The letter that asked a question

A referral letter usually opens with a history. The practice tried opening with the question instead, and the replies started arriving faster.

The change was administrative rather than clinical. Certain patients were flagged to a named clinician, and the booking system stopped offering them anyone else.

The referral that worked

The referral letter was rewritten to lead with the question rather than the history, which cut a round of clarification out of most onward pathways.

Specialists were spending a letter working out what we wanted. So we put it in the first line.

Dr. Priya Ramanathan, general practice

The third appointment

The practice runs a flag on anyone presenting three times with the same complaint and no diagnosis, regardless of what was concluded each time.

Median time to first contact fell by nineteen days across the year, on no extra staff.