The letter, from case notes to Grade B.
OET Writing gives you five minutes of case notes and forty minutes to turn them into a letter a real reader could act on. It is marked by people on six criteria, and five of the six are about the letter as a document rather than the English in it. This page is the method, a worked example, the criteria at the B line, and a marker that reads your own letter against them.
Why this matters. Most candidates lose the letter on selection, not on grammar. The case notes are written to contain more than the reader needs, and the untrained instinct is to prove diligence by including everything. Since 2024 the assessors have marked that instinct down harder on Conciseness and Genre. The method below is built on one question asked of every line in the notes: does this change what the reader will do? Everything on this page is what I teach in OET Writing lessons, and the marker at the bottom applies the same six criteria the assessors do, as a first read.
One letter, one reader, forty minutes.
The shape is fixed, so learn it once. Everything that varies is in the notes and the reader.
The reader
Named in the task line at the foot of the notes
Usually another professional: a GP, a specialist, a community nurse, a care-home manager. Sometimes a patient, a parent or a carer. Everything about register, abbreviations and what counts as necessary follows from who this person is and what they already know.
A GP knows the patient's regular medication. A care-home manager does not know what happened in theatre. Write for the gap.
The case notes
Headed sections, shorthand, more than you need
Social history, medical history, presenting complaint, hospital course, discharge plan. Written in note form with abbreviations. Deliberately over-complete: the reader's needs are a subset, and finding the subset is the task.
The notes are the raw material, never the letter. Copying a line across unchanged is the most common way to lose Genre and Style.
The timings
5 minutes reading, 40 minutes writing
You may not write during the reading time, and that is a gift: five minutes of pure planning, if you know what to plan. Spend them on the reader, the purpose and the must-list, not on reading the notes twice.
A candidate who leaves the reading time with a purpose line and a marked must-list has done the hard half.
The letter types
Referral, transfer, discharge, advice
A referral asks a colleague to take something on. A transfer or discharge letter hands over care and says what the next carer must do. A letter of advice, to a patient or carer, explains in plain language what to do and when to worry. The structure is the same; the register is not.
Ask which of the four you are writing before you read a single case-note line. It decides the tone of everything.
Five moves, in a fixed order.
The first three happen in the reading time. The fourth and fifth are the writing. Candidates who reverse the order, writing first and selecting as they go, produce the long, faithful, Grade C+ letter the assessors see most often.
Read for the reader
Task line first, then the notes
Start at the bottom: who is the letter to, and what do they need to do? Hold that question while you read up through the notes. Every line is now either relevant to that reader's next action or it is not.
Reading the notes before the task line is reading without a filter. Everything looks important.
Write the purpose line
One sentence, before anything else
Who the patient is, what has happened in a phrase, and what you want the reader to do. That sentence is your first paragraph and your Purpose mark. Get it down in your head during the reading time and on paper in the first minute of writing.
"I am writing to request a review of Mr Achebe within one week of his discharge today, following an admission for an exacerbation of COPD."
Mark the notes: must, may, leave
Three marks, every line
Must: the reader cannot act safely without it. May: it helps the reader understand, and there is room. Leave: it does not change what the reader will do. Social detail that explains a care need is must; social detail that paints a picture is leave.
His wife works part time and he is anxious about being alone: must, because the GP's plan depends on it. He was a bus driver: leave.
Order for the reader
Purpose, then history, then the request
Paragraph one is the purpose line. Paragraph two is what happened, in the order that explains the request. Paragraph three is the current situation and anything the reader must know to act. The last paragraph is the request itself, specific, with any dates. Paragraphs by topic, never by case-note heading.
If a paragraph does two jobs, it is two paragraphs. If two paragraphs do one job, they are one.
Write, then cut to 200
Full sentences, then the knife
Turn each must item into a complete sentence in the reader's register. Count. If you are over 200, the may items go first, then any sentence that repeats the notes' wording rather than reporting it. Under 180 usually means a must item is missing, not that you need padding.
