Introduction
Learning how to write a discharge summary nhs-style is a fundamental skill, and it’s one of the most high-stakes responsibilities you will have as a Foundation Year 1 (FY1) doctor. It is often the final administrative task for a patient, done under time pressure. However, a rushed, inaccurate, or incomplete summary is a major source of clinical risk, leading to medication errors, patient harm, and preventable readmissions.
This document is the only formal handover of care to the patient’s GP and the wider community team. For the UKMLA, this process is a cornerstone of the “Readiness for Safe Practice” and “Professionalism” domains. This 7-step guide provides a robust, repeatable framework to ensure every discharge summary you write is safe, clear, and effective, demonstrating your competence as a safe and reliable junior doctor.
Key Takeaways
It’s a Legal Document: A discharge summary is a medical-legal document that becomes part of the patient’s permanent record. Accuracy is non-negotiable.
The TTO is the Highest-Risk Step: Errors in the “To Take Out” (TTO) medications are the most common and most dangerous part of the discharge process.
“Why” is the Most Important Word: The single biggest error is failing to explain why a medication was stopped, started, or changed. This is the information a GP needs most.
Clear GP Actions are Non-Negotiable: The summary must contain a clear, explicit “to-do list” for the GP, including who is responsible for pending results.
Why Knowing How to Write a Discharge Summary NHS-Style is a Core FY1 Skill
Mastering how to write a discharge summary nhs-style is not just about admin; it’s a test of your clinical and professional competence.
It’s a Medical-Legal Document
Every summary you sign with your name and GMC number is a formal document. If a patient comes to harm due to an error in your summary (e.g., a critical medication was omitted), this document will be the primary piece of evidence reviewed.
The Critical Role of Continuity of Care
You are handing over care from a 24/7 monitored hospital environment to a community setting. The GP relies entirely on your summary to understand what happened and what to do next. The GMC’s Good Medical Practice guidance is explicit on this.
“You must share all relevant information with colleagues in a timely way… to ensure patients receive safe, effective, and coordinated care.”
— GMC, Good Medical Practice
Patient Safety and Professionalism
A poor summary is a failure of professional duty. It’s a core skill that demonstrates your commitment to professionalism and patient safety, which is a key focus of the CPSA.
The 7-Step Framework for a Safe NHS Discharge Summary
Follow this structure for every summary you write.
Step 1: Confirm Patient Details & Admission Synopsis
Get the basics right. This section must be 100% accurate.
Patient Details: Full name, DOB, NHS Number, Patient’s GP, and discharge destination.
Admission & Discharge Dates: Including the consultant responsible for their care.
Primary Diagnosis: What was the main reason for their admission? (e.g., “Community-Acquired Pneumonia”).
Secondary Diagnoses: Other active issues managed during the admission (e.g., “Acute Kidney Injury Stage 2,” “Type 2 Diabetes”).
Step 2: Detail the Clinical Narrative & Key Investigations
This is the “story” of the admission. It should be a concise summary, not a copy-paste of every ward round entry.
Clinical Narrative: What happened from presentation to discharge? (e.g., “Presented with cough and fever. Found to be hypoxic and hypotensive. Treated as per Sepsis Six with IV antibiotics. Clinically improved and stepped down to oral antibiotics on Day 3.”)
Key Investigations: List only the results that led to a diagnosis or changed management. (e.g., “CXR: RLL consolidation. Sputum Culture: Strep. pneumoniae.”).
Table 1: Essential Components of a High-Quality Discharge Summary
| Section | Purpose | Gold-Standard Example |
|---|---|---|
| Diagnosis | What they were treated for. | 1. NSTEMI 2. Type 2 Diabetes 3. Hypertension |
| Clinical Narrative | The “story” of the admission. | “Admitted with central chest pain. Troponin 1500. Treated as NSTEMI. Commenced on dual antiplatelet therapy.” |
| TTO Changes & Rationale | The *most important* section. | STARTED: Ticagrelor (for NSTEMI) STOPPED: Ramipril (for AKI) CHANGED: Metformin dose reduced (due to AKI) |
| Actions for GP | A clear “to-do” list. | – Please repeat U&Es in 1 week to check renal function. – Please re-challenge Ramipril if Cr returns to baseline. |
Step 3: The TTO (Medication Reconciliation) – The Most Critical Step
This is where most errors happen. This section requires your full attention. For a full breakdown, review our guide on prescribing safely for the UKMLA.
Reconciling: What They Came In On
First, list the patient’s medications on admission. You must use multiple sources for this (patient, GP record, previous summary, pharmacy).
Reviewing: What Changed and Why?
This is the most critical part. You must explain every change.
STARTED: Why? (e.g., “Bisoprolol 2.5mg OD – started for new-onset Atrial Fibrillation”).
STOPPED: Why? (e.g., “Ibuprofen – stopped due to AKI on admission”).
CHANGED: Why? (e.g., “Warfarin dose – changed as per INR, follow-up anticoagulation clinic”).
