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Outpatient Clinic Letter

Find out about Outpatient Clinic Letters, including advice on how they should be implemented in England.

To support the delivery of high quality care, there's an increasing need to share information more efficiently and consistently across health and social care. The Transfer of Care Initiative aims to improve patient care by promoting and encouraging the use of professional and technical document standards.

Using standards in electronic healthcare records allows clinical information to be recorded, exchanged and accessed consistently to deliver high quality care to patients.

Other benefits include:

  • improved patient care and safety due to the availability of complete, accurate and timely information
  • reduction in the risk of missing or inappropriate critical clinical information
  • reduction in costs by removing the administrative task of correcting information and eliminating paper exchange

To support this care integration, the timescale for the production and transmission to GPs of letters (where clinically required) following clinic attendance is reducing. The current requirement is to produce the letter within 10 days of attendance.

From the 1 October 2018, the Outpatient Clinic Letter must:

  • conform to the clinical record standard headings
  • be sent nationwide (in and out of catchment areas within England) using any direct electronic transmission including proprietary solutions, except email, which will no longer be allowed
  • use a nationally specified structured message capable of carrying narrative, SNOMED CT and dm+d encoded information

These requirements are detailed in the NHS England Standard Contract Technical Guidance, section 39.22.

Outpatient Clinic Letters standard

The Professional Record Standards Body (PRSB) has published the PRSB Standards for the Structure and Content of Health and Care Records, which replaces the Academy of Medical Royal College's Publication Standards for the Clinical Structure and Content of Patient Records, published in 2013. 

The PRSB standards have been updated to reflect current professional practice and incorporate new or changed structured content resulting from the development of detailed Transfer of Care standards. They have been developed with input from thousands of professionals from all health and social care specialties, carers and people who access services. They agreed what information is essential to share in order to provide timely, high-quality care efficiently that is well-coordinated and meets an individual’s needs.

This is the first major release since 2013 and PRSB has produced guidance, FAQs and other materials to help organisations and system suppliers replace previous versions of the standards in their information systems. 

The PRSB Outpatient letter standards are the headings that must be implemented in Outpatient Clinic letters by 1 October 2018.

Technical standards

Providers are reminded that, as detailed in the NHS England Standard Contract Technical Guidance, from the 1 October 2018 they must have aligned their Outpatient Clinic Letters with the nationally published specification.

Transfer of Care documents must be sent within England (in and out of catchment areas) by any direct electronic transmission, including proprietary solutions, except email, using a structured and coded message specification capable of carrying SNOMED CT encoded diagnosis, procedures, allergies and dm+d encoded medication information.

NHS Digital has adopted Fast Healthcare Interoperability Resources (FHIR) based structured document standards for Transfer of Care. Download the Transfer of Care FHIR specifications.

The Transfer of Care FHIR messages will use the ITK3 (Interoperability Toolkit) specification.

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Last edited: 1 October 2018 1:32 pm