Are written responses to referrals acceptable?

Editor—Tso et al highlight the potential effective use of communication in writing between primary and secondary care when both doctors—the general practitioner and the haematologist in this case—can complement each other and hence reduce unnecessary duplications of investigations and the burden on outpatient departments.¹

The same process may be applied between general practitioners and other specialists and between hospital doctors when they refer patients to each other. For this to work effectively, however, the initial referral communication has to provide sufficient relevant clinical details that allow specific advice to be given by the specialist. For example, in this survey how many general practitioners' letters provided all the information the consultant haematologist felt necessary to give safe written advice without assessing the patient personally?

The conditions referred in the paper are heterogeneous. Some conditions such as an isolated raised mean corpuscular volume seem appropriate to give advice on while others such as leucopenia and polycythemia seem of sufficient importance to require a direct assessment by a haematologist. How many general practitioners would be sufficiently reassured by written advice alone in such cases and how many haematologists would be sufficiently confident to give such advice without more detailed haematological assessment?