“To Whom It May Concern” (TWIMC) Letters Policy

1. Purpose

This policy sets out the practice approach to requests for “To Whom It May Concern” letters to ensure:

• Safe and appropriate clinical governance
• Consistent handling of requests
• Clarity for patients regarding availability, process, and charges

2. Scope

This policy applies to all:

• Clinical staff
• Administrative staff
• Patients requesting general supporting letters not addressed to a specific organisation

3. Definition

A “To Whom It May Concern” (TWIMC) letter is a general letter requested by a patient, typically for:

• Housing or accommodation purposes
• Travel or gym membership
• Employment or education
• General supporting statements

These letters are usually non-specific and may rely on clinical information and/or patient-reported information.

4. Submitting a Request

All requests for TWIMC letters must be submitted:

✅ In writing, addressed FAO the Administration Team, or
✅ Via an online consultation request

Requests made verbally (e.g. at reception or by telephone) will not be accepted.

Requests must include:

• The purpose of the letter
• Who the letter is for (if known)
• Relevant supporting information

5. Policy Statement

The practice does not routinely provide TWIMC letters as part of NHS services.

Where such letters are provided, they are considered:

✅ Private (non-NHS) work

and will be managed in line with this policy.

6. Private Fees

• A charge will apply for TWIMC letters
• Fees are set in accordance with the practice private fees schedule
• Payment must be made in advance of the letter being prepared
• Fees are non-refundable once work has commenced

7. Clinician Discretion

All requests are subject to:

• Clinical appropriateness
• Review of the medical record
• Professional judgement of the GP

The GP:

• Is not obliged to provide a letter
• Will decide whether the request can be supported
• Will determine the content of the letter

8. Control of Content

• Patients cannot dictate or prescribe the wording of any letter
• Patients cannot insist on specific phrases, diagnoses, or outcomes being included
• All letters will:
  • Be based on factual clinical information only
  • Only include content supported by medical evidence

9. Requests for Amendments

• Requests for rewrites, amendments, or alterations after completion will:
  • Not routinely be accepted
  • Be treated as a new request if considered appropriate
• Additional charges may apply for any further work

 

10. Multiple Requests / GP Shopping

• Patients may not request the same letter from multiple GPs within the practice
• Patients cannot request a different GP to rewrite or provide an alternative version of a letter for the same purpose
• The original clinician’s decision is final

11. Face-to-Face Assessment

• The GP may require the patient to attend a:
  • Face-to-face consultation, or
  • Telephone/clinical review

before issuing a letter

• If an assessment is required:
  • This must be completed before the letter is prepared
  • Attendance does not guarantee a letter will be issued

12. Processing Timeframes

All TWIMC letter requests require:

✅ Up to 28 days to complete

• Urgent requests cannot be guaranteed
• Timescales begin once:
  • Request is received correctly, and
  • Payment has been made (if applicable)

 

 

13. Refusal of Requests

Requests may be declined where:

• There is insufficient clinical evidence
• The request is inappropriate or outside medical scope
• The content requested is not clinically justified
• The GP considers it professionally inappropriate to issue a letter

Patients will be informed of the outcome where appropriate.

14. Responsibilities

• Practice Manager
  • Oversight of policy implementation
  • Maintaining fee schedule
• Clinical Staff
  • Decision-making on appropriateness and content
• Administrative Staff
  • Initial handling of requests
  • Communication with patients regarding process, fees, and timeframes

15. Equality and Fairness

All requests will be managed consistently to ensure:

• Fair access
• No preferential treatment
• Transparency in decision-making

16. Review

This policy will be reviewed every 2 years or sooner if guidance changes.