Writing A Recommendation Letter For The NHS
A letter of recommendation for an NHS position needs to meet specific expectations that differ from corporate references. The NHS uses a structured recruitment process, and hiring managers want concrete evidence of clinical competence, professionalism, and alignment with NHS values. Generic praise gets discarded quickly. I've written these for colleagues applying to band 5 through band 8 roles, and the pattern is consistent. Here is how you actually do it properly. Start with your relationship to the candidate and how long you have worked with them. Name the setting. "I am a consultant physician at St Thomas' Hospital and I have supervised Sarah's training over the past eighteen months in acute medicine" is far more useful than "I am pleased to recommend..."
Then move into specific examples. Not a list of duties. Actual incidents. The time the candidate stayed late to ensure a handover was complete. The way they handled a distressed family member. These details matter because panel reviewers read hundreds of letters and can spot manufactured content immediately. Cover the seven NHS values: commitment to quality of care, compassion, improving lives, working together, respect and dignity, courage, and openness. You do not need to address every single one explicitly, but your examples should naturally demonstrate at least four or five of them. If you write about clinical excellence without mentioning compassion, the letter feels incomplete. Close with a clear endorsement. "I recommend them without reservation" carries more weight than "I think they would be suitable." Be honest about that distinction. Overstating can come back to haunt everyone involved.
What Goes Wrong Most Often
Two mistakes dominate. First, people write the letter as if it is a character reference for university. The NHS is looking for operational readiness, not moral philosophy. Second, people forget that the letter often goes into a selection file that may be reviewed months later. Date it, letterhead it, and include your direct contact details. Without a phone number or email, the panel cannot verify anything, and that creates doubt. I once wrote a strong letter for a junior doctor applying to a surgical registrar role. Two weeks later the selection panel called me. They had a specific concern about her decision-making under pressure, and they wanted my direct input. If I had only provided an email address, that conversation might not have happened, and her application could have been quietly deprioritized. I learned to always give a landline or direct mobile number when possible.
Get the Full Details
Format And Length
Keep it to one page unless the candidate has an exceptional track record requiring two. Panels are overwhelmed. A dense one-page letter beats a rambling two-page one. Use clear paragraphs. Avoid bullet points for the main narrative, though a brief skills summary near the end can help. Reference number if one exists. Job title and band if known. Your full title and department. These small administrative details show you understand the process.
Common Pitfalls To Avoid
Do not include medical information about patients, even anonymized cases. Even the smallest detail could breach confidentiality. Do not compare the candidate unfavorably to peers. "Better than most trainees I have seen" sounds like backhanded praise to someone reading rapidly. Do not use template language. Phrases like "hardworking individual with excellent communication skills" appear in tens of thousands of letters. Specificity is what makes yours readable and credible. Also avoid vague timelines. "Worked well with the candidate" means nothing. "Supervised 47 clinical assessments over twelve months" tells the panel exactly what level of interaction you had.
Counter-Intuitive Detail
Most people think recommending a candidate means highlighting only strengths. But a balanced letter that acknowledges a development area and shows how the candidate responded to feedback often ranks higher. I wrote about a nurse who struggled initially with documentation speed. I described how she completed a targeted course, improved her turnaround time significantly, and now produces clean records consistently. That narrative arc demonstrates growth mindset, which is far more valuable to a hiring panel than a spotless but unremarkable profile. The downside of this approach is that it requires honesty. If the candidate had not actually addressed the gap, you are making a claim that could be checked. Only include developmental details when you can vouch for the resolution.
When You Should Decline To Write
If you have not worked closely with the person, say so. A lukewarm letter from a distant colleague does more harm than no letter at all. The NHS recruitment system allows candidates to proceed without a reference in some cases, particularly for entry-level positions where academic references may suffice instead. If you genuinely cannot recommend the person, decline politely. I have seen applicants submit letters from supervisors who clearly resented writing them. The tone leaks through regardless of the words chosen, and it undermines the entire application.
