Recommendation 2: Patient-focused correspondence
From Report of the Independent Inquiry into the Issues raised by Paterson, published 4 February 2020.
Recommendation
We recommend that it should be standard practice that consultants in both the NHS and the independent sector should write to patients, outlining their condition and treatment, in simple language, and copy this letter to the patient's GP, rather than writing to the GP and sending a copy to the patient.
In brief (written by this site)
In July 2026, Baroness Merron, Parliamentary Under-Secretary at the Department of Health and Social Care, stated that the NHS Standard Contract requires outpatient letters to follow Professional Record Standards Body guidance to write directly to patients, and that private providers must send letters detailing costs and procedures under a Competition and Markets Authority order (Baroness Merron, Jul 2026). In February 2026, the Thirlwall Inquiry legal team noted that guidance was published in 2018 and 2021, and recorded that exploring how to monitor progress and make the process easier for professionals remained to be done (The Thirlwall Inquiry legal team, Feb 2026).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
About this summary
This recommendation applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accept
Guidance across the healthcare system now states that consultants should write directly to patients and in a way they understand. Key stakeholders have committed to writing to their members to encourage uptake.
Over the next 12 months, we will explore with providers how their systems can change to make the process of writing to patients easier for healthcare professionals and how this can be monitored.
The government accepts this recommendation in full and agrees that the language used by consultants when writing to patients should always be accessible.
Delivery
Department of Health and Social Care says in progress (16 July 2026)
In October 2021, the Professional Record Standards Body (PRSB) updated its guidance on standard outpatient letters to make it clear that it is best practice for most outpatient letters to be written directly to the patient. The NHS Standard Contract states that outpatient letters should be consistent with PRSB’s standards. All National Health Service and independent sector providers are regulated by the Care Quality Commission, and assessments include how services ensure that patients understand and are involved in decisions regarding their care. As per the Competition and Markets Authority’s Order, private healthcare providers must send letters to patients prior to consultations or further tests and treatments setting out the costs, reasons, and other relevant information regarding the procedure.
From: Patients: Safety (written question UIN HL1746)
Site note: Baroness Merron answered HL1746, HL1747 and HL1748 together on 16 July 2026. HL1746 asks about compliance with this recommendation, and the row holds the answer's first paragraph, which is on it. The answer's later paragraphs are on the Paterson Inquiry Response Programme Board and on the recommendations as a group.
DHSC and NHS England say in progress (27 February 2026)
The Hospital Discharge Service policy and operating model (August 2020) details the discharge requirements for all NHS trusts, community interest companies, private care providers of acute community beds and community health services and social care staff in England. It is published by the Department of Health and Social Care. The guidance, based on successful discharge to assess principles, aims to ensure that all individuals are discharged from hospital in a safe, appropriate and timely way. It includes patient information leaflets for a variety of different circumstances, as well as staff action cards summarising the responsibilities of health and care staff in the hospital discharge process.
Professional Guidance
In 2018, the Academy of Medical Royal Colleges (AoMRC) published guidance which states that letters should be written directly to patients, copying their GP (and provides a template). The AoMRC’s guidance is also reflected in National Institute for Health and Care Excellence (NICE) guidance on shared decision making.
In December 2021, the AoMRC, the Professional Record Standards Body (PRSB) and NHS Employers wrote to their members to remind them of best practice when writing to patients, referring to AoMRC’s guidance. In October 2021, the PRSB updated its guidance on standard outpatient letters to make it clear that it is best practice for most outpatient letters to be written directly to the patient.
The GMC updated its Good Medical Practice guidance to include communicating effectively with patients. This came into effect in January 2024.
Regulation
The NHS Standard Contract states that outpatient letters should be consistent with PRSB’s standards. All NHS and Independent Sector providers are regulated by the Care Quality Commission (CQC), and assessments include how services ensure that patients understand and are involved in decisions regarding their care. As per the Competition and Markets Authority’s (CMA) Order, private healthcare providers must send letters to patients prior to consultations or further tests and treatments setting out the costs, reasons and other relevant information regarding the procedure.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented – Ongoing”. Table row: section 29.2 No. P1 / Action 1.2, PDF page 740.
DHSC states no delivery position (15 May 2024)
Action 1.2
In 2018, the Academy of Medical Royal Colleges (AoMRC) published guidance which states that letters should be written directly to patients, copying their GP (and provides a template). In December 2021, the AoMRC, the Professional Record Standards Body (PRSB) and NHSE wrote to their members to remind them of best practice when writing to patients, referring to AoMRC’s guidance. In October 2021, the PRSB updated its guidance on standard outpatient letters to make it clear that it is best practice for most outpatient letters to be written directly to the patient. The NHS Standard Contract states that outpatient letters should be consistent with PRSB’s standards. The AoMRC’s guidance is also reflected in NICE guidance on shared decision making. All NHS and Independent Sector (IS) providers are regulated by CQC and assessments include how services ensure that patients understand and are involved in decisions regarding their care. As per the Competition and Markets Authority’s (CMA) Order, private healthcare providers must send letters to patients prior to consultations or further tests and treatments setting out the costs, reasons and other relevant information regarding the procedure. The GMC updated its Good Medical Practice guidance to include communicating effectively with patients, which came into effect in January 2024.
From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024), The Department of Health and Social Care
Site note: DHSC's own comments on progress, supplied to the Thirlwall Inquiry in February 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). They are not a finding of the Inquiry. Table row: section 26.2 No. P1 / Action 1.1, 1.2, 1.3, PDF page 729-735.
Earlier statements on delivery (2)
Department of Health and Social Care (15 December 2022)
In December 2021, the AoMRC, PRSB, IHPN and NHSE wrote to their members to remind them of best practice in writing letters to patients, pointing to the AoMRC’s Please, write to me: writing outpatient clinic letters to patients guidance.
Independent practitioners must, as per the CMA order, send letters to patients prior to consultations or further tests and/or treatments setting out:
costs
reason for the procedure
other relevant information
NHSE will consider a project plan to drive culture change in this area, dependent on availability of appropriate resource.
Communicating effectively has been incorporated into the GMC review of Good medical practice. Updated guidance is due to be published in early 2023.
Department of Health and Social Care (23 March 2021)
NHS England and NHS Improvement will examine how current guidance published by the Academy of Medical Royal Colleges (AoMRC) in 2018 on writing outpatient clinical letters addressed to patients (and copied to their GP) using simple, appropriate language can be incorporated into the requirements of the NHS standard contract.
Site note: Written statement HCWS869 of 23 March 2021, made by Nadine Dorries, Minister of State for Patient Safety, Suicide Prevention and Mental Health, for the Department of Health and Social Care. It prints this recommendation and gives this passage under it.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (27 February 2026)
Action 1.2:
Accepted by the government.
Guidance was published in 2018 and 2021 stating that consultants should write directly to patients in a way they understand.
The next 12 months will explore how to make the process of writing to patients easier for professionals and how to monitor this.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 29.2 No. P1 / Action 1.2, PDF page 740.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
Action 1.2:
Accepted by the government.
Guidance was published in 2018 and 2021 stating that consultants should write directly to patients in a way they understand.
The next 12 months will explore how to make the process of writing to patients easier for professionals and how to monitor this.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 26.2 No. P1 / Action 1.1, 1.2, 1.3, PDF page 729-735.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - DHSC
Delivery statement - Thirlwall Inquiry legal team
Finding