Prescribing: The Final TTO List
This is the final, complete list of medications the patient is going home with. Be explicit about dose, frequency, duration (e.g., “Co-amoxiclav 625mg TDS – 5 day course (2 days remaining)”).
For more guidance, the CQC has a useful resource on medicines reconciliation.
Table 2: Common TTO Prescribing Errors and How to Avoid Them
| Common Error | Why It’s Dangerous | How to Fix It |
|---|---|---|
| ✗ Missing the “Why” | GP doesn’t know why a drug was stopped (e.g., allergy vs. AKI) and may restart it inappropriately. | ✓ Always add a rationale. (e.g., “Ramipril stopped due to hyperkalaemia”). |
| ✗ Unclear Duration | Patient is discharged on antibiotics or steroids with no end date, leading to overuse. | ✓ Specify duration. (e.g., “Prednisolone 30mg OD – 5-day course (3 days remaining)”). |
| ✗ Starting “PRN” Opiates | Discharging a patient with a new PRN opiate (e.g., Oramorph) without a clear indication or review plan. | ✓ Be specific. (e.g., “Oxycodone 5mg PRN, max 4 doses/day, for post-operative pain. Review in 3 days.”). |
Step 4: Document Allergies, Complications & Procedures
Allergies: This must be prominent. List the drug and the reaction (e.g., “Penicillin – Anaphylaxis”).
Procedures: List any procedures performed (e.g., “Coronary angiogram via R radial artery. 2 stents to LAD.”).
Complications: Be honest. (e.g., “Hospital-acquired pneumonia, treated with Tazocin.”).
Step 5: The Clear Follow-Up Plan (Actions for the GP)
This is the second most important section. Do not be vague. This is a clear “to-do” list.
What needs checking?
Bad: “Check U&Es.”
Good: “Please repeat U&Es in 1 week (to monitor for hyperkalaemia from new Spironolactone).”
Who is responsible?
Bad: “Follow up in clinic.”
Good: “Patient has been referred to the ‘Hot Clinic’ for review in 2 weeks. No GP action needed for this.”
Pending Results and Your Ethical Duty
You (and your consultant) are responsible for actioning any results you ordered. You cannot just write “Pending blood cultures, GP to check.”
Good: “Pending blood cultures. We will check these and inform the GP if a change in antibiotics is needed.”
This is a common UKMLA ethical dilemma; you must not abdicate your responsibility.
Step 6: Information Given to the Patient
Confirm what you have told the patient and/or their family. This includes:
Diagnosis explained.
Medication changes explained.
“Sick day rules” (e.g., for diabetics, or patients on ACEi/ARBs).
Red flags for readmission (e.g., “Return to A&E if you experience severe shortness of breath or chest pain.”).
This is a key CPSA skill.
What to Say: Explaining TTO Changes to a Patient (CPSA Script)
“Hello Mr. Smith, we’ve got your discharge medications ready. I want to quickly go over the main changes, as it’s really important.”
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1. Check Understanding: “Do you normally use a box to organise your pills, or do you take them from the packets?”
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2. Explain the “Why”: “The most important change is this new tablet, Apixaban. This is a blood thinner. We’ve started it because your heartbeat was irregular, and this will help prevent a stroke. This tablet replaces the Aspirin you were taking. So you must stop taking your old Aspirin and take this one twice a day instead.”
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3. Confirm & Safety Net: “Does that make sense? The instructions are all on the box and in the letter for your GP, but the key thing is to stop the old one and start the new one. If you notice any unusual bleeding, you must let your GP know.”
Step 7: Final Check & Your Contact Details
Your Details: Sign off with your Full Name, Grade (e.g., FY1), and GMC Number.
Final Check: Read it back to yourself. Does it make sense? If you were a GP, would you know exactly what happened and what to do?
Putting It into Practice: 2 UKMLA-Style Clinical Scenarios
Scenario 1: The Complex TTO (Warfarin to DOAC)
Vignette: A 78-year-old man on Warfarin for AF is admitted with a fall and head injury. His INR is 2.5. CT head is clear. The medical team decides to stop his Warfarin and start him on Apixaban for stroke prevention, as it has a lower bleeding risk.
How to Handle on Discharge Summary:
TTO Changes:
STOPPED: Warfarin (Rationale: High falls risk; patient preference).
STARTED: Apixaban 5mg BD (Rationale: Stroke prevention in AF. Started 24h post-admission, after clear CT head).
Actions for GP:
“Warfarin has been stopped. Patient has been counselled.”
“Please check FBC and U&Es in 1 month to review renal function for Apixaban dosing.”
Patient Info: “Counselled patient that Warfarin is stopped and Apixaban is the new replacement. Advised on bleeding/bruising risks.”
Scenario 2: The Critical GP Follow-Up (Incidentaloma)
Vignette: A 55-year-old man is admitted with pneumonia. A CT chest confirms consolidation but also shows a “4cm indeterminate renal mass” incidentally. He is now medically fit for discharge.
How to Handle on Discharge Summary:
Clinical Narrative: “CT chest showed RLL consolidation and an incidental 4cm indeterminate right renal mass.”
