The task
Original independent practice. All patient findings and arrangements are fictional case facts, not general clinical recommendations. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today is 3 November 2026. Ms Cannan has been assessed at your general practice.
You are the general practitioner assessing Ms Cara Cannan. Using the case notes, write a referral letter to Dr Freya Doudigan, Consultant Ophthalmologist, Same-day Eye Clinic, 14 Clinic Road, SW1A 2AA, requesting the same-day assessment already agreed by telephone for suspected anterior uveitis. 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: Referral letter.
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Which case notes belong in this letter?
Suspected anterior uveitis: referral
You are the general practitioner assessing Ms Cara Cannan. Using the case notes, write a referral letter to Dr Freya Doudigan, Consultant Ophthalmologist, Same-day Eye Clinic, 14 Clinic Road, SW1A 2AA, requesting the same-day assessment already agreed by telephone for suspected anterior uveitis. 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: Ms Cara Cannan
- DOB: 17/05/1978 (48 yrs)
- GP assessment: 03/11/26, 11:00; first presentation with these symptoms
Social background
- Lives with adult daughter; daughter available to accompany her today
- Library assistant; usual work involves prolonged reading
- Enjoys knitting; recently completed a scarf
- Complained receptionist sounded unfriendly when arranging today's appointment
Medical and ocular history
- Reading glasses for 5 yrs; used for near work only
- Longstanding near-vision difficulty unchanged; no recent prescription change
- Routine optometry review 1 yr ago; no eye disease reported
- No known inflammatory disease; no previous similar eye episode
- No regular medication; no known drug allergies
- Ankle sprain 2022; recovered fully
Current presentation
- L red eye since yesterday morning → worse today
- Deep ocular ache and marked photophobia; difficulty keeping L eye open
- New blurred distance vision today; R eye asymptomatic
- Watering; no purulent discharge or eyelid crusting
- No trauma, chemical exposure, contact lenses or recent eye surgery
- No severe headache, nausea or haloes reported
Examination
- Unaided distance VA: L 6/18, pinhole 6/12; R 6/6
- L circumlimbal injection; no lid swelling
- L pupil smaller than R; sluggish light response
- Cornea appears clear on torch examination
- Fluorescein: no corneal staining seen
- No slit lamp/tonometer available; anterior chamber/IOP not assessed
Assessment and plan
- Working diagnosis: suspected anterior uveitis; requires specialist confirmation
- Dr Freya Doudigan accepted same-day eye-clinic assessment by telephone; appointment 13:00
- No ocular treatment commenced before specialist review
- Daughter taking her directly to clinic; advised not to drive
- Advised emergency department immediately if vision lost before assessment
Who is reading, and what do they need?
Dr Doudigan is the consultant ophthalmologist who has already accepted today's referral by telephone. Identify Cara Cannan clearly; her date of birth, 17 May 1978, is a useful additional identifier. Prioritise the acute painful, photophobic left red eye, measured visual acuity, circumlimbal injection, suspected diagnosis and agreed 13:00 assessment. Select some supporting findings and background as space allows; a complete negative history is unnecessary.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Suspected anterior uveitis; Dr Doudigan accepted review today at 13:00. | Essential: establishes the referral purpose, diagnostic uncertainty and agreed assessment time immediately. |
| Left red eye since yesterday morning, worse today; deep ache and marked photophobia. | Essential: provides the acute symptom sequence and features supporting urgent ophthalmological assessment. |
| New blurred distance vision today; left 6/18, pinhole 6/12; right 6/6. | The measured acuities and pinhole result are essential. The new distance blur and asymptomatic right eye are useful optional supporting details. |
| Left circumlimbal injection; smaller pupil with sluggish light response. | Circumlimbal injection is essential. The pupil findings are useful optional evidence supporting the suspected anterior segment inflammation. |
| Clear-appearing cornea on torch examination; fluorescein showed no corneal staining. | Optional supporting observations: select either, both or neither as space allows. If included, preserve the limits of the examination and do not imply that these findings confirm the diagnosis. |
| No slit lamp or tonometer; anterior chamber and intraocular pressure not assessed. | Useful optional context explaining the limits of the GP assessment. Omission is acceptable when diagnostic uncertainty and the agreed same-day specialist assessment are clear. |
