Private Letters and Reports

Purpose

This policy sets out the Practice's approach to requests for private letters, reports, certificates, and supporting statements that fall outside NHS contractual obligations.

Examples include, but are not limited to:

• Supporting letters for housing applications or housing priority requests
• Letters to schools, colleges, or universities regarding educational support or mitigating circumstances
• Letters supporting requests for workplace adjustments
• Private sickness certificates for periods not covered by NHS certification requirements
• Letters supporting benefit, travel, insurance, or other third-party applications where no statutory requirement exists
• Character references or statements regarding social circumstances

This policy does not apply to:

• NHS medical reports or certificates that are contractually required
• Private referral letters
• Subject Access Requests
• Statutory forms and reports covered by separate Practice policies

Policy statement

Requests for private letters and reports are considered non-NHS work and are not included within the General Medical Services (GMS) contract or other NHS contractual arrangements.

Accordingly:

• The Practice is under no contractual obligation to provide these letters or reports.
• Requests will be reviewed and considered on an individual basis.
• Provision of any letter or report is entirely at the discretion of the Practice and the clinician concerned.
• There is no automatic entitlement to a private letter, report, certificate, or supporting statement.

Clinical appropriateness and professional scope

When considering a request, the Practice will assess whether it is appropriate for a GP or other clinician to provide the information requested.

Factors that may be considered include:

• Whether the clinician has sufficient knowledge of the patient and their circumstances.
• Whether the information requested falls within the clinician's professional competence and expertise.
• Whether the clinician has adequate evidence available to support any statement made.
• Whether the request relates to matters more appropriately assessed by another professional, organisation, specialist service, educational institution, employer, or local authority.
• Whether sufficient relevant information exists within the patient's medical record.
• Whether providing the letter would create a conflict of interest or place the clinician in a professionally inappropriate position.

The Practice will not provide information, opinions, recommendations, or statements that cannot be supported by the patient's medical records and the clinician's professional judgement.

Factual information and advocacy

Where a private letter is provided, it will generally contain factual information that is documented within the patient's medical record.

Examples may include:

• Confirmed diagnoses
• Medication history
• Relevant symptoms or medical conditions
• Dates of consultations or treatment
• Information already recorded within the medical record

The Practice will not normally provide letters that:

• Advocate for a particular outcome.
• Guarantee eligibility for housing, educational support, benefits, workplace adjustments, or other services.
• Express opinions outside the clinician's expertise.
• Confirm circumstances that are not evidenced within the medical record.
• Make decisions that are the responsibility of third-party organisations.

Decisions regarding housing allocations, educational adjustments, examination mitigation, benefits, employment matters, and similar applications remain the responsibility of the relevant organisation. The role of the GP, where appropriate, is generally limited to providing factual medical information.

Equality and fairness

The Practice is committed to providing services fairly and without discrimination.

Decisions regarding private letter requests are based solely on considerations of clinical appropriateness, professional competence, available evidence, and workload capacity.

The Practice will not discriminate on the basis of age, sex, disability, race, ethnicity, religion or belief, sexual orientation, gender reassignment, pregnancy and maternity, marital status, socioeconomic status, or any other protected characteristic.

A decision not to provide a letter does not reflect the Practice's view of the merits of a patient's application or circumstances. It reflects only the Practice's assessment of whether it is appropriate for a GP or clinician to provide the requested statement.

Fees

• Private letters and reports constitute non-NHS work and are therefore chargeable.
• Fees will be charged in accordance with the Practice's current private fee schedule.
• Patients will be informed of any applicable fee before work is undertaken. Payment may be requested in advance.
• Payment of a fee does not guarantee that a letter will be provided or that a clinician will express a particular opinion or recommendation.

Timescales

Private work is undertaken in addition to NHS clinical duties.

The Practice will aim to complete agreed private letters within a reasonable timeframe. However, timescales cannot be guaranteed and may vary depending on clinical workload, staffing levels, and the complexity of the request.

Urgent requests may not be accommodated.

Requests that may be declined

The Practice may decline requests where:

• The request falls outside the clinician's professional competence.
• There is insufficient evidence within the medical record.
• The clinician does not have adequate knowledge of the circumstances.
• The request seeks advocacy rather than factual medical information.
• Another professional or organisation is better placed to provide the information requested.
• The request would require the clinician to make assumptions or provide opinions that cannot be substantiated.

Appeals

Where a request is declined, the Practice is not obliged to provide a detailed explanation beyond confirming that the request falls outside NHS contractual work and/or that the clinician does not consider it appropriate to provide the requested statement.

The decision of the Practice and the clinician regarding provision of a private letter is final.

Amendments and re-issue of letters and reports

The Practice aims to ensure that all private letters, reports, and certificates accurately reflect the information available within the patient's medical record at the time they are produced.

Once a letter or report has been completed and issued:

• The Practice will only consider amendments where a factual inaccuracy has been identified.
• Requests to alter wording, opinions, conclusions, or professional judgements that accurately reflected the clinician's assessment at the time of writing will not normally be accepted.
• Requests to amend letters to meet the requirements of third parties, where no factual error exists, will be declined.
• Any agreed amendments will be clearly documented and, where appropriate, a corrected version will be issued identifying the date of amendment.

The Practice will not:

• Re-date previously issued letters, reports, or certificates to make them appear current.
• Issue historic letters with a new date where the content relates to a past assessment, consultation, or opinion.
• Alter the original date of any document that has already been issued.

Where an updated letter or report is requested, the Practice may, at its discretion, provide a new document based on a current assessment and the information available at that time. Any such document will clearly state the date on which it was prepared and will not be presented as a retrospective opinion unless specifically indicated.

These measures are necessary to maintain the integrity, accuracy, and medico-legal validity of all documentation issued by the Practice.