Physiotherapist · Referral to GP · 3 bands compared
OET Physiotherapist: Grade A vs B vs C Letters Compared (Referral to GP)
Three referral letters to a GP from a physiotherapist, written to the same case notes at three different bands. Read to see how content, clarity and requests change between bands.
In short
- →Grade A gives organised clinical reasoning, clear red‑flag action and precise requests.
- →Grade B includes most relevant details but lacks specificity and tight timeframe.
- →Grade C is vague, missing key findings and fails to request appropriate investigations.
The shared case notes
Mrs S. Patel, 67, with type 2 diabetes and osteoarthritis, presented after a low‑level fall onto her left knee three weeks ago. She reports worsening left knee pain, progressive swelling and night pain limiting sleep, now unable to weight‑bear without a stick. Physiotherapy provided four supervised sessions (education, unloaded exercises, isometric quadriceps work), with minimal improvement. On assessment there is an effusion, reduced flexion (approx. 10–80°), warmth, localised tenderness, and painful weight‑bearing. She takes metformin and lisinopril; no known drug allergies. No recent imaging. The physiotherapist is concerned about underlying intra‑articular pathology or infection and requests GP review.
The three letters at a glance
The three letters — same case, different bands
Grade A
450/500Dear Dr Khan,
Re: Mrs S. Patel, DOB 14/02/1959. I am writing to refer Mrs Patel for urgent medical review following a three‑week history of progressive left knee pain and swelling after a fall.
History and findings: pain progressive with night pain, limited walking tolerance, and difficulty weight‑bearing. On examination there is a moderate effusion, warmth, localised medial joint line tenderness and reduced active range 10–80° flexion. Pain on weight‑bearing and antalgic gait. She has type 2 diabetes (metformin) and hypertension (lisinopril). No prior imaging performed.
Treatment and response: four physiotherapy sessions of education, unloaded strengthening and pain management with minimal improvement. Given the combination of swelling, night pain and reduced function I am concerned about possible intra‑articular pathology (fracture, complex osteoarthritis) or septic arthritis.
Request: please review within 48 hours, arrange AP/ lateral X‑ray of the knee and blood tests (FBC, CRP, ESR). If effusion persists with raised inflammatory markers, please consider urgent orthopaedic review and aspiration. Review analgesia and consider temporary mobility aid prescription.
Please contact me for further functional information or to discuss findings.
Verdict: Band A. The letter fulfils task, offers focused clinical reasoning, clearly prioritises red flags, and requests specific investigations and timeframe. Language is precise and professional; layout and sign‑post make actions easy for the GP.
Grade B
360/500Dear Dr Khan,
Re: Mrs S. Patel, DOB 14/02/1959. I refer Mrs Patel for medical assessment after a fall three weeks ago causing persistent left knee pain and swelling.
Clinical summary: ongoing pain with night pain and reduced walking distance. Examination shows a visible effusion, warmth and reduced knee flexion around 10–80°. She reports pain on weight‑bearing and uses a stick. Co‑morbidities: type 2 diabetes (metformin) and hypertension.
Physiotherapy to date: four sessions focusing on education, quadriceps activation and unloaded exercise; symptoms have not settled.
Request: would you please review her and consider imaging such as knee X‑ray and bloods to exclude infection or other intra‑articular causes. Please advise if aspiration or orthopaedic referral is needed and consider analgesia adjustment.
I am happy to provide further details of functional limitations and prior therapy on request.
Verdict: Band B. The letter gives relevant information and appropriate requests but lacks a clear timeframe and a firmer recommendation. Organisation is acceptable but clinical urgency and specificity of tests are less explicit than required for A.
Grade C
290/500Dear Dr Khan,
Re: Mrs S. Patel. I am referring Mrs Patel after a fall a few weeks ago. She has persistent left knee pain and swelling and cannot walk far.
On assessment there was swelling and reduced movement. She has diabetes and high blood pressure. I have done several physio sessions but she has not improved.
