The psychiatrist's letter to the GP after an initial assessment

The letter back to the referring GP is the most-read document a psychiatrist writes. It has three jobs: say what you found, say what you are doing, and say exactly what you need the GP to do. Everything else in it is supporting detail, and most letters that fail do so by burying those three things under the interview.

By PsychDispatch · Last reviewed 3 September 2026 · Drafted in PsychDispatch by the GP - Initial Assessment preset

What this letter is for

In most specialties the consultation note is the record. In psychiatry the letter to the GP is the record that travels. It arrives at the practice that will see the patient next week, prescribe the medication you started, order the bloods you asked for and field the phone call when something changes. The GP reads it in the two minutes before the patient walks in, which is why the order of information matters more than its completeness.

The letter also has a second reader: you, at the next review, and any colleague who inherits the patient. A letter that states the formulation, the plan and the reasoning plainly is worth more at that point than any amount of transcribed history.

What it must contain

  1. A summary at the top. One or two sentences: the diagnosis (or working formulation) and the plan. GPs read the first three lines; if the letter said nothing else they should still know what to do.
  2. The reason for referral and the question asked. Restate it. It tells the GP you answered their question, and it tells the next reader why the patient was seen.
  3. Relevant history, briefly. The parts that bear on the formulation and the plan. Not the interview. A GP who wants the full developmental history can ask for it; almost none do.
  4. Mental state and risk. An explicit statement of the risk assessment and the current safety plan, in plain words. If risk is low, say so and say why; if it is not, say what has been put in place and what the GP should watch for.
  5. Diagnosis and formulation. What you think is going on and how you understand it, with the differential where it matters for management.
  6. Medication, completely. Drug, dose, titration schedule, expected duration, monitoring (bloods, ECG, weight, blood pressure) and who is prescribing. A letter that names a drug without a dose and a plan for it generates a phone call.
  7. What you are asking the GP to do. A short, explicit list. Prescribe this; check that; refer here; call me if. The most useful heading in the letter is "Actions for the GP".
  8. Follow-up. When you will see the patient next, and how the GP reaches you in between.

The MBS 291 angle

If the patient was referred for an initial consultation under item 291, the assessment and the preparation of a management plan for the referring GP are what the item pays for, and the descriptor sets requirements for duration, content and the provision of the plan to the referring practitioner. Item 293 does the same for a review of that plan. In practice the GP letter is usually where the plan lives, so the letter has to meet the descriptor, not just good manners. Read the current descriptors on MBS Online rather than relying on what the item required last time you checked; they are linked under Sources below.

Why letters fail

The complaints GPs make about specialist letters are consistent, and none of them is about clinical quality.

  • It arrives after the patient has already been back to see them.
  • It has no plan they can act on, or the plan is implied rather than stated.
  • The medication is named but the dose, duration or monitoring is missing.
  • There is no explicit risk statement, so they cannot tell whether silence means low risk or an omission.
  • It is a transcript of the interview arranged under headings, and the plan is on page three.
  • It is not clear which parts of the plan are the GP's to do and which are the psychiatrist's.

Every one of these is a structure problem, which is why a fixed skeleton fixes most of them.

A skeleton that works

Dear Dr [GP],
Re: [Patient], DOB [date]
Summary. Thank you for referring [Patient], whom I assessed on [date]. My working diagnosis is [diagnosis]. I have started [drug] at [dose] and will review in [interval]. Actions for you are listed below.
Reason for referral. [The question asked, in a sentence.]
Relevant history. [The history that bears on the formulation and plan. A paragraph, two at most.]
Mental state and risk. [Mental state in brief. An explicit risk statement: current risk, protective factors, safety plan, what to watch for.]
Diagnosis and formulation. [Diagnosis, differential where it matters, how you understand the presentation.]
Management plan. [Medication: drug, dose, titration, duration, monitoring, who prescribes. Psychological and social elements of the plan. What the patient has agreed to.]
Actions for the GP.
- [Prescribe or continue X at Y.]
- [Arrange Z bloods at N weeks.]
- [Contact me if A or B.]
Follow-up. I will see [Patient] again on [date]. I can be reached on [contact] between appointments.
Yours sincerely,
[Name, qualifications, provider number]

Adapt the headings to your voice; keep the order. The summary and the actions are the two blocks GPs read first, so they sit first and last.

Who else gets a copy

The patient, increasingly, and in plain language rather than as a cc of the clinical letter (see the FAQ). Other treating clinicians where the patient has consented. Any cc line belongs after the signature, where the recipient expects it, not in the addressee block.

How PsychDispatch drafts this

The GP - Initial Assessment preset drafts this letter from the consultation itself, in your own letter style, in the order above: summary first, actions explicit, medication complete. Every claim is verified against the transcript before you sign it off, it is rendered onto your letterhead, and it is dispatched to the GP by secure link with delivery tracked, the same day as the consult rather than at the end of the week. At the next review, Patient Intelligence carries the plan forward so the review letter knows exactly what this one said.

Sources

FAQ

Questions about this letter.

How long should the letter be?

Long enough to carry the plan and short enough to be read in the two minutes a GP has before the patient walks in. One to two pages is the norm. The first three lines should carry the diagnosis and the plan; the detail sits underneath for whoever needs it.

How quickly should it go out?

Before the patient's next contact with the GP, which is often within a fortnight and sometimes within days if a medication was started. A letter drafted from the consultation itself can go the same day; one dictated at the end of the week usually cannot.

Should the patient get a copy?

Increasingly, yes, and many patients expect it. The GP letter is written for a clinician, so where a copy is appropriate a plain-language letter to the patient (PsychDispatch has a separate preset for it) usually serves them better than a cc of the clinical one. Use judgement about content that could cause harm if read out of context.

Is the GP letter the same thing as the MBS 291 management plan?

In practice the letter to the referring GP usually is where the management plan lives, but the item descriptor sets requirements of its own for duration, content and provision to the referring practitioner. Read the current descriptor on MBS Online rather than relying on habit, and make sure the letter meets it if you are billing the item.

In PsychDispatch

Drafted from the consult by the GP - Initial Assessment preset.

In your own letter style, every claim verified against the transcript, rendered onto your letterhead and dispatched by secure link in one click, with the patient’s full history behind it. Every one of the PsychDispatch letter types works the same way.

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