OET Writing Task for Nurses: How to Write a Referral or Discharge Letter

The OET Writing sub-test gives you one task: read a set of patient case notes and write a professional healthcare letter based on them. For nurses, that letter will typically be a referral to a specialist, a discharge summary, or a transfer letter to another facility or care setting. You have 45 minutes to plan, write and review it.

That might sound straightforward if you have been writing clinical correspondence for years. In practice, OET Writing is more demanding than it first appears – not because the English is difficult, but because the task requires you to demonstrate a specific kind of professional judgment: knowing what to include, how to structure it, and how to address the recipient in a way that reflects your professional role.

This guide walks through the main letter types you will encounter in OET Writing for nurses, the structure that works for each one, and the mistakes that most commonly prevent nurses from reaching Band B.

What the case notes give you

Before you write a word of the letter, you need to read the case notes carefully. OET case notes are detailed – they typically include the patient’s personal information, medical history, recent admissions or consultations, current diagnoses, medications, test results, observations, and any relevant social or family history.

Not all of that information should go into your letter. One of the core skills being assessed in OET Writing is your ability to select what is clinically relevant to the specific reader and purpose of the letter. An assessor reviewing a referral letter to a cardiologist does not expect a full social history. They expect you to have identified the cardiac-relevant information and presented it efficiently.

Read the case notes once to understand the full picture. Then read the task instruction carefully to identify: who the letter is going to, what the purpose of the letter is, and what action or information the recipient needs. That determines your selection.

Referral letters

A referral letter requests that the recipient – a specialist, a clinic, or a service – accepts the patient for assessment or treatment. It needs to explain why the referral is being made and provide enough background for the recipient to understand the patient’s situation before they see them.

Structure for a referral letter

• Opening: state the purpose immediately – that you are referring the patient, who they are, and why
• Relevant history: include the medical background that is relevant to the reason for referral
• Current presentation: what has prompted the referral now – recent symptoms, test results, or change in condition
• Current medication and treatment: what the patient is currently prescribed or receiving
• Your request: what you are asking the recipient to do
• Contact details: how to reach you if needed

The opening is where many nurses lose marks. Avoid beginning with the patient’s name and date of birth – begin with the purpose. Something like: ‘I am writing to refer Mrs [patient details] who has presented with…’ establishes purpose in the first line. The recipient knows immediately why they are reading the letter.

Discharge letters

A discharge summary is sent to the patient’s GP or primary care provider when the patient leaves your care – either from hospital, a specialist clinic, or another clinical setting. Its purpose is to ensure continuity of care by giving the GP the information they need to support the patient going forward.

Structure for a discharge letter

• Opening: state that the patient has been discharged, the date, and from where
• Reason for admission: what brought the patient in
• Treatment received: what was done during the episode of care
• Outcome and current status: how the patient is now
• Discharge medication: what they have been prescribed and at what dose
• Follow-up plan: any outpatient appointments, further investigations, or monitoring required
• Recommendations for ongoing care: what you are asking the GP to do

Discharge letters require you to be particularly careful about what you include from the case notes. A thorough patient history is in the notes, but the GP does not need to know everything – they need to know what is relevant to managing this patient going forward. A concise, well-selected discharge letter is more useful to a GP than a complete transcription of the clinical record.

Transfer letters

A transfer letter is sent when a patient is moving between facilities or care settings – from one ward to another, from hospital to a nursing home, or from a specialist centre back to a district hospital. The reader is whoever will be taking over the patient’s care.

Transfer letters follow a similar structure to discharge letters but emphasise the handover of ongoing responsibilities. You should include any time-sensitive information – pending test results, scheduled procedures, specific monitoring requirements – because the reader needs to know what to action immediately on receiving the patient.

Register in healthcare letters

Register – the level of formality and the professional conventions appropriate to a particular type of writing – is one of the most common reasons nurses fall below Band B in OET Writing.

Healthcare letters are formal professional documents. They use full sentences rather than note form, avoid contractions (write ‘she does not’ rather than ‘she doesn’t’), and maintain a consistent level of professional courtesy throughout. At the same time, they should not be so formal that they become stilted. A good healthcare letter reads clearly and efficiently – it does not sound like a legal document.

Two specific register problems come up repeatedly in OET Writing. The first is informal phrasing that creeps in when nurses write quickly – using expressions from spoken clinical English that do not belong in a formal letter. The second is excessive abbreviation – using clinical shorthand that the reader may not know, or that makes the letter difficult to read as a piece of professional correspondence.

Time management in the writing task

45 minutes is enough time to write a complete, well-structured letter if you plan it properly. Nurses who do not finish the letter consistently lose marks on Genre and Organisation, even if their writing is strong up to the point where they stopped.

A practical approach: spend the first five minutes reading the case notes and the task instruction carefully. Plan your letter structure before you write – a brief bullet-point outline takes two minutes and will save you from having to restructure mid-letter. Allow five minutes at the end to review for register, completeness, and any grammar slips. That leaves roughly 33 minutes of writing time, which is more than sufficient for a complete letter.

If you practise with a timer from the first time you sit a practice task, the time pressure will become familiar rather than alarming. Head to FunctifyLearning.co.uk/oet-writing to find out how our Practice Educator Reviews can help you develop your letter writing to Band B standard.