Please see her to check what is wrong. Maybe tests or an x‑ray are needed. She is in pain and needs help with medicines and walking.
Contact me if you need more info about her treatment.
Regards, Dr Mariam, Physiotherapist (contact details)
Note: brief summary without detail on exact findings, urgency or specific blood tests requested, and limited clinical reasoning provided.
Verdict: Band C. The letter is vague and missing important objective findings, lacks explicit red‑flag reasoning and gives only a broad request. Organisation and language are insufficiently precise for safe medical handover.
Criterion-by-criterion: Grade A vs B vs C
| Criterion | Grade A | Grade B | Grade C |
|---|---|---|---|
| Purpose | Clear urgent referral; explicit reason and requested actions. | Appropriate referral purpose but urgency and timeframe not explicit. | Unclear purpose; referral lacks distinct clinical justification. |
| Content | All key findings, co‑morbidities, treatment and rationale included. | Most relevant facts present but one or two specifics omitted. | Important clinical details and objective measures missing. |
| Conciseness & Clarity | Concise, focused sentences; clinical reasoning easy to follow. | Generally clear but occasionally verbose or vague. | Imprecise language and unclear requests reduce clarity. |
| Genre & Style | Professional tone with explicit requests and clinical vocabulary. | Generally professional but less decisive in recommendations. | Informal/vague tone; not confidently instructive. |
| Organisation & Layout | Well‑structured paragraphs and sign‑posted requests. | Logical order but lacks tight signposting or timeframe. | Disorganised; poor sequencing of clinical information. |
| Language | Accurate grammar, appropriate register and medical terms. | Mostly accurate language with minor slips. | Frequent imprecision and limited clinical vocabulary. |
How to lift this letter one band
To move a Grade C to Grade B in this scenario, add objective assessment data and a clearer clinical rationale. Include specific findings (e.g. ROM 10–80°), describe the effusion and warmth, and state current functional limitations (walking distance, ADL impact). Explicitly request investigations (X‑ray and blood tests) and outline potential next steps (aspiration, orthopaedic referral) while keeping the tone professional. A defined but not urgent timeframe (e.g. review within a few days) and medication list are also needed.
To move a Grade B to Grade A, tighten clinical reasoning and prioritise red flags. Give a concise problem statement, indicate exact concern (possible septic arthritis or fracture), and set a clear timeframe (eg review within 48 hours). Specify exact investigations (AP/lateral X‑ray; FBC, CRP, ESR), trigger conditions for aspiration or urgent orthopaedic review, and suggest analgesia adjustments. Use short clinical paragraphs and a final action box so the GP can act immediately.
2026 update
What changed in 2026 for Physiotherapist band scoring
From 2026 the scoring emphasises clearer task fulfilment and sharper clinical prioritisation for all professions. Examiners now expect physiotherapist letters to demonstrate explicit clinical reasoning and clearly justified requests, not just relevant facts.
For physiotherapy referrals this means including objective functional measures and red‑flag indicators, setting timeframes for GP action, and specifying precise investigations or escalation steps. Language accuracy and concise organisation carry greater weight under the stricter regime.
Frequently asked questions
How long should an OET physiotherapy referral be?
Aim for 160–200 words. Be concise but include key findings, treatment, and clear requests.
What red flags must I highlight?
Highlight infection signs (fever, warmth, raised CRP), sudden severe loss of function, or suspected fracture.
Should I request specific tests?
Yes. State exact tests (e.g. AP/lateral X‑ray, FBC, CRP, ESR) and conditions that trigger aspiration or urgent referral.
How specific must my timeframe be?
Be as specific as clinically justified. Use urgent (within 24–48 hours) for red flags; otherwise state within a few days.
What details of physiotherapy treatment are needed?
Summarise sessions, interventions, and objective response (improved ROM, pain scores, or minimal change).
How do I improve language accuracy?
Use short clinical sentences, medical terms appropriately, and check grammar and tenses; avoid vague words like "maybe".
Keep learning
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