Referral letter templates

For any new presentation that you would otherwise refer on the NHS 2-week-wait pathway, where the patient is private-insured or self-paying.

Dear Dr Tsang-Wright,

Re: [Patient name], [DOB], [contact number], [address]
Insurance: [Insurer + membership number, or “Self-pay”]

I would be grateful for your urgent review of this patient, who presents with [brief description of the symptom — e.g. “a new 2 cm right upper outer quadrant lump, noted three weeks ago, slowly enlarging”]. There are no associated skin or nipple changes / there is associated [feature].

Relevant history:

• Previous breast surgery / imaging: [date, where, summary, or “none”]
• Family history of breast or ovarian cancer: [summary, or “none of note”]
• Current medications relevant to breast: [HRT / hormonal contraception / tamoxifen / none]
• General health: [brief — comorbidities, smoking status]

The patient is keen to be seen privately for prompt assessment. I have not requested any imaging in primary care.

Please contact the patient directly to arrange an appointment.

Yours sincerely,
[GP name, GMC number, practice]

For presentations where you would not necessarily use the NHS 2-week-wait pathway but would still like specialist assessment within a reasonable timeframe.

Dear Dr Tsang-Wright,

Re: [Patient name], [DOB], [contact number], [address]
Insurance: [Insurer + membership number, or “Self-pay”]

Please could you see this patient for assessment of [brief description — e.g. “a long-standing, smooth, mobile lump in the right breast, recently noticed to feel slightly larger; no other concerning features”]. I have explained that this is most likely a benign finding but specialist examination and imaging would be appropriate to confirm.

Relevant history:

• [As above, edited for the case]

The patient is happy to be seen privately. There is no clinical urgency.

Yours sincerely,
[GP name, GMC number, practice]

For patients who have been seen elsewhere (NHS or private) and would like a second opinion before deciding on treatment. Helpful to include the histology, imaging report, and MDT outcome from the original centre.

Dear Dr Tsang-Wright,

Re: [Patient name], [DOB], [contact number], [address]
Insurance: [Insurer + membership number, or “Self-pay”]

This patient was recently assessed at [centre] and has been advised to proceed with [proposed treatment — e.g. “a left wide local excision with sentinel lymph node biopsy”]. She would like a second opinion before making a decision.

The patient has [specific question or area of uncertainty — e.g. “particular concerns about the cosmetic outcome”; “wants to discuss whether mastectomy with reconstruction would give a better long-term result for her”; “would like to understand the trade-offs between immediate and delayed reconstruction”].

Relevant materials available:

• Histology report from the diagnostic biopsy ([date, centre]).
• Imaging report and images on disc ([date]).
• MDT outcome letter from [centre, date].

The patient will bring all of these to the consultation.

Yours sincerely,
[GP name, GMC number, practice]

For patients whose family history meets criteria for high-risk assessment, where you would like specialist input on imaging surveillance, chemoprevention, and (where applicable) risk-reducing options.

Dear Dr Tsang-Wright,

Re: [Patient name], [DOB], [contact number], [address]
Insurance: [Insurer + membership number, or “Self-pay”]

This patient has a family history of breast / ovarian cancer that I would like to discuss with a specialist. Family pattern is briefly:

• [Mother / sister / aunt etc.] diagnosed with breast cancer at age [age], [side, type if known].
• [Other relatives, ages, types].
• [Known genetic mutation in the family — e.g. “BRCA2 mutation in the patient’s mother”, or “no genetic testing in family to date”].

The patient is currently [age] and would like to understand her risk and the options for surveillance, chemoprevention, and (in due course) any role for risk-reducing surgery.

[If genetic testing has already been done, attach the report. If not, mention whether a referral to clinical genetics has been made or is being considered.]

Yours sincerely,
[GP name, GMC number, practice]

For patients with a confirmed high-risk genetic mutation (BRCA1, BRCA2, PALB2, etc.) who are considering risk-reducing surgery. The genetic counselling and testing should usually be complete before surgical consultation; this template assumes that.

Dear Dr Tsang-Wright,

Re: [Patient name], [DOB], [contact number], [address]
Insurance: [Insurer + membership number, or “Self-pay”]

This patient has a confirmed [BRCA1 / BRCA2 / PALB2 / other] mutation, identified through clinical genetics at [centre, date]. She is currently [age] and would like to discuss the option of bilateral risk-reducing mastectomy with reconstruction.

She is currently under [surveillance pathway — e.g. “annual breast MRI under the family-history clinic at X hospital”]. [She has / has not] yet considered risk-reducing salpingo-oophorectomy with the gynaecology team.

Please arrange a consultation. The patient is aware that this is likely to involve more than one appointment before any decision, and she has time to consider her options carefully.

Yours sincerely,
[GP name, GMC number, practice]

Dear Dr Tsang-Wright,

Re: [Patient name], [DOB — typically under 25], [contact number], [parent/guardian contact if patient is under 16]
Insurance: [Insurer + membership number, or “Self-pay”]

Please could you see this [age]-year-old patient for assessment of [brief description — e.g. “a 2 cm mobile lump in the left breast, noted six weeks ago, not changing in size, not painful”; “marked breast asymmetry causing significant distress”; “persistent localised tenderness with no obvious cause”].

Her parents [or partner / guardian] would prefer specialist review for reassurance and to confirm the diagnosis. She is fit and well otherwise; no relevant family history. Not on any regular medication.

Yours sincerely,
[GP name, GMC number, practice]

Including the insurer name and membership number on the referral letter helps the PA arrange pre-authorisation efficiently before the first appointment. Most insurers can issue a pre-authorisation code within the same day with the consultant’s GMC number (Dr Tsang-Wright: GMC 4549831) and the procedure code, which the PA will request directly.

If the patient is self-paying and would like an indication of fees before the first appointment, this is straightforward — the PA can provide a clear quote for consultation, imaging, and any biopsy that may be needed. Surgery fees are quoted separately once a treatment plan is agreed. See fees and insurance.

For email referrals (the fastest route): [email protected]. Postal address and fax details — see how to refer.