A GP referral letter for OET Writing (medicine), taken apart

Referral letters are a staple of OET Writing for doctors; OET's own medicine sample task asks for one to a gastroenterologist. Below are an invented case, a finished letter and the reasoning behind each choice.

The task

You are Dr Fiona Callander, a GP at Ashgrove Medical Practice, Wexley. Today is 9 November 2026. Using the case notes, write a letter referring Mr Pellow on the suspected cancer pathway to Mr Anthony Merriman, Consultant Colorectal Surgeon, Wexley General Hospital, Hollins Road, Wexley.

The case notes

An invented case, not an official OET task.

• Mr Graham Pellow, DOB 04/03/1959 (67)
• Social: retired postman; main carer for wife Sheila (70, Alzheimer's dementia); son in Leeds; enjoys sea fishing; ex-smoker (stopped 2001); alcohol about 6 units/week
• PMH: hypertension since 2014, well controlled; CKD stage 3a; R inguinal hernia repair 2010; NKDA
• Medication: for hypertension only, unchanged for 3 years; no anticoagulant or antiplatelet medicines
• FH: father bowel cancer aged 74; mother stroke aged 81
• NHS bowel screening kit 2024: normal
• 02/10/2026: since mid-August (7/52), looser, more frequent stools (up to 4/day; was once daily); no blood seen; no abdominal pain; tired; appetite reduced
• Weight 82 kg in June, 77 kg on 02/10 (about 6% in 4 months)
• O/E: pale conjunctivae; abdomen soft, non-tender, no mass; DRE: no rectal mass
• Bloods 02/10: Hb 98 g/L (ref 130 to 170); MCV 76; ferritin 9 micrograms/L (low): iron-deficiency anaemia; LFTs, TFTs, CRP normal; coeliac serology negative
• Relevant to investigations: eGFR 52, stable (50 to 55 over 2 years)
• FIT returned 20/10: 142 micrograms Hb/g faeces
• 09/11 review: symptoms unchanged; told he is being referred to a cancer service, that most people referred do not have cancer, and that colonoscopy or CT colonography may be offered; leaflet given; agrees to referral
• Asks for as much notice of appointments as possible, to arrange cover for his wife; happy for this to be passed on; mobile 07700 900461
• Plan: suspected cancer pathway referral (lower GI) today; GP review after specialist assessment

The model letter

Above the greeting go Mr Merriman's name, title and address, copied from the task, then the date and a subject line, for example "Re: Mr Graham Pellow, DOB 04/03/1959".

Dear Mr Merriman,

I am referring Mr Graham Pellow, aged 67, on the suspected cancer pathway for urgent investigation of possible colorectal cancer. He has a change in bowel habit, iron-deficiency anaemia and a raised faecal immunochemical test (FIT) result.

Since mid-August his stools have been looser and more frequent, up to four times daily, with no blood seen. He has lost 5 kg in four months (82 to 77 kg), with tiredness and reduced appetite. His father had bowel cancer at 74. On examination he was pale, with no abdominal or rectal mass.

On 2 October, his haemoglobin was 98 g/L with a low ferritin. His FIT on 20 October showed 142 micrograms of haemoglobin per gram of faeces.

He has stable stage 3a chronic kidney disease (eGFR 52) and well-controlled hypertension, and takes no anticoagulant or antiplatelet medicines.

I have explained that this is a cancer service referral, that most people referred do not have cancer, and that colonoscopy or CT colonography may be offered. As his wife's main carer (she has dementia), he would appreciate as much notice of appointments as possible. His mobile is 07700 900461.

I would be grateful if you could assess and investigate him urgently.

Yours sincerely,

Dr Fiona Callander, General Practitioner, Ashgrove Medical Practice

The body, from "I am referring" to "urgently", is 199 words.

Taking it apart

The opening

A surgeon triaging referrals decides what to do next from the first two sentences. So the opening names the patient, the pathway and the question (possible colorectal cancer), and the second sentence gives the three findings behind it. OET's Purpose criterion wants the reason for writing clear from the start and expanded in the letter: here the opening states the referral and the last line turns it into a request.

The order

The notes run by date. The letter follows the questions a colorectal surgeon asks in turn: is this a red-flag presentation (history and examination), what do the tests show (bloods and FIT), can he be investigated safely (kidneys, blood thinners), and what does the patient know and need. Each middle paragraph answers one, so nothing needs hunting.

Why these facts went in

• Two weights and a time span: NICE NG12 lists, for people aged 60 and over, unexplained weight loss greater than 5% within a six-month period as a symptom of concern. This is about 6% in four months, and the figures show it.
• The father's bowel cancer: it changes the surgeon's sense of risk; the mother's stroke does not.
• "No rectal mass": NICE says a rectal mass needs no FIT before referral is considered, so the surgeon will look for this normal finding.
• The FIT figure and the haemoglobin: the referral rests on them. The ferritin becomes simply "low".
• Kidney function and blood thinners: teams usually ask about both before planning bowel preparation, contrast or polyp removal.
• His caring role and mobile number: NICE asks GPs to pass on, with the patient's agreement, circumstances that create extra support needs. He asked for early notice and agreed to this being passed on, and it affects booking.

The request

"I would be grateful if you could assess and investigate him urgently" is polite and leaves no doubt about timing. It does not choose the test: colonoscopy and CT colonography appear only as what the patient was told, so that decision stays with the specialist.

Tone

UK surgeons are usually addressed as Mr, Miss, Mrs or Ms rather than Dr, hence "Dear Mr Merriman". The reader is a senior medical colleague, so FIT, eGFR and CT colonography stay, with FIT spelled out once. Note form becomes sentences ("pale conjunctivae" becomes "he was pale"), and his own cancer is mentioned only as a possibility and as what he was told, never as a finding.

What stayed in the notes

• Retirement, fishing, the son, smoking history and alcohol: without them he would be triaged and tested no differently.
• The hernia repair, NKDA and the mother's stroke: no bearing on this referral.
• The 2024 screening kit: NICE says FIT is still offered after a negative screening result, so it changes nothing for the reader.
• No abdominal pain, unchanged symptoms, the MCV, LFTs, TFTs, CRP and coeliac serology: negatives or detail already covered by "iron-deficiency anaemia".
• The leaflet, "agrees to referral" and the GP review: his agreement is implied; the rest is practice housekeeping.

Length and format

OET gives a range of about 180 to 200 words for the body. Straying outside brings no automatic penalty, but a much longer or shorter letter usually reveals weaknesses the criteria pick up. Reading time is 5 minutes and writing time 40. On paper, you may not write, highlight or make notes during reading time, and you handwrite the letter in an answer booklet. On computer, you type it on a standard keyboard; OET says structure, content, length and marking are the same. OET does not prescribe one layout: any clear arrangement that suits the task is accepted.

The free OET Writing guide for doctors has another model letter, the six criteria applied to medicine and a final checklist.

Check the current rules. OET can change the format, the word guidance and the criteria, so confirm them on the official OET Writing page before you sit the test. Clodia is independent and not affiliated with OET or Cambridge Boxhill Language Assessment.