When you'll write one
A referral is set when you need someone with different skills to take on part of the patient's care, usually while you remain responsible for the patient. Typical readers are specialists, allied health professionals or community services receiving a request from a GP, nurse or therapist.
Usual readers: specialist physician, surgeon, physiotherapist, dietitian, psychologist, community mental health team. Purpose verbs: refer, request assessment of, request investigation of, seek your advice on, request management of.
Structure
| Paragraph | Content | Tip |
|---|---|---|
| 1 · Purpose | Patient's name and age, the problem, and what you want: assessment, investigation or management, and how urgently. | Put urgency in the first sentence if it matters; a busy specialist triages from that line. |
| 2 · Presenting problem | The symptoms or history that led to the referral: onset, duration, key positives and important negatives. | Include negatives only when they change the specialist's thinking, such as no rectal bleeding. |
| 3 · Findings and treatment so far | Examination, results, relevant background and anything you have already started. | Group normal results into one sentence instead of listing each one. |
| 4 · Request and practical points | The specific action you want, patient concerns or preferences that affect the appointment, and an offer of further information. | Name the investigation or service you expect, not just 'please see'. |
Template (a structure, not sentences to memorise)
[Recipient name, title, address as given] [Today's date from the notes] Dear [title surname], Re: [patient full name], [DOB or age] [Referral verb] + [patient] + [age] + for [assessment / investigation / management] of [problem], [urgency]. [Onset and duration] + [key symptoms] + [relevant negatives] + [relevant risk factors]. [Examination findings] + [grouped results] + [relevant history / medicines] + [treatment already started]. [Specific request] + [timing] + [patient concern or practical need] + [offer of further information]. Yours sincerely, [Your role]
Sample referral letter (Medicine)
Case: A GP is referring a 61-year-old man with iron-deficiency anaemia, a change in bowel habit and weight loss. The reader is a gastroenterologist who needs to decide how quickly to investigate.
Case notes (16 lines)
- Patient: Mr Desmond Achterberg, DOB 03/05/1965 (61 yrs)
- Lives with partner; bus driver, works rotating shifts
- Enjoys fishing on weekends
- PMHx: hypertension (amlodipine); gout 2019, no attacks since
- FHx: father, bowel cancer aged 70
- 22/10/26: intermittent loose stools x 3 mths (previously regular)
- Unintentional wt loss 4 kg over 3 mths (82 → 78 kg)
- Fatigue; SOB climbing stairs
- No rectal bleeding noticed; no abdo pain
- National bowel screening kit 15/10/26: positive
- Did not return screening kits sent in 2021 and 2023
- O/E: abdo soft, non-tender, no masses; PR: no mass, brown stool
- Bloods 20/10/26: Hb 98 g/L, ferritin 6 µg/L, MCV 74 fL
- Coeliac serology neg; TFTs, renal and liver function normal
- Plan: oral iron started today; urgent referral for colonoscopy and gastroscopy
- Pt anxious about cancer; mornings easier because of shift roster
Task: Using the information in the case notes, write a letter of referral to Dr Helen Varga, Gastroenterologist, Eastbank Specialist Centre, 40 Harbour Street, Eastbank, requesting urgent investigation of Mr Achterberg's symptoms.
Dr Helen Varga
Gastroenterologist
Eastbank Specialist Centre
40 Harbour Street
Eastbank
22 October 2026
Dear Dr Varga,
Re: Mr Desmond Achterberg, DOB 03/05/1965
I am writing to refer Mr Achterberg, a 61-year-old bus driver, for urgent investigation of iron-deficiency anaemia1, a recent change in bowel habit and unintentional weight loss.
Over the past three months, Mr Achterberg has had intermittent loose stools, and he has lost 4 kg without trying. He also reports tiredness and breathlessness when climbing stairs. He has not noticed any rectal bleeding or abdominal pain. A bowel screening test he completed on 15 October was positive, and his father was diagnosed with bowel cancer at the age of 702.
