The NHS writes to millions of patients every year. For people whose first language is not English — or who have recently moved to the UK and are unfamiliar with how the health system works — these letters can be confusing, alarming, or simply unclear.
This guide explains every type of NHS letter you might receive, what it means, and exactly what you need to do when you get one.
How the NHS communicates with patients
The NHS primarily communicates in writing. You may receive letters by post, increasingly by email, or via the NHS App (nhs.uk/nhs-app) if you have registered for digital access.
NHS letters come from different parts of the system: your GP surgery, NHS hospitals and trusts (including outpatient departments, surgical teams, and specialist clinics), screening programmes, and NHS 111.
Each type of letter has a different purpose and requires a different response.
GP referral letters
A GP referral letter is sent to a hospital specialist after your GP has decided you need to be seen by a consultant. You receive a copy, and the hospital receives the original.
What it typically contains:
Two-week wait referrals are important. If your GP has referred you under the two-week wait pathway, it means they want you to be seen by a specialist within two weeks because of a potential concern about cancer or serious illness. This does not mean you have cancer — it means your GP wants to rule it out promptly. You will receive a separate appointment letter from the hospital within days.
What to do: Keep your copy for your records. Wait for the hospital appointment letter. If you have not heard from the hospital within two to three weeks, call your GP surgery to check the referral was sent and contact the hospital's outpatient booking team.
Hospital outpatient appointment letters
This letter is your invitation to attend an outpatient consultation at a hospital clinic.
What it contains:
The Choose and Book / NHS e-Referral service: For many referrals, you will not receive a direct appointment but instead receive a letter with a unique booking reference number. You must use this number to book your appointment online, by phone, or via the NHS App. If you do not book within a certain period, the referral may lapse.
What to do: Book your appointment promptly if required. If the letter gives you a time directly, confirm whether you can attend. If you cannot attend, call the department to rebook — do not simply not show up. Missed appointments (DNA — Did Not Attend) can affect your position on waiting lists.
Discharge summary letters
A discharge summary is sent to your GP after you have been in hospital (including after A&E attendance, day surgery, or a hospital stay). You receive a copy. It summarises what happened and any follow-up action needed.
What it contains:
What to do: Read the medication section carefully. If new medications have been prescribed, you may need to collect them from your GP surgery. If follow-up appointments are recommended "through your GP," book a GP appointment to arrange this. Keep the discharge summary in a safe place — it is a useful record.
Test results letters
Test results may come directly from your GP surgery, from a hospital department, or from a screening programme.
Normal results are often sent as a brief letter or via the NHS App stating your results are within the normal range and no action is needed.
Abnormal or borderline results should be followed up. The letter will usually state that your GP or a specialist will be in contact, or ask you to make an appointment to discuss the results. Do not wait indefinitely — if you receive a letter saying your results need discussion and you have not been contacted within the timeframe mentioned, call your GP surgery.
Cervical screening (smear test) results and bowel cancer screening results come from NHS screening programmes and are clearly labelled. If the result shows anything that requires further investigation, the letter will explain this clearly and the programme will arrange next steps.
Prescription and medication letters
These are letters about your repeat prescriptions, medication reviews, or changes to your prescribed medications.
Medication review requests — most GP surgeries conduct annual or biennial medication reviews. You will be invited to attend an appointment (with a GP, nurse, or pharmacist) to review your current medications. This is important — attend if you can.
Letters about medication changes — if a medication you have been prescribed is being discontinued, or its prescribing guidance has changed, your GP surgery may write to inform you of alternative arrangements.
Mental health and talking therapy letters
Letters from mental health services, IAPT (Improving Access to Psychological Therapies — the NHS talking therapy service), and community mental health teams follow the same structure as other NHS letters but cover mental health referrals, assessments, and treatment.
These letters are confidential. The NHS has strict confidentiality rules about who can access your mental health records.
If you cannot understand an NHS letter
Use NHS 111 — available 24/7 by phone (dial 111) and online at 111.nhs.uk. They can provide guidance on NHS correspondence and next steps.
Contact the sending department directly — the phone number of the relevant department is always on the letter.
Use Translova to translate the letter — if the letter is in English but difficult to understand, Translova's explanation feature gives you a plain-language summary of what the letter says and what action is required. If the letter was originally in another language, Translova translates it and explains it simultaneously.
Contact your GP surgery — for any NHS letter that confuses or concerns you, your GP is your primary point of contact within the health system.
Your NHS number
Every person registered with the NHS has a unique 10-digit NHS number. It appears on every NHS letter. Keep a note of your NHS number — it speeds up every interaction with the NHS considerably.
If you are new to the UK and have not yet registered with a GP, you can find and register with your nearest NHS GP practice at nhs.uk/service-search/find-a-gp. GP registration is free and open to everyone living in the UK.