The task
Original independent practice. All patient details, appointments and individual care-plan decisions are fictional. Assume that today's date is 3 November 2026, following yesterday's swallowing assessment.
You are Mr Roel Bruce's general practitioner. Write to his wife and agreed carer, Ms Amanda Leonardi, 22 Station Road, AB10 1AA. Explain his documented swallowing plan, when to seek help and the arranged specialist reviews. Address her suggestion of moving his Parkinson's medicines to mealtimes, reinforcing use of his verified current prescription chart. A list of individual medicines is not required. Use plain language. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Advice letter.
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Which case notes belong in this letter?
Parkinson's disease with swallowing concerns: advice
You are Mr Roel Bruce's general practitioner. Write to his wife and agreed carer, Ms Amanda Leonardi, 22 Station Road, AB10 1AA. Explain his documented swallowing plan, when to seek help and the arranged specialist reviews. Address her suggestion of moving his Parkinson's medicines to mealtimes, reinforcing use of his verified current prescription chart. A list of individual medicines is not required. Use plain language. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mr Roel Bruce
- DOB: 08/06/1952 (74 yrs)
- Home: 22 Station Road, AB10 1AA
- Wife/carer: Ms Amanda Leonardi; lives with pt
- Consent recorded: share swallowing advice with wife
Medical and social background
- Parkinson's disease diagnosed 2018; specialist follow-up ongoing
- Current Parkinson's prescription chart checked against labelled packs with wife; copy at home; doses/times unchanged
- Cognitively alert; feeds himself; wife prepares meals
- Independent indoors; needs help with buttons
- Remote inguinal hernia repair; uncomplicated
Earlier reviews
- 12/10/26: wife reports coughing when gulping drinks
- Weight stable; no recent chest infection
- Urgent speech and language therapy referral made
- 28/10: smaller sips helped; occasional coughing persists
- No food sticking or painful swallowing reported
Swallowing assessment and individual plan
- 02/11: therapist's home swallowing assessment; wife present
- Usual food and unthickened drinks retained after assessment
- No coughing observed with single sips during assessment
- Individual plan: fully awake/upright; wife nearby; small mouthfuls/single sips, slowly; finish each before next
- Wife demonstrated prompts correctly; pt wishes to continue self-feeding
- Follow current prescription chart doses/times; no moving doses to meals/stopping/crushing; medicine-swallowing difficulty → urgent same-day practice advice before next dose due; NHS 111 if unavailable
- No difficulty swallowing usual tablets reported at assessment
- Recurrent coughing/wet voice → stop meal; urgent practice/NHS 111 advice
- Choking, unable to breathe/speak/cough effectively → 999; follow operator
Home support and follow-up
- Wife asks about moving Parkinson's doses to mealtimes to simplify new routine; no changes made; requests written advice
- Wife unhappy with previous appointment's waiting time
- Neighbour's unrelated marital dispute discussed during visit
- Therapist home reassessment booked 10/11
- Parkinson's specialist review 17/11; bring swallowing symptom record
- 03/11: GP letter requested to explain agreed home plan
Who is reading, and what do they need?
Amanda Leonardi is the co-resident wife and agreed carer, with recorded consent to receive advice; she attended the assessment and prepares meals. She has a verified medicine chart at home and asks whether doses can move to mealtimes. She needs a practical explanation of the agreed routine, a clear answer about medicine timing, escalation and booked reviews. Identification belongs in the heading; the history of Parkinson's disease need not be retold.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 2 November home assessment: usual food and unthickened drinks retained. | This states the assessed dietary decision and prevents an unsupported switch to thickened drinks or altered food. |
| Fully awake/upright; wife nearby; small mouthfuls/single sips, slowly; finish each before next. | Every component is part of the individual routine Amanda needs to help implement. |
| Follow current prescription chart doses/times; no moving doses to meals/stopping/crushing; medicine-swallowing difficulty → urgent same-day practice advice before next dose due; NHS 111 if unavailable. | This answers Amanda's proposed timing change using the chart she already has and gives a prompt route for medicine-swallowing problems. |
| Recurrent coughing or wet voice: stop meal; urgent practice/NHS 111 advice. | This identifies the documented meal-related escalation threshold and the required action. |
| Choking with inability to breathe, speak or cough effectively: 999; follow operator. | This distinguishes an immediate airway emergency from symptoms requiring urgent clinical advice. |
| Therapist home reassessment: 10 November. | Amanda needs the booked reassessment date to continue the agreed care arrangements. |
| Parkinson's specialist review: 17 November; bring swallowing symptom record. | The appointment and requested record give Amanda a specific preparation task for specialist review. |
| Wife demonstrated prompts correctly; patient wishes to continue self-feeding. | This supports the agreed carer role while respecting the patient's documented wish for independence. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Remote uncomplicated inguinal hernia repair. | The resolved operation does not help Amanda carry out the swallowing plan. |
| Independent indoors; needs help with buttons. | General mobility and dressing assistance do not change the documented eating and drinking instructions. |
| Wife unhappy with previous appointment's waiting time. | The service complaint is unrelated to home swallowing care or follow-up preparation. |
| Neighbour's unrelated marital dispute. | This is unrelated third-party information with no role in the advice letter. |
| No coughing with single sips during assessment; no usual-tablet swallowing difficulty reported. | Compress or omit these observations; neither establishes unrestricted swallowing safety or removes the need for the agreed precautions. |
A paragraph plan for this case
Open with the purpose of the written explanation and yesterday's assessment, then explain the retained food and drink choices and individual eating routine. Supported self-feeding is useful optional context. Address Amanda's proposed medicine-timing change by directing her to the current prescription chart and keeping its doses and times unchanged. Do not independently move doses to meals, stop treatment or crush tablets. Make the three documented reasons for seeking help clear: difficulty swallowing medicines requires urgent same-day practice advice before the next dose is due, using NHS 111 if the practice is unavailable; recurrent coughing or a wet voice requires stopping the meal and seeking urgent practice/NHS 111 advice; choking with an inability to breathe, speak or cough effectively requires calling 999 immediately and following the operator's instructions. Close with the 10 November home reassessment and 17 November specialist review, including the swallowing symptom record. Earlier coughing history, weight and chest-infection findings can be omitted or briefly compressed. Keep the advice within the recorded plan; do not add a first-aid algorithm or unrecorded procedures and numerical instructions.
Where candidates slip on this task
- Retain usual food and unthickened drinks as the assessed plan; the absence of coughing during observed single sips does not establish that aspiration cannot occur.
- Amanda's proposed move to mealtime dosing has not been implemented or authorised. Reinforce the verified prescription chart at home; do not invent medicine names, quantities or administration times. Explain the urgent advice route for any new difficulty swallowing medicines.
- Treat 10 November and 17 November as future appointments from 3 November; keep NHS 111 and 999 because this particular card describes UK care arrangements.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
How should the letter answer Amanda's question about moving medicines to mealtimes?
Tell her to keep the doses and times on the current prescription chart at home and not move them to mealtimes herself. The chart has already been checked with her, so individual medicines do not need to be listed again. Include the precautions against stopping or crushing tablets and the urgent advice route if swallowing medicines becomes difficult.
Does an uneventful single-sip observation justify simplifying the plan?
No. Treat the observation as limited assessment context, not permission to remove precautions or declare swallowing safe. The selection should prioritise the therapist's complete individual routine and retained diet decision. Supported self-feeding can be described without implying that Amanda must take over feeding.
Sources
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