Abdominal and rectal examinations were unremarkable. Blood tests on 20 October showed a haemoglobin of 98 g/L, ferritin of 6 µg/L and an MCV of 74 fL3. Coeliac serology, thyroid function, and renal and liver function were all normal4. His only regular medication is amlodipine for hypertension, and I started oral iron today.
I would be grateful if you could assess Mr Achterberg and arrange a colonoscopy and gastroscopy as soon as possible5. He is understandably anxious about the possibility of cancer, and as he works shifts, morning appointments would suit him best. Please contact me if you require further information.
Yours sincerely,
[Name]
General Practitioner
Body: 191 words
Why it works
- “for urgent investigation of iron-deficiency anaemia”: Purpose: the reason and the urgency are clear in the first sentence, so the specialist can triage immediately.
- “his father was diagnosed with bowel cancer at the age of 70”: Content: a risk factor this reader needs, placed with the symptoms it makes more worrying.
- “an MCV of 74 fL”: Genre and style: a gastroenterologist uses MCV every day, so the abbreviation suits this reader.
- “Coeliac serology, thyroid function, and renal and liver function were all normal”: Conciseness and clarity: four normal results grouped into one sentence instead of four.
- “arrange a colonoscopy and gastroscopy as soon as possible”: Purpose expanded: the closing names the exact procedures and timing, not just 'please see'.
What it leaves out, and why
| Case note | Why it's left out or compressed |
|---|---|
| Enjoys fishing on weekends | A hobby with no bearing on the investigation. |
| PMHx: hypertension (amlodipine); gout 2019, no attacks since | Gout is old and inactive; only the current medication matters here. |
| Did not return screening kits sent in 2021 and 2023 | Does not change the plan and may read as blame. |
| Lives with partner; bus driver, works rotating shifts | Partner detail is irrelevant; shift work is kept only for appointment times. |
Useful phrases (adapt, don't copy)
Opening
- I am writing to refer [patient], [age], for [assessment / investigation] of [problem].
- I would be grateful if you could assess [patient], who presented today with [problem].
- I am referring [patient] for your opinion on the management of [condition].
- I am writing to request an urgent review of [patient], [age], because of [red-flag finding].
Linking
- On examination, …
- Of note, [risk factor] …
- Investigations so far have shown …
- In view of [finding], I have started …
Closing
- I would be grateful if you could [specific action] within [timeframe].
- [Patient] would prefer [practical need], if possible.
- Please contact me if you require any further information.
- I look forward to hearing your opinion on further management.
Mistakes to avoid in a referral letter
| Mistake | Fix |
|---|---|
| Opening with 'I am writing regarding…' and no reason or request. | Name the problem and the action in the first sentence: 'to refer… for assessment of…'. |
| Copying every normal result and every old diagnosis into the letter. | Group normal results in one sentence and keep only the history that affects the specialist's decision. |
| Hiding the red flag, such as weight loss or a positive screening test, in the middle of a long paragraph. | Mention the most worrying finding early, ideally in the opening or the first line of the next paragraph. |
| Ending with 'Please see and treat' and nothing more. | State what you expect (an investigation, a management plan, an opinion) and how soon. |
Questions candidates ask
How do you start an OET referral letter?
With the purpose: who the patient is, the problem, and what you want from the reader, for example a request for assessment or investigation, plus the urgency if it matters. Avoid general openers that delay the reason for writing.
What is the difference between a referral and a transfer letter?
In a referral you ask someone to assess or treat part of the problem while you usually stay involved. In a transfer, the patient moves and the reader takes over responsibility for ongoing care, so you hand over everything they need from day one.
Should I include all test results in a referral letter?
Include the abnormal results that explain the referral and group the relevant normal ones into one sentence. Results that do not affect the specialist's decision can be left out.
Can I use medical abbreviations in an OET referral letter?
Yes, if the reader would use them: a gastroenterologist will understand MCV. For a reader in a different field, write the full term the first time or avoid the abbreviation.
Other letter types: OET discharge letter, OET transfer letter, OET advice letter, OET update letter. Lessons: Purpose: tell the reader what you need, Layout and paragraphs: a letter the reader can scan.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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