The solicitor’s email arrives with a hearing in it. They want a letter by Thursday. A relative has already drafted something that says this person is kind, unwell, and not a risk to anyone. That draft is a character reference with a diagnosis stuck on the end. It is not what the court can use, and it is not what I will sign.
A medical letter criminal case work actually needs is a structured assessment. Bail, curfew, fitness to attend, fitness to be interviewed, the effect of a condition on compliance: those are questions about function and risk. They are not an invitation to take sides. The doctor writes what the examination supports. They do not write the defence.
The real question is whether the solicitor has asked a medical question, and whether anyone has examined the person in order to answer it.
Chest pain, signs of a stroke, severe breathlessness, heavy bleeding, a severe allergic reaction or symptoms of sepsis need 999 or A&E immediately.
What a medical letter criminal case requires
The short version is this. Bring the solicitor’s exact questions. Vague requests make weak letters. “Please help with court on Friday” is not a question. “Please assess current mental state, current treatment, and whether this person can comply with a curfew at this address” is a question. I may still not be the right expert for all of it. If I am not, I will say so rather than stretching a GP letter over a gap that needs a psychiatrist or a psychologist.
Here is the longer version.
What I look at in clinic is the instruction first. Who is asking, for which hearing, and what they want the court to understand about health. Then the person, face to face, at 466 Green Lanes, or at a home visit if attending is the problem the letter is trying to describe. I take a history that would survive being asked about later: the condition, the course, the treatment, the substance use if that is part of the picture, the sleep, the memory, the last time they missed an appointment, the last time they coped with a queue, a cell, a long hearing. I examine. Mental state if that is the issue. The relevant physical systems if the issue is mobility, pain, a chest, a need for medicines at set times. I read the papers they have sent, including previous reports, rather than glancing at a covering email.
The pattern matters more than the single reading. A composed 30 minutes in a quiet room is not proof that a six hour hearing will be fine. It is also not proof that it will be impossible. I will say what I found, what I was not able to test, and what a reasonable adjustment might look like: breaks, a ground floor room, a time of day, a person to sit with. I will not say that the prosecution has the wrong defendant. That is not medicine.
When this comes up in consultation, families want me to like the person. Liking is irrelevant. Independent is relevant. From our practice, the useful letters are dull: dates, findings, limits, an opinion that stays inside the question. The letters that cause trouble later are the warm ones. Warmth reads as taking a side. Courts are not confused by that. They discount it.
The piece most people miss is risk. If the question is bail or a curfew, I need to talk about the things doctors are actually qualified to comment on: whether a condition would make compliance harder, whether medicines have to be taken at night, whether memory is impaired in a way that makes conditions difficult to follow, whether a house is needed for a specific treatment. I am not a probation officer. I do not assess offending risk in the round. If that is what they wanted, they have instructed the wrong professional, and we say so on the first call if it is obvious from the email.
Duty, not loyalty
It is worth saying plainly. I have a duty to be honest. If the person is instructing me through their solicitor, they are still not entitled to a favourable opinion. They are entitled to a competent one. If the examination does not support what they hoped, they hear that before a letter is produced. They can still have a letter that sets out the true picture. They cannot have a letter that writes the defence.
I will not backdate. I will not copy a draft. I will not write about a person I have not seen. I will not guess a diagnosis to fill a gap in the papers. I will not comment on guilt. I will not offer a view on whether a sentence should be suspended. Those last two are for the court.
If the work is in fact an expert report with a duty to the court, that is a different product. A short GP letter and a medico legal report are not interchangeable. The report takes the documents, the time, and a fee agreed in writing. Do not ask for the letter and hope the court will treat it as the report.
When to come in sooner
Come in sooner if the hearing is already in the diary. Give us the date on the first call. We will say what is realistic. We will not invent a Thursday letter on a Wednesday afternoon if the papers have not arrived and the person has not been seen.
Come in sooner if fitness to attend or fitness to be interviewed is the live question, and nobody has assessed that recently. Old clinic letters that mention low mood in 2023 are not an assessment of today’s interview.
Do not use a letter appointment as the response to a medical emergency, and do not bring someone in crisis to Palmers Green when they need A&E.
- Chest pain, stroke signs, severe breathlessness, heavy bleeding, a severe allergic reaction, or sepsis: 999.
- A person who is not safe, who has a plan to harm themselves, or who is so unwell in their mind that they cannot be left: 999 or A&E.
- A head injury, a first seizure, collapse, or they cannot be woken: 999.
- Acute withdrawal that is shaking, confused, or fitting: A&E, not a GP letter slot.
- A child with a fever who is floppy, or a rash that does not fade: 999.
- Severe breathlessness or chest pain after substance use: 999.
How we approach this at Clinique Alpa
The solicitor, or the person, calls 020 8882 8088. WhatsApp enquiry is 447742163571, without putting charge sheets in the thread. Send the questions, the date, and a list of the papers. We confirm the fee in writing before work begins. A 30 minute clinic appointment is £100 if this is first a GP assessment. Supporting letters of this kind are confirmed after we have seen the instruction, because the length follows the questions. Injury and accident confirmation letters are listed from £500 on the appointments and fees page. Home visits £250 day, £450 night, if the house is the necessary room. A referral letter is £50 if the honest next step is a specialist, not me.
This is done face to face after a proper assessment. I read. I examine. I write to the questions. The letter goes to the instructing solicitor, or to you, securely. I do not attend court on the back of a short letter unless that has been separately instructed as expert work.
Process and independence are set out on the medical reports page. If you want to know who is writing it, read about us. GMC 6113670. If the product is in fact a full report, say that on the call so we do not start the wrong job.
Bring the exact questions. Then come in. The letter is the assessment, written down. It is not a favour to the defence.
A structured assessment, written to the solicitor’s questions, not a character reference. Read our fees page, or call 020 8882 8088. Clinic 30 minutes £100. Fees for supporting letters confirmed in writing. In an emergency call 999. Subject to availability.
Written by Dr Mitesh Parmar, MBBS MRCGP, GP and founder of Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.