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Background, issues and progress

  • Last modified date:
    8 February 2007

The Copying Letters to Patients initiative is a government objective which originated in the NHS Plan: "letters between clinicians about individual patient's care will be copied to the patient as of right".

Rationale

The NHS has an obligation to involve patients in decisions about their health care and communicate with them. Copying letters is an effective way of keeping patients up-to-date with their diagnosis and treatment and demonstrates a commitment to good communications and valuing patients.

Evidence

Engaging and informing patients is at the heart of good clinical practice.  Involving patients also pays dividends in terms of outcomes.  We know that almost half of patients with chronic conditions do not take their medication as recommended, resulting in huge personal and financial cost in avoidable continuing illness and premature death, as well as increased health expenditure.  The traditional method of "compliance" (follow doctor's orders and take your medicine) does not work very well.  By contrast, there is clear evidence that shared decision making - concordance - in which patients understand and negotiate with clinicians the best course for themselves, can lead to higher follow through with the agreed course of treatment and better outcomes and satisfaction.  Copying letters to patients is an important strand of involving patients in understanding and agreeing their treatment.

(Evidence from the Royal Pharmaceutical Society and reported in the Pharmaceutical Journal)

Resource implications

There are no additional funds available for copying letters. Copying letters is based on best practice and organisations must decide how they will deliver this policy in the most cost effective way possible. Not only that, but it is consistent with the spirit of openness underpinning the Data Protection and Freedom of Information Acts. All organisations should be taking steps to improve communications with patients and involve them in decisions about their treatment and care. Copying letters is one way they will do this. It is not intended to increase the burden on staff and organisations, but to bring benefits and savings in the long run.

We do not have any hard evidence of the costs of implementation but we prefer to look at it as a resource issue, because copying letters has benefits for the clinician/patient relationship and as such improves compliance and potentially leads to more effective treatments, fewer repeat enquiries etc.  Therefore implementation is more broadly about resources rather than costs.

Timetable

NHS organisations were to have implementation plans in place from April 2003 onwards, with full implementation from April 2004. 

However, the Copying Letters to Patients initiative signals a major change in culture for the NHS and full implementation is not yet complete across the country.  Therefore the Department is continuing to drive forward this important initiative by working with Strategic Health Authorities and Primary Care Trusts to develop a long term communications strategy.

Forward look - picture of changes brought about

There are many potential benefits of copying letters between professional to patients, including:

  • more trust between patients and professionals: Increased openness leads to greater trust and openness between professionals and patients
  • better informed patients: Patients and carers have a better understanding of their condition and how they can help themselves
  • better decisions: Patients are more informed and better able to make decisions about treatment options
  • better compliance: Patients who understand the reasons for taking medication or treatment are more likely to follow advice
  • more accurate records: Errors can be spotted and corrected by the patient
  • better consultations: Professionals confirm that patients understand what is said during the consultation. Patients are better prepared and less anxious
  • health promotion: The letters can be used to reinforce advice on self-care and life styles
  • clearer letters between professionals: Letters written between professionals are clear and understandable to both professional and lay people.

A continued focus on "copying letters to patients" will confirm that the NHS is serious about putting patients at the heart of its work.

Additional links

Copying letters to patients learning resource

This resource has been developed with contributions from over 60 NHS organisations. It presents their experiences of implementing Copying Letters to Patients.

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