The NHS Plan promises that letters about patients will be copied to them as of right. Yet, beyond a few small studies, little is known of the views of clinicians and patients about the process, and few have any experience of it. The aim of this study was to elicit the views of clinicians and patients about the idea of copying general practitioner (GP) referral letters to patients (part one), and to describe the experiences of GPs and patients actually involved in the process (part two). The setting was one health district in the north of England (part one) and three research practices in the same district (part two). A questionnaire survey was used to elicit the views of 214 consultants, 260 GPs and 584 patients (part one), and semi-structured interviews to assess the experience of 11 GPs and 48 patients involved in the process of copying referral letters (part two). The main outcome measures were the perceived and reported bene ts and disadvantages of copying referral letters to patients and the practical implications of making this a routine activity. In the rst part of the study, replies were received from 148 hospital consultants (70%), 144 GPs (55%) and all the patients in an opportunistic waiting-room sample. Seventy-six of these consultants (55%) but only 49 of the responding GPs (34%) thought that referral letters should be routinely copied to patients. This compares with 499 (85%) of the patients surveyed who were in favour of this in principle. Potential bene ts suggested by clinicians included better informed patients and improved communication. There were concerns about making patients anxious and about the dif culty of writing letters that were both comprehensible to patients and informative to colleagues. In the second part of the study, GPs involved in copying letters to patients experienced no major problems in writing letters that patients could understand but which were also fully informative to consultants. There was some increase in administrative workload. A sense of increased openness in the communication process was reported. Patients valued seeing a copy of their referral letter and few admitted to any major problems in understanding its content. In general, they felt better informed about their illness and better prepared for their outpatient appointment-44 patients (91%) thought copying letters should become routine practice. In this study, carried out before the NHS Plan was published, a majority of consultants supported, with some reservations, the idea that patients should receive a copy of their GP referral letter. Surveyed GPs anticipated major dif culties in copying letters to patients, and most were not in favour of this becoming routine practice. Patients and GPs actually involved in copying letters reported important bene ts but also identi ed issues which will need to be addressed before copying letters can be effectively implemented as a routine activity.

BackgroundGPs collect multisource feedback (MSF) about their professional practice and discuss it at appraisal. Appraisers use such information to identify concerns about a doctor's performance, and to guide the doctor's professional development plan (PDP). AimTo investigate whether GP appraisers detect variation in doctors' MSF results, and the degree of consensus in appraisers' interpretations of this information. Design and settingOnline study of GP appraisers in north-east England. MethodGP appraisers were invited to review eight anonymised doctors' MSF reports, which represented different patterns of scores on the UK General Medical Council's Patient and Colleague Questionnaires. Participants provided a structured assessment of each doctor's report, and recommended actions for their PDP. Appraiser ratings of each report were summarised descriptively. An 'agreement score' was calculated for each appraiser to determine whether their assessments were more lenient than those of other participants. ResultsAt least one report was assessed by 101/146 appraisers (69%). The pattern of appraisers' ratings suggested that they could detect variation in GPs' MSF results, and recommend reasonable actions for the doctors' PDP. Increasing appraiser age was associated with more favourable interpretations of MSF results. ConclusionAlthough preliminary, the finding of broad consensus among GP appraisers in their assessment of MSF reports should be reassuring for GPs, appraisers, and employing organisations. However, if older appraisers are more lenient than younger appraisers in their interpretation of MSF and in the actions they suggest to their appraisees as a result, organisations need to consider what steps could be taken to address such differences.

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