrow. |
| The patient has gone home and someone else will follow up | discharge, inform, request follow-up | Mr Paul Becker was discharged home today, and I would appreciate your follow-up of his blood pressure. |
| You are reporting progress to the usual clinician | update | I am writing to update you on Ms Sunita Rao's progress since she started physiotherapy. |
| The reader is not a health professional and needs guidance | advise, explain | I am writing to advise you on how to support Jack at school following his recent diagnosis of epilepsy. |
Expand the purpose with specific requests
The final paragraph makes the opening concrete. A vague request such as 'please follow up' leaves the reader guessing. A specific request is tied to this patient's problems.
Nurse writing to a community physiotherapist
Please see him and provide any necessary treatment. Thank you.
I would be grateful if you could assess his balance and set up a home exercise programme. As he lives alone, a check of his home for fall hazards would also be helpful.
Why: The better version names concrete actions and links one of them to a fact from the notes: he lives alone.
Hospital doctor writing to a GP
Please continue to monitor her.
Could you please check her potassium level in one week, as her diuretic dose was increased during admission?
Why: The reader now knows what to check, when, and why.
A specific request can include some of these elements:
- What to do: check, review, adjust, arrange, monitor, teach.
- When or how often: in one week, at her next visit, daily for the first fortnight.
- Why, if it is not obvious: because her dose was changed, because she lives alone.
Urgent letters
If the task or notes point to urgency (worrying symptoms, a rapid change, a result that needs action), the reader must see it in the opening, not only at the end.
GP referral to a respiratory physician
I am writing to refer Mr Tomas Novak, who has had a cough for some time.
I am writing to request an urgent assessment of Mr Tomas Novak, 58, who has a six-week history of cough with blood-stained sputum and unintended weight loss.
Why: The word 'urgent' and the key warning features appear in the first sentence, so the reader can prioritise him.
Why memorised openers fall short
Many candidates use one memorised opening sentence in every letter. A fixed sentence usually stays general: it names the patient and the letter type and stops there. To score well on Purpose, the opening should fit this patient and this reader.
GP referral to a breast surgeon
I am writing to refer Mrs Grace Mensah, who requires your further management.
I am writing to refer Mrs Grace Mensah, 45, for assessment of a left breast lump that she first noticed three weeks ago.
Why: 'Further management' could appear in any letter. The better version belongs to this patient only.
Four openings: weak and better
GP to a neurologist
I am referring this patient to you for review. Mr Arjun Mehta is a 39-year-old man.
I am writing to refer Mr Arjun Mehta, 39, for assessment of recurrent severe headaches with visual disturbance, which have not improved with simple painkillers.
Why: The better version gives the reason in the same sentence as the referral, so the specialist knows what question you are asking.
Ward nurse to a nursing home
Mrs Wong is being transferred to your facility. She has been in hospital for two weeks.
I am writing to transfer the care of Mrs Mei Wong, 82, who will return to your facility tomorrow after treatment for a urinary tract infection and who now needs help with all transfers.
Why: The reader learns when she arrives, why she was in hospital and the change in care that affects them most.
Ward nurse to a community nurse
Mr Hughes was discharged today. Please see him.
I am writing to inform you that Mr Owen Hughes, 71, was discharged home today with a lower-leg cast for an ankle fracture, and to request home visits to help with personal care and check the skin around the cast.
Why: 'Please see him' gives no task. The better version tells the nurse what each visit is for.
Doctor to a patient's daughter, who is her main carer
I am writing about your mother, who has diabetes.
I am writing to explain how you can help your mother, Mrs Rosa Fernandes, manage her newly diagnosed diabetes at home, especially her new tablets and her meals.
Why: A lay reader needs the purpose in plain words. The better version tells her exactly what the letter will help her do.
Check yourself
5 quick questions. Tap an answer to see why.
1 Where should the reader first find the purpose of your letter?
2 A patient is leaving your ward for a rehabilitation unit, which will take over her care. Which verb fits best?
3 Which closing request best expands the purpose?
4 Your notes describe a new skin lesion that has grown quickly and bled twice. What should your opening do?
5 Why does a memorised opening sentence often limit your Purpose score?