Clinic letters & admin / Letter
Did not attend - letter before discharge
Gives someone a defined window to get back in touch before they are discharged, rather than removing them silently.
Dear [], I see that you did not attend your appointments in my clinic on [] and []. I hope that this is not because you have been unwell. If you would still like to be seen, please contact us on the number below within the next three months and we will arrange another appointment. You are also welcome to telephone to discuss things instead of coming in, if that is easier. If we do not hear from you within three months, you do not need to do anything further and you will be discharged from the clinic. Your GP will be informed. If you need to be seen again after that, your GP can refer you back. If any of the following happen, please see your GP without waiting: a cough that will not go away or is getting worse, coughing up blood, worsening breathlessness, chest pain, or losing weight without trying to. If there is something that makes it difficult for you to attend - the time of day, getting here, needing an interpreter, or anything else - please tell us. We can usually work around it. With all best wishes, Yours sincerely,
Variants
Straightforward discharge after non-attendance
When the referral question is answered, the risk is low, and there is no reason to hold the slot open.
Dear [], I see that you did not attend your appointment in my clinic on []. I hope this means that your symptoms have settled. I am therefore discharging you from the chest clinic, and I have written to your GP to let them know. If you develop worsening cough, coughing up blood, worsening breathlessness, chest pain, or weight loss that you cannot explain, please see your GP, who can refer you back to us. With all best wishes, Yours sincerely,
How to use it
Non-attendance is a marker of risk rather than of disinterest, and it is concentrated in exactly the groups least well served already, so this version keeps a window open and asks what got in the way. The offer of a telephone conversation and the invitation to name the obstacle both exist because the commonest reasons are work, caring, transport and language rather than choice. The safety-netting sentence is the important one clinically: it should be specific, so use the second version only when the referral question has actually been answered. Check local policy — some trusts require a specific number of contacts before discharge, and some require the GP to be copied.
Why it says that
None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.
- NHS England guidance on patient-initiated follow-up and did-not-attend policy Discharge after non-attendance should follow a policy that accounts for clinical risk and for vulnerability, rather than being automatic.
- Academy of Medical Royal Colleges: please write to me Write to the patient directly, in plain English.