The email usually arrives with a specialist’s name already chosen. Someone has been on a waiting list long enough to have learned the spelling of the clinic. They want the letter today, because the private appointment is on Thursday, and Thursday will not go ahead without a referral sitting in that inbox.
The real question is not whether I can type a name onto headed paper. It is whether a private referral letter is the right next step, or whether we are skipping the part where someone actually looks.
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 private referral letter has to contain
People ask for the document. What they need is a usable one. A usable letter is not a stamp. It is a short, structured account of what has been examined, what has already been tried, and why this person needs this specialty now rather than later, and rather than a different door.
The short version is this. I can often send that letter the same day, once I have seen you. I cannot promise that the specialist will take you next week. That is not mine to give. Clinics run their own lists. A letter that pretends otherwise is a letter that a good secretary learns to ignore.
Here is the longer version. A specialist reads hundreds of these. The ones that get a date answer the clinical question in the first paragraph: what the problem is, how long, what the examination showed, and what the referrer wants done.
A letter that only says you would like to see a knee surgeon, because the knee hurts, has told the surgeon nothing they could not have guessed from the subject line. A letter that says the joint is warm, the range is reduced in one plane, there has been night pain for 6 weeks, simple pain relief has not changed the picture, and the x ray is already in the packet, has done its job.
It is worth saying plainly. No assessment, no honest referral. That is the line. If I have not examined you, I am guessing, and a guessed referral is how people wait 4 months for the wrong clinic.
What I look at before I write one
What I look at in clinic is the story first, in the order it actually happened, not the order it was typed into a search box at midnight. When this started. Whether it is new or an old pattern that has changed. What you have already tried, including the things you assume do not count: rest, a bandage, a friend’s tablets, a week of waiting because work was busy.
Then the examination. The part most people miss is that I am often ruling something else out while I appear to be looking at the thing you booked for. Abdominal pain that is really a chest problem. A headache that is really blood pressure. Fatigue that is really a mood change, or iron, or both. The referral destination changes if that second layer is sitting there.
I ask what has already been done on the NHS, and what the last letter actually said, not what you remember it said. Bring that letter. Bring the scan report. Bring the blood printout if you have one. I would rather read a clumsy photocopy than write a referral that duplicates a test from March.
I also ask who you want the letter to go to, and why that name. Sometimes the private appointment was booked first, and the referral is being reverse engineered to fit a diary. We can still write a proper letter. We should not pretend the sequence was the medical one.
Red flags change the destination. New neurological signs, unexplained weight loss, bleeding, a breast lump, swallowing that has become difficult: those are not routine outpatient letters. Some leave this room for A&E. Some go as an urgent suspected cancer referral on the NHS, which is often the faster and the correct route even if you also want a private opinion. I say so if that is the case.
If the picture is unclear, I do not dress that up. I do not know yet, let us look again in 2 weeks, is a legitimate sentence. So is: I want bloods first, then the letter, because the destination may change when the numbers come back. Nothing is rushed, because medicine done properly takes time. That time is the point.
When the letter is the right tool, I write what the examination supports. I do not write the case for a particular surgeon. I do not promise an outcome. Accuracy is what gives a letter weight.
When to come in sooner
Come in sooner, or go straight to A&E, if any of these are true. This is routing, not a complete list.
- Chest pain, signs of a stroke, severe breathlessness, heavy bleeding, a severe allergic reaction, or symptoms of sepsis.
- A new lump, unexplained bleeding, swallowing that has become difficult, or weight loss you cannot account for.
- Pain or neurological change that is getting worse over hours rather than weeks.
- You have been told you need an urgent suspected cancer pathway and you have not yet been referred.
- You cannot wait for a routine clinic because you cannot work, cannot sleep, or cannot eat.
- A specialist has already asked for a GP letter with specific questions, and the date is close.
If the problem can wait a few days, book an ordinary slot and bring the paperwork. If it cannot, say that when you ring. We will tell you honestly whether the diary can take you, or whether 999 or A&E is the safer door.
How a referral is done here
You are seen face to face at Clinique Alpa, 466 Green Lanes, Palmers Green, or on a home visit if leaving the house is the problem. A 30 minute clinic appointment is £100. The referral letter itself is £50. Those figures are published. We agree them before the work, not on the way out.
If I cannot write the letter you asked for, because the examination does not support it, we say that too. You still leave with a plan. With your consent we send a summary to your NHS GP, so the record stays joined up.
Read the fees page before you book if money is part of the decision. If the document you need is a report rather than a referral, the medical reports page sets out that work separately. They are not the same product. A referral asks a colleague to take over a piece of care. A report is evidence written for someone who is not treating you.
Bring the specialist’s email or the form if that is what started this. If the letter can go the same day, it does. If I am waiting on a result, it waits.
Get the letter written after someone has actually examined you. Read our fees page, or call 020 8882 8088. A 30 minute appointment is £100. A referral letter is £50. Home visits £250 in the day, £450 at night, published in full. 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.