The task
Assume that today's date is 21 October 2026.
You are the practice nurse at Hillview Medical Practice. The GP has asked you to refer Mr Clarke to the local pulmonary rehabilitation programme. Using the information in the case notes, write a letter to Ms Laura Pham, the Pulmonary Rehabilitation Coordinator, requesting assessment and enrolment. Address the letter to Ms Laura Pham, Pulmonary Rehabilitation Coordinator, Hillview Community Health Centre, 3 Park Lane, Hillview. 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.
Case notes
Patient details
- Name: Mr Desmond Clarke
- DOB: 25/11/1959 (66 yrs)
- Retired train driver
Social background
- Lives with wife on 2nd floor of apartment building — no lift; avoids going out because of stairs
- No longer drives since admission; wife can drive him on Tuesday and Thursday mornings
- Ex-smoker — quit 09/26 (during admission); 45 pack-years
- Football fan; attends grandson's matches when able
- Grandson's wedding March 2027 — goal: 'wants to be able to dance'
Medical history
- COPD — spirometry 06/26: FEV1 48% predicted, FEV1/FVC 0.55 post-bronchodilator
- 2 exacerbations in last 12 months; hospital admission 24/09–01/10/26 (no ventilation required)
- Type 2 diabetes — diet controlled; HbA1c 6.4%
- Osteoarthritis L hip — limits walking; uses walking stick
- Hearing impairment — wears bilateral hearing aids
- Cataract surgery R eye 2023
- Allergies: nil known
Current medications
- Tiotropium + olodaterol inhaler, 2 puffs once daily
- Salbutamol inhaler 2 puffs PRN (approx. 3x/day currently)
- Paracetamol 1 g BD for hip
- Influenza and pneumococcal vaccinations up to date
Practice nurse review 20/10/26
- Stops for breath after walking approx. 100 m on level ground (mMRC grade 3)
- SpO2 93% at rest on room air; HR 88; BP 134/82
- 6-minute walk test 240 m; SpO2 lowest 89% during test, recovered in 2 min
- Inhaler technique checked and corrected
- Anxious about breathlessness — fears 'not being able to breathe' when exercising
- Reports limited understanding of what COPD is
- Says hospital 'rushed him out' and complains about discharge process
- Asked whether lunch is provided at rehabilitation sessions
Plan
- Refer to 8-week pulmonary rehabilitation programme (Tue/Thu mornings preferred)
- COPD action plan provided; GP review in 4/52
Who is reading, and what do they need?
Ms Pham coordinates the programme and will decide on assessment and enrolment. She does not know Mr Clarke. She needs objective severity measures, recent exacerbations, exercise limits and safety findings, as well as practical barriers such as mobility, hearing and transport. Concise clinical detail suits her; personal grievances do not.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| COPD: FEV1 48% predicted, FEV1/FVC 0.55; 2 exacerbations in 12 months | Objective severity and exacerbation history support the referral and eligibility. |
| Admission 24/09–01/10/26, no ventilation required | A recent admission is a main reason for referral and shows the severity of the latest exacerbation. |
| mMRC grade 3; 6MWT 240 m; SpO2 lowest 89%, recovered in 2 min | Baseline function and desaturation on exertion are what the programme needs for assessment and safe exercise planning. |
| Salbutamol about 3x/day; maintenance inhaler; technique corrected | Current symptom control and corrected technique are relevant before starting an exercise programme. |
| L hip osteoarthritis, uses stick; bilateral hearing aids | Mobility and hearing affect exercise prescription and communication in group sessions. |
| Anxious about breathlessness; limited understanding of COPD | Fear on exertion and an education need directly shape the programme's approach. |
| Tue/Thu mornings; wife drives; 2nd floor, no lift; ex-smoker | Transport and access explain the session preference, and smoking status is relevant to a COPD programme. |
| Goal: 'wants to be able to dance' at March 2027 wedding | A personal goal helps set programme targets and motivation. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Says hospital 'rushed him out' and complains about discharge | A complaint about another service is not relevant to the referral and should not appear. |
| Asked whether lunch is provided | Looks like a programme question, but it is a logistics query the coordinator can answer directly with him. |
| Cataract surgery R eye 2023 | Old and unrelated to exercise capacity. |
| Diet-controlled type 2 diabetes, HbA1c 6.4% | Compress or omit; it is not a limiting factor listed in the notes. |
| Football fan; grandson's matches | Social detail not needed once the dancing goal is stated. |
| BP, HR and vaccinations; paracetamol | Routine findings that add little beyond the exertional measures already included. |
A paragraph plan for this case
Open with the request for assessment and enrolment in the 8-week programme and the reason. Then give COPD severity, the recent admission and exercise findings, followed by factors affecting participation: hip, hearing, anxiety, understanding and transport. Close with the goal and the follow-up plan.
Where candidates slip on this task
- Give the exertional findings accurately: the 6MWT distance, the lowest SpO2 and the recovery time. Do not call the desaturation dangerous or imply a conclusion the notes do not state.
- Express the session preference as Tuesday and Thursday mornings linked to his wife's availability; he does not drive at present, so do not present the preference as a convenience only.
- Word the anxiety and limited understanding as needs for the programme, not criticism of the hospital, and leave out the complaint entirely.
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 Nursing. Layout and structure: OET letter format.
Questions about this task
Should the lunch question go in the letter?
No. It is a practical question for the coordinator to answer directly with Mr Clarke. The letter should concentrate on clinical findings and barriers relevant to enrolment.
How much of the diabetes should I mention?
Very little. It is diet controlled with a recorded HbA1c, and the notes do not link it to exercise limits. A short mention or omission is acceptable; the hip, hearing and anxiety matter more.
Sources
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