Mastering the OET Writing sub-test is a critical milestone for nurses seeking registration with international bodies like the NMC – Nursing and Midwifery Council UK. In this comprehensive guide, we provide a high-quality OET referral letter sample nursing focused on a post-natal depression scenario, accompanied by a model answer that achieves a Grade B. This post will break down the essential strategies needed to navigate complex case notes and transform them into a professional, concise, and logically structured referral letter.

Success in the writing sub-test requires more than just good English; it requires an understanding of clinical priority and professional communication standards. For those aiming for a high score, understanding the OET Score Guide is the first step in recognizing what examiners are looking for. Whether you are currently enrolled in OET Writing for Nurses or studying independently, this breakdown will serve as a roadmap for your preparation.

Case Notes

Patient Details:
Name: Mrs Elena Rossi
DOB: 12/05/1996 (Age: 28)
Address: 42 Oak Lane, Newtown
Social History: Married to Mark (accountant). Migrated from Italy 2 years ago. No local family support. Husband works long hours. Primary caregiver for newborn.

Medical History: No previous psychiatric history. No known allergies.

Obstetric History: G1P1. Term delivery (40+2 weeks) on 12/09/2025. Emergency Caesarean section due to fetal distress. Significant intraoperative blood loss (800ml). Iron supplements prescribed post-discharge.

Current Presentation: 24/10/2025 (6 weeks postpartum).
Visit to Community Health Centre for routine 6-week check. Patient appeared dishevelled and tearful. Reports constant fatigue, but unable to sleep even when baby is sleeping. Loss of appetite (weight loss 3kg in 2 weeks).

Psychological Assessment: Expresses feelings of “numbness” and guilt. States, “I feel like a failure as a mother.” Reports difficulty bonding with baby Leo; finds his crying “unbearable.” No thoughts of self-harm or harm to the infant. Edinburgh Postnatal Depression Scale (EPDS) score: 18/30.

Physical Examination: BP 110/70. HR 82. C-section scar healing well. Baby Leo: weight gain appropriate, breastfeeding established but mother finding it stressful.

Management Plan:
1. Urgent referral to Community Mental Health Team (CMHT) for specialist assessment.
2. Increased home visits by Community Nurse.
3. Referral to local mother and baby support group.
4. Continue iron supplements.

Reason for Referral: Specialist assessment and management of suspected Postnatal Depression (PND) in the context of social isolation and traumatic birth.

Model Referral Letter — Grade B

The following model letter demonstrates the structure and level of detail required to achieve a Grade B. Note that the body length is approximately 190 words, adhering to the 180-200 word recommendation for the body paragraphs.

24 October 2025

Intake Officer
Community Mental Health Team
Newtown District Hospital
Newtown

Re: Mrs Elena Rossi, DOB: 12/05/1996

Dear Sir/Madam,

I am writing to urgently refer Mrs Rossi, a 28-year-old first-time mother, who is experiencing significant symptoms of postnatal depression. She requires a specialist mental health assessment and ongoing management.

Mrs Rossi underwent an emergency caesarean section six weeks ago following a traumatic labor involving fetal distress and significant blood loss. Socially, she is isolated as she moved from Italy two years ago and has no local family support. Her husband works long hours, leaving her as the primary caregiver for her six-week-old son.

During today’s routine check, Mrs Rossi appeared dishevelled and tearful. She reported persistent insomnia, poor appetite, and feelings of “numbness” and maternal failure. Notably, she is experiencing bonding difficulties with her infant and finds his crying overwhelming. Her Edinburgh Postnatal Depression Scale (EPDS) score was 18, indicating a high probability of depression. However, she denied any thoughts of self-harm or harm to her baby.

In light of the above, I would appreciate your urgent assessment of Mrs Rossi. I have increased her community nursing home visits and referred her to a local support group, but specialist intervention is now indicated.

Yours faithfully,

Registered Nurse

Examiner Analysis

To achieve a Grade B, a candidate must demonstrate proficiency across six specific criteria. Below is a detailed breakdown of how the model letter above meets these standards.

Purpose

The purpose of the letter is immediately clear. In the very first paragraph, the writer states, “I am writing to urgently refer Mrs Rossi… for a specialist mental health assessment.” This ensures the recipient knows exactly why they are reading the letter and what is expected of them. In OET Writing, a “hidden” purpose or one buried at the end of the letter will result in a lower score for this criterion.