Actions for GP:
“Patient has been informed of the incidental renal mass found on CT, which requires further investigation.”
“We have submitted an urgent 2-week-wait (2WW) referral to the Urology team.”
“Please ensure this referral is actioned and chase if no appointment is received. Patient is aware of this plan.”
Patient Info: “I have informed the patient of the incidental finding on his CT scan (renal mass) and explained that we are referring him to the urology specialists as an urgent outpatient. He understands the need for this.”
Your Turn: A Self-Assessment Exercise
Scenario: A 62-year-old woman with Type 2 Diabetes was admitted with a pyelonephritis and an AKI (creatinine 180, baseline 90). Her Metformin was stopped on admission. She was treated with IV antibiotics and is now fit for discharge. Her creatinine is back to 100.
Your Task: Write the “Actions for GP” section for this discharge summary.
Model Answer (Actions for GP):
“Patient’s Metformin was held on admission due to AKI.”
“Please restart Metformin 500mg BD (patient’s usual dose) as her renal function has now recovered (Cr 100).”
“Please repeat U&Es in 1-2 weeks to ensure renal function remains stable.”
“Please arrange follow-up for diabetes review.”
Frequently Asked Questions (FAQ) about how to write a discharge summary nhs
These terms are often used interchangeably, which can be confusing. The Discharge Summary is the entire clinical document that details the admission. The TTO (To Take Out) or TTA (To Take Away) specifically refers to the medication prescription that is written for the patient to take home. This TTO list is a section within the main discharge summary.
GMC and NHS standards state that the summary should be sent to the patient’s GP within 24 hours of discharge. This is a critical safety step, as the GP needs to be aware of medication changes (like a new anticoagulant) or follow-up actions (like a blood test) immediately. From an examiner’s perspective, delaying this handover is a failure in professionalism and patient safety.
You have the same duty of care, but you fulfill it by communicating with the correct person. You must clearly document who you spoke to (e.g., “Patient lacks capacity; TTO changes and plan discussed in full with son, John Smith, who holds Lasting Power of Attorney for Health and Welfare”). This demonstrates you understand the principles of the Mental Capacity Act.
The most dangerous errors involve high-risk medications. The classic (and tragically common) error is failing to reconcile anticoagulants—for example, forgetting to restart one, or discharging a patient on both an old and new one (e.g., Warfarin and Apixaban). This is a ‘never event’ that can lead to catastrophic bleeding or stroke and is a primary focus of how to write a discharge summary nhs safely.
No, and you shouldn’t. This is a common novice error that creates “noise.” Include only the key results that led to the diagnosis, changed management, or are needed for follow-up (e.g., the positive blood culture, the CT head finding, the diagnostic ECG). The GP does not need a list of every normal daily blood test; they need a concise summary.
You must have a clear, safe plan. You cannot write “GP to chase.” The hospital team (and consultant) who ordered the test is responsible for reviewing and actioning it. The correct entry is: “Pending outpatient CT aorta (booked for 10/11/25). We will review this result, and the consultant will write to you and the patient with the finding and plan.”
The team (and consultant) who ordered the test is responsible, even after the patient is discharged. This is a core ethical and professional responsibility. In a CPSA station, stating “I will check the result and contact the GP” is the correct answer, whereas “The GP will check” is a clear failure.
You must act immediately. Do not ignore it. First, try to call the patient directly to inform them of the error. Second, you must call their GP surgery (do not just send an email/update) and speak to the on-call doctor or practice pharmacist to explain the error and the correction. Document these conversations in the patient’s electronic record as a new entry.
Be concise but thorough. Include the name of the procedure, the date it was done, the lead operator/surgeon, and (most importantly) any complications. For example: “OGD (Dr. Smith, 02/11/25). Showed large gastric ulcer. Biopsies taken for H. pylori. No immediate complications. Patient to be followed up in GI clinic.”
This is impractical and can be overwhelming for the patient. You should focus your counselling on the changes.
New medications (what it’s for, key side effects).
Stopped medications (why they must not take it anymore).
Dose-changed medications.
All high-risk medications (e.g., anticoagulants, insulin) and any requiring “sick day rules” (e.g., ACEi, Metformin).
Conclusion
Learning how to write a discharge summary nhs-style is one of the most important procedural skills you will learn as a new doctor. It is not “just paperwork”; it is a vital, safety-critical handover of care. A poor summary can directly lead to patient harm, while a clear, accurate, and timely summary ensures a safe transition from hospital to home.
By using this 7-step framework, you are not just ticking a box. You are fulfilling your professional duty, protecting your patients, and demonstrating your competence as a safe practitioner. Take the extra five minutes to get it right—it’s one of the best ways to ensure your patient’s recovery continues long after they’ve left your ward.
Your Next Steps
Find a good example: Ask your registrar or a clinical pharmacist if you can review a “gold standard” discharge summary they have written.
Practice the TTO step: The next time you are prescribing, mentally (or verbally) explain the “why” for every change you make.
Prepare for the ward: The discharge summary is a key part of FY1 life. Prepare yourself by reading our essential guide on navigating your first on-call shift as an FY1.
