Transformation Directorate

Sending clinical correspondence electronically to primary care

The Clatterbridge Cancer Centre NHS Foundation Trust is one of the UK’s leading cancer centres providing highly specialist cancer care to a population of 2.3m people across Cheshire, Merseyside and the surrounding areas including the Isle of Man. It is one of the largest cancer centres in the UK, employing approximately 1,200 staff and treating more than 27,000 patients every year.

Clatterbridge is a tertiary cancer centre, which means that the patients who are seen have already been diagnosed and referred by other hospitals. The centre provides non-surgical cancer care, for example, chemotherapy and radiotherapy for solid tumours and blood cancers. The vast majority of their care is delivered on an outpatient or day-case basis.


The Clatterbridge Cancer Centre creates on average 4,500 clinical letters per month after a clinical appointment (54,000 per year), with all of them copied to the GP (unless stated).

Previously they were only sent in paper format costing £0.55 per letter (£2,475 per month just for primary care letters) based on paper, printing, staff time and distribution costs.

The Trust lacked a clear audit trail, which meant it was difficult to track whether or when a letter had been sent and/or delivered.


To implement a way of sending clinical correspondence electronically to primary care directly from the Trust's electronic patient record system (EPR) Meditech (MT).

Solution and impact

The Trust implemented the messaging exchange for social care and health (MESH) service for sending clinical letters and discharge summaries to GPs digitally through its integration engine (TIE). MESH is the main messaging service used across health and social care and works using the Spine infrastructure. It allows for electronic messages to be communicated securely from one application to another.

Clatterbridge worked in close partnership with NHS Informatics Merseyside to implement MESH to all Merseyside GP practices in a short period of time (less than 18 months). This has helped to progress work with Wirral CCG and a Wirral GP practice. Merseyside and Wirral account for more than 80% of Clatterbridge’s patient population.

The benefits of the project include:

  • savings from eliminating paper and postage costs and staff time savings from sending clinical correspondence and discharge/end of treatment summaries electronically
  • greater auditable control and traceability with the end-to-end electronic sending of documents
  • reduced risk of sensitive correspondence being lost or delayed in the post, or misdirected/intercepted by fax
  • compliance with NHS England requirement to send discharge summaries electronically by October 2015


Clatterbridge worked collaboratively with NHS Digital and Informatics Merseyside in order to enable use of the Message Exchange for Social Care and Health (MESH) to support transfer of large files across health and social care organisations.

MESH is a free and secure NHS Digital product with no associated software or licensing costs and includes full 24/7 user support. MESH is used to transfer large electronic files securely from one organisation to another. Organisations can have one or more MESH mailboxes, which are the endpoints that users send and receive files. Files are moved and not copied. MESH connects to the NHS Spine infrastructure through the N3/HSCN network; however, there is an option to instead connect through the internet for MESH client and MESH application programming interface (API).

At Clatterbridge, the MEDITECH (v6.08) electronic patient record (EPR) system is used to create the electronic clinical correspondence which is sent through MESH. A Trust integration engine (TIE) was then required in order to send letters electronically from EPR to MESH. The TIE parses text and Microsoft word documents generated by the EPR and maps the data to Kettering XML file format consumed by MESH / EMIS GP systems; this ensures that Trust-side systems are able to transmit data through MESH.


  • MESH enables the GPs’ clinical system to absorb digital correspondence into their day-to-day workflow to readily read, action and sign off letters
  • GPs are able to view documents electronically and then file into the patient’s record without any manual intervention
  • GPs can access clinical information quicker, enabling patients to be seen sooner for any required follow-up care
  • The system allows improved accessibility to clinical data and sharing of information
  • Improved clinical care and discharge planning with primary care and reduced GP and Trust staff time querying and responding to care issues
  • The process creates an audit trail of all correspondence sent to primary care


To streamline the sending of clinical correspondence from the Clatterbridge Cancer Centre, created within the administration services department, to primary care (and in particular GPs). The Trust was keen to reduce paper and associated costs as part of the paperless strategy.

Key learning points

Factors that supported success:

  • baseline assessment of current mailing process to assess the opportunity for implementing electronic correspondence with GPs
  • communications at the beginning of the project was important to establish ways of working with each clinical commissioning group (CCG) particularly where a different approach was required
  • this was a fast paced project, from initiation to the first message was 4 months. It was important that there were no staff changes to the core team during that time so that no knowledge is lost

Key figures/quotes

“Knowing that the GP will receive clinical letters digitally as soon as they are signed off is extremely important, not only to support planning with our primary care colleagues, but it also means that for our patients they can be seen sooner and closer to home for their follow-up care needs.”
Dr Richard Griffiths, consultant in medical oncology (taken from the Global Digital Exemplar Blueprint on the NHSFutures platform)

Key contact

Sarah Barr, chief information officer, Clatterbridge Cancer Centre NHS Foundation Trust