Content

The writer has selected all high-priority information from the case notes. This includes the “EPDS score of 18,” the “emergency caesarean section,” and the “lack of local family support.” These elements are crucial for a mental health professional to understand the patient’s risk factors and current state. The letter also correctly identifies the absence of suicidal ideation, which is a vital safety detail in psychiatric referrals.

Conciseness and Clarity

This letter successfully omits irrelevant details that do not impact the mental health referral. For example, the patient’s exact blood pressure (110/70) and the fact that the baby’s weight gain is appropriate are excluded. While these are important for a general health check, they are secondary to the psychological crisis. By focusing on “insomnia, poor appetite, and feelings of numbness,” the writer remains concise and clinically relevant.

Genre and Style

The register is appropriately formal and professional. The use of clinical terminology such as “primary caregiver,” “traumatic labor,” and “specialist intervention” demonstrates a high level of professional literacy. The writer avoids informal language (e.g., saying “she is very sad”) and instead uses objective descriptions like “appeared dishevelled and tearful.”

Organisation and Layout

The letter follows a logical progression. It starts with the purpose, moves to the background/risk factors (the birth and social isolation), then details the current clinical presentation, and concludes with the request for action. This structure allows the reader to follow the clinical reasoning behind the referral. Each paragraph has a clear theme, which is a hallmark of a Grade B response.

Language

The grammar and syntax are accurate throughout. The writer uses complex sentence structures effectively, such as: “Mrs Rossi underwent an emergency caesarean section six weeks ago following a traumatic labor involving fetal distress…” This shows a command of the English language that is necessary for professional practice. Spelling and punctuation, including the correct use of the “Re:” line and salutations, are flawless.

Grade B vs Grade C Comparison

Understanding the difference between a passing grade (B) and a near-miss (C) is essential for effective preparation. Often, the difference lies in how information is synthesized and the level of grammatical precision.

Grade C Version (Lower Performance):
Mrs Rossi had a baby 6 weeks ago by emergency C-section and she lost a lot of blood. Now she is crying a lot and she can’t sleep. She moved from Italy 2 years ago so she has no family here. Her EPDS is 18 and she is not eating well. She feels like a failure and she is not bonding with Leo.

Grade B Version (Model Answer):
Mrs Rossi underwent an emergency caesarean section six weeks ago following a traumatic labor involving fetal distress and significant blood loss. Socially, she is isolated as she moved from Italy two years ago and has no local family support. Currently, she presents with an EPDS score of 18, persistent insomnia, and significant bonding difficulties with her infant.

What changed?
In the Grade B version, the writer uses linking words (“following,” “socially,” “currently”) to create flow. The Grade C version uses simple, repetitive “and” structures and lacks professional “weight.” Furthermore, the Grade B version groups related ideas (social history together, clinical symptoms together), whereas the Grade C version jumps between different topics within the same paragraph.

Useful Phrases for Referral Letters

Common Mistakes to Avoid

• Irrelevant Clinical Data: Nurses often include every vital sign (BP, Temp, HR) from the case notes. If the patient is being referred for depression, a normal temperature is usually irrelevant. Focus on the reason for referral.
• Incorrect Date Format: OET prefers “24 October 2025” or “24/10/2025”. Avoid American formats like “October 24th, 2025” which can lead to inconsistencies.
• Confusing the Salutation: If you know the recipient’s name (e.g., Dr. Smith), use “Yours sincerely”. If you do not know the name (e.g., Intake Officer), use “Yours faithfully”.
• Over-reliance on Case Note Wording: Do not just copy and paste sentences from the notes. You must transform the bullet points into cohesive, grammatical prose.
• Missing the “Re:” Line: Ensure the patient’s full name and date of birth are clearly stated before the salutation. This is a standard professional requirement.
• Poor Time Management: Candidates often spend too long on the 5-minute reading time and don’t leave enough time for the 40-minute writing phase. Practice writing the letter within the 40-minute limit.

If you are preparing for other parts of the exam, you may find our guide on OET Nursing Speaking: Supporting a Patient with a New Diagnosis helpful, as many of the communication skills overlap with the empathy required in writing. Similarly, for clinical scenarios involving post-operative care, check out our post on OET Nursing Speaking: Colostomy Care.

Conclusion

Writing a referral letter for postnatal depression requires a delicate balance of clinical accuracy and professional empathy. By focusing on the high-priority symptoms, social risk factors, and clear communication of the referral’s purpose, you can consistently achieve a Grade B or higher. Use this OET referral letter sample nursing as a template for your own practice, and remember that clarity and conciseness are your most valuable tools on test day.