VHG clinical guidance for GP letters

This document outlines some guidance and expectations for clinicians on writing letters to GPs on clients’ behalf where there is a need or a request from a client to do so.

1.       When a GP letter is required. 2

2.       Client consent for GP letters. 2

3.       What to include in a GP letter. 2

4.       What to avoid in a GP letter. 3

5.       Support for therapists. 3

1.    When a GP letter is required

1.  A GP letter may be needed when a client is presenting with significant risk or there are safeguarding or other welfare concerns. A GP letter may be advised or requested in such cases by the Risk Duty team
2. A GP letter may be helpful for a client in sharing information related to the client’s mental health and wellbeing and we encourage open discussions about this during therapy
3. A GP letter may be required for the purpose of sharing relevant information relating to the safety and wellbeing of others who may be affected by the client’s actions, including a child or vulnerable adult.
   
4. A GP letter may be requested or agreed to by a client to assist them in accessing a referral for further psychological support, assessments, or medical care after their discharge from VHG.
5. A GP letter is not required for every client on discharge as standard practice and should be decided on a case-by-case basis.

2.    Client consent for GP letters

1. As part of the contracting process, clients should be asked in their initial session whether they consent to information sharing with their GP or other professionals involved in their care.
   
2. If a client consents to information sharing, it is still best practice to discuss any contact we may need with other professionals, including GP letters, at the time the need arises.
   
3. Discuss with the client the purpose of the letter and what it will contain wherever possible.
   
4. If a client does not consent to information sharing in the initial session, we may still need to discuss with them if we feel it would be appropriate or helpful to inform their GP of a concern or approach the GP for further support. However, if the client still does not agree, and the concerns do not reach the threshold for breaching client confidentiality on the grounds of risk or safeguarding a child or vulnerable adult, the client’s autonomy should be respected. The Risk Duty team can advise if there are any concerns or doubts about whether there is cause to override consent in specific cases.
   
5. If there are significant concerns about risk, safeguarding or welfare, the Risk Duty team can advise and support. Any decision to write a GP letter against a client’s wishes should first be individually assessed with the Risk Duty team and the decision documented on the case management system.  The risk team can be contacted at network.clinical@vitahealthgroup.zohodesk.eu ensuring that you write "Risk Review" in the subject bar. 
6. It is good practice to check the client’s GP details on their file are correct before creating a GP letter so that we can ensure the letter goes to the correct practice/GP and avoid the risk of a data breach.

3.    What to include in a GP letter

1. Technical guidance for using the MPB system to create a GP letter is available here: Therapist User Manual - Creating a GP Letter (zohodesk.eu).
   
2. A GP letter can also be manually created by using the template here: VHG GP Letter Template (zohodesk.eu)
   

1. GP letters should include the correct GP name, address, and email – please check with the client before writing that we have the correct details on file to ensure that we avoid a data breach through information being sent to a practice the client no longer uses.
   
2. Use the client’s correct name and preferred pronouns.
   
3. Professional, formal written English should be used. Avoid using slang or acronyms.
   
4. The GP letter should contain brief and relevant details of the presenting issue(s) and needs, including any risk of harm to self or others, and details of what you are requesting from the GP on the client’s behalf, such as a medication review, a review of their support, or an appointment to discuss a referral to further psychological support services.
   
5. The tone of GP letters should remain professional and collaborative and not instructive or combative, even if a client expresses frustration with their GP practice.
   
6. Letters must be VHG headed with the correct VHG contact details at the bottom (phone 0333 222 0710 or email Vitahealthgroup.VHGPTS@nhs.net) not personal mobiles or email addresses.
   
7.  All communication between therapists and GPs must be documented on our system.
   
8. Check spelling, grammar, punctuation, and formatting before finalising the letter. 

4.    What to avoid in a GP letter

1. Ensure that the details given in the letter are kept to what is relevant to the issues that require the GP’s support. Avoid giving excessive detail about the content of therapy sessions.
   
2. Avoid giving subjective opinions or judgements about the client’s difficulties, or any significant others in the client’s life.
   
3. When requesting a referral for a diagnostic assessment, be clear that it is assessment and not diagnosis being requested, as diagnosis is not within the scope of therapy.
4. Recommendations to refer for any specific diagnostic assessment or to a specific service should not be made without prior discussion with and agreement from the client.
   
5. Avoid using GP letters as an outlet to vent a client’s frustrations with their care. If you are concerned about the quality or safety of care a GP practice is providing, clients can be signposted to the appropriate complaints procedure via the practice and/or local Integrated Care Board (ICB) and to any local advocacy organisations that may be able to support them in that process.

5. Support for therapists

1.  If you require support with a GP letter from a technical or system perspective, please raise a ticket here: Vita Health Group | My Area | Submit a Ticket (zohodesk.eu) and our operations team will be in touch.
   
2.  If you require clinical support with a GP letter, please contact network.clinical@vitahealthgroup.zohodesk.eu
   
3. If you require support with risk or safeguarding concerns, please contact network.clinical@vitahealthgroup.zohodesk.eu ensuring that you write "Risk Review" in the subject bar.