In October 2015, the Care Quality Commission placed a GP Practice into special measures for finding 1,200 clinical letters not actioned, amongst other things. The letters spanned a period of twelve months and although distributed to doctors, had not been read. It’s clear that unread letters and reports put a patient’s treatment and care at risk and that un-actioned letters and reports is not ‘safe’ practice.

The Paper Flow Process

Establishing who is responsible for processing, reading and acting upon clinical letters and reports is crucial. As well as confirming when letters are scanned onto patient’s notes, filed and shredded.

Letters come from a variety of sources

Clinical letters come from different sources throughout a working day – mail, courier, fax, online reports and even email attachments. But how long does it take for a letter or report to be read by the intended recipient? And how are the different sources managed and prioritised?

Addressed to the Wrong Doctor?

A genuine problem for a Practice when processing clinical letters, is the marked recipient. There may be a delay in dealing with a clinical letter, simply because it has been addressed to the wrong doctor.

The Right Doctor is away!

More and more doctors work part time and naturally take time off for holidays, sickness, maternity or paternity leave, meetings and courses. So, the system designed should allow for absent doctors – who reads their clinical letters in their absence? And what is a reasonable time to wait before deputising the mail?

How urgent is it?

Many letters aren’t actually marked with ‘urgent’ or ‘immediate action required’, so letters that ask for referrals or tests can easily get missed. Furthermore, some letters might have more than one date on them – the clinic date, draft date and dispatch date. Ideally, the letter or report should be received, read and actioned before the patient needs attention at the medical practice and on receipt should be read right away.

Non-Clinical Staff

The Care Quality Commission, has made critical comment about the use of non-clinical staff to review clinical letters and triage the urgency.  When doctors read clinical mail they might mark data that needs to be recorded in the patient’s notes and suggest the codes that should be used, but is this a safe process?

Document Management Systems

Some practices use software, which provides each doctor with a file of scanned letters to review and comment on, before filing the letter on the patient’s notes. However, there are some instances where the letter is read by another doctor who isn’t necessarily treating the patient. Should they take action or delay the process and let the patient’s own doctor read the letter?

What is safe practice?

If you feel it’s time to review your clinical letter process, here’s some aspects to consider:

• All incoming mail should be sorted by named doctor and date stamped.
• All documents should be scanned onto a document management system or the patient’s notes on the date of receipt.

(The Practice should decide whether priority is given to letters received by fax/email or marked for immediate or urgent attention)

The Practice should:

• Implement a deadline for letters to be read and actioned by a clinician.
• Outline a clear process for absent doctors that exceeds the normal deadline.
• Have documented arrangements for deputising mail reading.
• Specify the time scanned documents should be retained.
• Conduct regular process audits to ensure correct patient filing and coding.

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Managing and delegation of post
Download our popular toolkit in the resources section on how to analyse your current system of incoming mail, both electronically and via post.