| No ocular treatment started; no regular medication or known drug allergies. | Optional treatment and prescribing background. Candidates may select some of these details without reporting the entire line. |
| Daughter taking her directly to clinic; advised not to drive. | Useful optional information about attendance and transport. It may be included, compressed or omitted when the agreed same-day assessment is clear. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Library assistant; prolonged reading; knitting and a recently completed scarf. | Occupational reading can be compressed if needed; hobbies and the scarf do not affect the immediate assessment. |
| Complaint about the receptionist's unfriendly manner. | The service complaint contributes nothing to diagnostic assessment or the agreed referral arrangements. |
| Reading glasses for five years; unchanged near-vision difficulty; no recent prescription change. | This optional background may be omitted when the acute symptoms, key findings and referral arrangements are clear, or briefly compressed to distinguish baseline near-vision difficulty from the new distance blur. |
| Routine optometry review one year ago; no eye disease reported. | A previous routine review adds limited information about this first acute episode and should not imply current reassurance. |
| Ankle sprain in 2022, fully recovered. | The resolved injury has no stated connection to the ocular presentation or specialist management. |
| Emergency-department advice if vision lost before assessment. | The documented advice may be included or briefly summarised as space allows. Omission is also acceptable when the urgent assessment arrangements are clear. |
A paragraph plan for this case
Start with patient identification and the agreed same-day referral for suspected anterior uveitis. Group the acute symptom onset and deterioration, pain and photophobia, measured visual acuity and circumlimbal injection. Then select some supporting details as space allows: new distance blur, pupil findings, examination limitations, corneal observations, relevant history or treatment status. Assessment at 11:00, first presentation, watering, discharge and crusting negatives, exposure and surgery negatives, and absence of severe headache, nausea or haloes are optional. Do not attempt to reproduce every negative finding. Close with the agreed 13:00 assessment; accompanied transport and documented emergency advice may be added briefly. Supporting notes may be included, compressed or omitted without penalty when the essential core is clear.
Where candidates slip on this task
- If including the unchanged near-vision difficulty, distinguish it from today's new distance blur; reading glasses and an old prescription history must not explain away the acute visual change. This background may be omitted when the acute presentation is clear.
- Describe anterior uveitis as suspected. Examination limitations, pupil findings, corneal appearance and fluorescein results are useful optional details. If included, report them accurately: clear torch findings and absent staining do not confirm the diagnosis, and unperformed slit-lamp examination or tonometry must not be presented as normal.
- State the agreed 13:00 review on 3 November. Direct transport with her daughter, no-driving advice and treatment status are optional supporting details; do not invent dilating drops or treatment.
- Select useful supporting information rather than a complete negative history. Omission of inflammatory history, watering or discharge details, exposure and surgery negatives, corneal appearance or staining results is acceptable when the essential symptoms, measured vision, circumlimbal injection, suspected diagnosis and same-day arrangement are clear.
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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Questions about this task
How much of the longstanding visual history belongs in this referral?
It may be omitted when the acute symptoms, key findings and referral arrangements are clear. If included, briefly distinguish unchanged near-vision difficulty from today's new distance blur. The reading glasses, unchanged prescription and previous routine optometry review should not displace the essential acute symptoms, visual acuity, circumlimbal injection, suspected diagnosis or agreed same-day assessment. Other useful supporting details can be selected as space allows.
Can the referral describe anterior uveitis as confirmed?
No. The notes explicitly identify a working diagnosis requiring specialist confirmation. Prioritise the circumlimbal injection, acute symptoms and measured acuity. Pupil findings and examination limitations are useful optional supporting details. If reporting the clear-appearing cornea or absent fluorescein staining, present these as observations rather than confirmation of anterior uveitis. A complete set of negative findings is not required.
Sources
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