The last three minutes are for reading it as the reader: could I act on this, and is there anything here I did not need?
The notes, the letter, and why it is a B.
A nursing case, invented for this page. Read the notes with the task line in mind, then read the letter I wrote from them, then the selection decisions underneath. The letter is a model to learn from, not a template to reuse: the next case will have a different reader and a different must-list.
The case notes
A model I wrote, at Grade B · 184 words
- Purpose The first sentence names the patient, the event, the request and the deadline. Dr Rahman knows what the letter is for before she reaches the second line.
- Must The admission story in three sentences, the oxygen figures because they show recovery, the inhaler technique because it is the reason for the review, the self-management plan and the early-contact advice because the GP continues both, the anxiety and the wife's concern because they change what the GP might arrange.
- Leave Retired bus driver, the ten-minute walk to the shops, the two-storey house, the amlodipine, no known allergies, the 30 pack-years. Dr Rahman is his GP: she knows his medication, his allergies and his smoking history, and none of the rest changes her next action.
- May, kept The flu vaccination, because it is due within the review window and the GP acts on it. Kept to one sentence at the end, where it does not interrupt the request.
- May, cut Managing stairs slowly with rests. Relevant to his function, but the pulmonary rehabilitation referral already covers it and the letter was at its limit.
- Genre Nurse to doctor: professional register, full words rather than ward shorthand, no abbreviation the reader would have to decode. "Requesting review" in the task line becomes "I would be grateful if you could review", which is the same request in letter register.
- Language Frequent error-free sentences, one complex structure per paragraph at most, the professional terms spelt correctly. Nothing here is Band 8 English. It does not need to be.
What each one is asking, and where B sits.
Purpose is scored out of 3, the other five out of 7. The official guidance puts Grade B at 2 of 3 for Purpose and 5 of 7 on each of the rest. The OET hub walks each criterion with a habit; here is the short form to check a letter against.
| Criterion | Scale | At Grade B |
|---|---|---|
| Purpose | 0 to 3 | The reason for writing is clear in the opening lines and expanded appropriately. |
| Content | 0 to 7 | Every item the reader needs is present and accurate; nothing the reader needs is missing. |
| Conciseness and Clarity | 0 to 7 | Irrelevant detail is left out; the letter is about 200 words and reads cleanly. |
| Genre and Style | 0 to 7 | Register and tone fit the reader; abbreviations only where that reader expects them; no note-form. |
| Organisation and Layout | 0 to 7 | Purpose first, history in a logical order, request last; paragraphs by topic; a proper opening and close. |
| Language | 0 to 7 | Frequent error-free sentences, controlled complex structures, correct spelling of professional terms. |
The consequence. Five of the six criteria can be lifted in a week by method. Only Language takes months, and if your IELTS Writing sits at 7 it is already there.
A practice case, and a marker for your letter.
A second nursing case, invented for this page, is loaded below. Set a timer for forty-five minutes, write the letter to the reader in the task line, then have it read against the six criteria. The read is indicative, the same first read the writing checker gives, and nothing you write is stored. Four further cases, one each for medicine, physiotherapy, pharmacy and dentistry, are on the practice page.
Fix this first
One fix, to show you the kind of thing
A first read against the six published criteria, built for one letter at a time. It marks the page, not the day: treat the grade as a rough position and the two lists as the work. The full marked letter, with every selection decision explained, is what a lesson is for.
The method is free. The marking is where it moves.
In an OET Writing lesson, a letter of yours is marked against the six criteria with every must, may and leave decision explained line by line, and the next one is written against the clock with me reading over your shoulder.
Lessons are £20 for fifty minutes, one to one with a native British tutor, with a written report after each. The first lesson doubles as a full assessment of where your letter sits against Grade B. The OET hub covers the other three sub-tests; the grammar pages cover the Language criterion, unchanged.