How to write a medication review action letter to a GP

How to write an action letter to a GP

An action letter to a GP does one job: it turns your clinical reasoning into a task the GP can approve in under a minute. To write an action letter to a GP that actually gets done, put five things in order for each recommendation, the reason you looked, what you found, the specific change you propose, the monitoring needed, and a timeframe, and leave everything else out. Structure it that way and your medication review recommendations to the GP get actioned at triage instead of parked in a pile.

This is the point where a structured medication review (SMR) either lands or quietly dies. You can run a faultless review, but if the write-up is vague the GP cannot safely say yes, so nothing changes. Under the Network Contract DES, SMRs are meant to be a proper clinical conversation and not a tick-box template, and the letter is the evidence that a decision was actually made. If you want the full review method first, see our guide on how to do a structured medication review; this piece is about the writing.

Two things you are actually writing

A medication review letter to a GP is really two documents with different readers. The first is the clinician-to-clinician task: your recommendation to the GP, written for speed and safety. The second is the patient-facing summary: plain language, no jargon, telling the person what was discussed and what happens next. Keep them separate. Mixing them produces a task the GP has to untangle and a summary the patient cannot follow.

The five parts of an SMR action plan

Whatever your clinical system's template looks like, a usable SMR action plan carries the same five parts for each item. Think of it as one tidy paragraph per recommendation.

Notice what the timeframe line does not do: it does not invent a monitoring interval. Taper steps and review intervals for a Z-drug or benzodiazepine follow local shared-care guidance and the current BNF, with the RCPsych guidance on stopping useful as a reference. Your job in the letter is to set a realistic point to check in, not to pretend a fixed number applies to everyone.

Write for busy triage

The GP opening your letter may have dozens of documents to clear before clinic. They are triaging, not studying. So put the ask in the first line, keep one recommendation per task where your system allows it, and cut the preamble. Do not paste the whole review into a single task; the important recommendation drowns. And do not hedge into meaninglessness: "might possibly be worth perhaps considering" tells the GP nothing about what you think.

Weak versus strong: a worked example

Take Mr Ali, 78, on 12 medicines, flagged for review after a near-fall at home. Here is the write-up you do not want to send:

Please review medications. Zopiclone, ? stop. Omeprazole, long term, ? still needed. Cholesterol not at target. Thanks.

Three problems bundled, no findings, no plan, no timeframe, and every decision handed back to the GP with no steer. It will either be actioned unsafely or ignored. Now the same zopiclone point, written as a task:

Reason: falls review; reducing sedative load. Finding: zopiclone 7.5mg nightly for around 3 years, originally started for short-term insomnia; reports a near-fall getting up at night. Recommendation: propose a gradual reduction with a view to stopping, with the patient's agreement; sleep hygiene advice given and patient willing to try. Monitoring: review sleep and withdrawal symptoms at each step; falls safety-net advice given. Timeframe: first reduction now, review before stepping down again. No change actioned without your agreement.

Same clinical point, but now the GP can read it, agree, and move on. The zopiclone item maps to a STOPP/START version 3 (2023) criterion on sedatives in older people at risk of falls; if you want to drill that reasoning, our interactive STOPP/START reference covers it. Handle the omeprazole and the statin as their own separate tasks, each with the same five parts.

Safe phrasing that protects you and the patient

You are recommending within your competence and local governance, not overruling the prescriber, and the phrasing should show it. Use "propose", "suggest" and "consider" rather than "stop" or "start" as a bare instruction. Spell out that no change happens without the GP's agreement and a conversation with the patient; the "no change without agreement" line is worth keeping as a habit. Record that the decision was shared. This is the same standard we teach as good, missed or unsafe in practice: a recommendation that removes the GP's judgement, or that changes a medicine the patient has not been told about, is unsafe however clinically neat it looks.

The patient-facing summary

The second document is for the patient. Plain language, what was discussed, what (if anything) is changing, what to look out for, and when to get in touch. Frame it as a record of a shared decision, not fresh medical advice bolted on. "We agreed to slowly reduce one of your sleeping tablets. You will drop to a lower dose first and we will review before any further change. If your sleep gets much worse or you feel unwell, contact the practice." No drug jargon, and no dose maths the patient did not ask for.

Documenting medication review recommendations

Documenting medication review recommendations properly is what makes the work auditable and safe to hand over. Code the review and the outcome in the record so the next clinician can see what was decided and why; get the coding right with our guide to clinical coding and SNOMED codes for GP pharmacists. Keep your own reflective note too. A well-run SMR and a clean action letter are exactly the kind of entry that feeds a private CPD log for appraisal and GPhC revalidation, which asks for CPD records, a peer discussion and a reflective account each year. If you are new to general practice, having your first letters checked by a mentor is the fastest way to calibrate, and that is what 1:1 supervision is for.

Frequently asked questions

What is the difference between a medication review letter and an action letter to a GP?

They overlap, but an action letter is the sharper version. A medication review letter can be a narrative summary of everything you found; an action letter to a GP strips each recommendation down to a task the GP can approve: reason, finding, specific change, monitoring and timeframe. In busy general practice the action format gets things done.

How long should an action letter to a GP be?

As short as it can be while carrying the five parts for each recommendation. One recommendation per task, one tidy paragraph each. If you have four recommendations, send four clear tasks rather than one long letter the GP has to unpick at triage.

Should I recommend a change or just flag the issue?

Recommend, within your competence, and make the decision easy to check. Flagging without a proposed action pushes the whole workload back to the GP. State what you would do and why, then make clear no change happens without the GP's agreement and a conversation with the patient. That keeps you inside safe, shared decision-making.

How do I document medication review recommendations for revalidation?

Code the review and its outcome in the clinical record, then write your own reflective note in your own words, never a pre-filled one. GPhC revalidation asks for CPD records, a peer discussion and a reflective account each year, and a real SMR with a clear action letter is a strong basis for any of them.

The quickest way to get fluent is to write letters against real cases and get scored on them, which is what the Letter Actioning lab in our interactive Practice Labs is built for. Make the mistakes there, not on a patient.