The psychiatrist's review letter to the GP, and shared-care arrangements

What this letter is for

The initial letter told the GP what you found and what you planned. The review letter tells them what happened. Between the two visits the GP has been prescribing from your last letter, fielding the patient's questions about side effects and possibly ordering the bloods you asked for. What they need now is the delta: what you changed, why, how the patient responded, and what they should do differently until the next review.

It is also the letter that makes shared care real. A shared-care arrangement that lives in two clinicians' heads is not an arrangement. The review letter is where it is written down, with names against tasks.

What it must contain

What changed since the last letter. One or two sentences at the top: the medication changed, the response, the current position. If nothing changed, say that, and say why the plan stands.
The complete current medication list, with doses. Not just the change. The GP prescribes from this list, so it must be reconcilable without the previous letter. Include what was stopped and when.
Response and side effects. What improved, what did not, what the patient reports, and what you observed.
Monitoring results and what is due next. The bloods, ECG, weight or blood pressure that were ordered, what they showed, and the next scheduled check with a date and a name against it.
Risk now. An explicit statement, as in the initial letter. Risk that has fallen should be said to have fallen; risk that has risen needs the plan that goes with it.
The plan from here. Continue, adjust or change, with titration steps and dates where they apply, and what the patient has been told to expect.
Actions for the GP. The explicit list: repeat prescribing scope, monitoring to order, thresholds at which to call, anything to stop.
The next review, and the triggers for an earlier one. A date, and the two or three developments that should prompt the GP to contact you before it.

Writing the shared-care arrangement

Shared care means a GP and a psychiatrist each hold part of the same treatment. It works when the split is written down and breaks when it is assumed. A shared-care section in the review letter should set out:

Who prescribes what. Which medications the GP will prescribe and repeat, which stay with the psychiatrist, and the authority basis where one applies. Rules on GP co-prescribing of stimulants differ by state and change; where the arrangement depends on a permit or authority, name it and its number.
The monitoring schedule. What is measured, how often, who orders it and who reviews the result. For clozapine this follows the mandatory monitoring programme for the product, and the letter must say who is responsible for each step of it.
Escalation thresholds. The findings or events that should send the patient back to the psychiatrist rather than being managed in general practice, stated concretely.
How the patient gets scripts between reviews, and what happens if they run out on a Friday afternoon.
The review cadence, and how the arrangement is changed or ended.

The GP - Shared Care Plan, Treatment - ADHD Shared Care / GP Co-prescribing and Treatment - Clozapine Shared Care / Monitoring presets each carry this structure with the specifics of their case.

The MBS 293 angle

Where the initial consultation was billed under item 291, the review of that management plan has its own item, 293, with its own descriptor setting out what a review comprises and what must be provided to the referring GP. As with 291, the review letter is usually where the reviewed plan lives, so it has to meet the descriptor rather than good manners alone. The current descriptor is linked under Sources.

Where review letters fall short

They restate the initial assessment, and the GP has to hunt for what changed.
They name the change but not the complete current medication list, so the GP reconciles two letters and the patient's memory.
Monitoring is ordered but the results, and who reviews them, are never mentioned again.
Risk is not restated, so the GP cannot tell whether silence means improvement or omission.
Shared care is implied by "the GP will continue prescribing" without saying what, for how long, or on what authority.
No review date and no triggers, so the GP does not know when to expect the next letter or when to break glass.

A skeleton that works

Dear Dr [GP],

Re: [Patient], DOB [date]. Review, [date].

Since last review. [What changed, the response, the current position, in one or two sentences.]

Current medications. [Complete list with doses, including what was stopped and when.]

Response and side effects. [What improved, what did not, what the patient reports.]

Monitoring. [Results received. Next check: what, when, ordered by whom, reviewed by whom.]

Risk. [Current risk, direction of change, safety plan.]

Plan. [Continue, adjust or change; titration steps with dates; what the patient expects.]

Shared-care arrangement. [Who prescribes what, authority basis where relevant; monitoring schedule and responsibility; escalation thresholds; scripts between reviews; cadence.]

Actions for the GP.

- [Continue X at Y until Z.]

- [Order N bloods at W weeks; results to me.]

- [Contact me if A or B.]

Next review. [Date.] Please contact me sooner if [triggers].

Yours sincerely,

[Name, qualifications, provider number]

How PsychDispatch drafts this

The GP - Progress Update preset drafts the review letter from the consultation, and the "since last review" line is not something you reconstruct: Patient Intelligence already holds the previous letter's plan, the medication history with doses and dates, the monitoring that was ordered and what it showed, and the risk picture over time. The draft opens with the change because the system knows what the last position was. The shared-care presets do the same for the arrangement, and every claim is verified against the transcript before the letter goes to the GP on your letterhead.

Sources

FAQ

Questions about this letter.

How is the review letter different from the initial letter?

The initial letter establishes the formulation and the plan. The review letter reports the change against that plan: what was altered, how the patient responded, what the monitoring showed and where risk sits now. If a GP could read the two letters and not tell which came first, the review letter has not done its job.

Should I list every medication, or only what changed?

Both, kept separate. State the change up top, then give the complete current list with doses further down. The GP prescribes from the list, not from the narrative, and a letter that only names the change leaves them reconciling it against an old letter or the patient's memory.

Does shared care need a separate signed agreement?

Often the letter that sets out the arrangement is the document, provided it states who prescribes what, the monitoring schedule and who reviews results, the escalation thresholds and the review cadence. Some practices and some medications warrant a signed template as well, and where stimulants are involved the state's rules on GP co-prescribing may require the GP to hold or be named on an authority. A dedicated S8 guide follows in this library.

What if the GP declines shared care?

Then the arrangement does not exist, and the letter should not assume it. Prescribing and monitoring stay with the psychiatrist until a GP agrees in writing, and the review letter should say so plainly so the patient is not caught between two practices each assuming the other is prescribing.

How often should the GP hear from me during shared care?

At every review, and at any change to the medication or the monitoring schedule between reviews. The cadence belongs in the arrangement itself, so the GP knows when to expect the next letter and when silence means something has gone wrong.

In PsychDispatch

Drafted from the consult by the GP - Progress Update 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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