Evaluation of correspondence to patients and General Practitioners in a Psychiatry unit

Background- Clear, effective and prompt correspondence between psychiatrists and General Practitioners (GPs) is a key method of providing safe and timely care for patients with mental illness. Sending a copy of the letter to the patient is an important component of patient-centred care. The Department of Health (DH) guideline (2003) on letter writing to GPs and copying letters to patients is the cornerstone for NHS trust policies in this domain. Aims – The aim of this paper is to review the guideline as it is now a decade old and may not have kept abreast of changes to NHS structures and practise in the interim. Methods – We conducted a systematic literature review from January 2012 to February 2013 on relevant articles published by January 31, 2013 Results – Ideally letters to GPs should be short (up to 300 words/ two A4 pages) with some standardisation of structure. Content should include risks, prognosis and detailed management plans in addition to existing DH guidelines. Copying letters to patients is routine NHS practice. Patients (80%) like them; elderly patients less so. Not all letters should be copied (20%) to patients. Issues other than those identified in the DH guideline to consider are: patient capacity; safeguarding and significant information not discussed with the patient. Recommendations – Letters to GPs should be short and semi-structured to include content in line with the DH guideline and issues of risk, prognosis and detailed management plans. Copying the letter to the patient, whilst a default position is not always apt. Consideration should be given to changes in legislation and policy – particularly the Mental Capacity Act and Safeguarding. We recommend referring to an updated flowchart based on the results of this review and the earlier DH guideline and consider when to send a separate letter to the patient instead of copy of the GP letter.