Forty audio files and one secretary
Your GPs dictate letters after consultations: referral letters, summaries for patients, letters for insurers, notes for the patient's NHS surgery. The audio files go into a shared folder or a dictation app. The medical secretary works through them in the order they arrived, types each one, looks up the recipient's address, and puts the draft in the doctor's tray for signing.
On a good week, the queue is manageable. When the secretary is on holiday, or two doctors do long clinics on the same day, it grows. A letter that matters to a patient this week sits behind routine ones from last week, and nobody can see that until the patient rings.
Once typed, drafts wait again for the doctor, who may only be in two days a week and has a pile of other paperwork.
Why letters get stuck twice
The typing queue is first in, first out, because the audio files carry no information about who the letter is for, what type it is or how soon it is needed. The secretary has to open each file to find out, which is itself time.
Approval is the second bottleneck. Drafts go back to doctors through email, paper or the practice system's task list, mixed in with everything else. Doctors approve in batches when they have a moment, and a letter that needs one small correction goes round the loop again.
Nobody owns the whole journey from dictation to sending, so nobody can say how long letters are taking or where they are waiting.
What the backlog costs
| Stage | What goes wrong | Effect |
|---|---|---|
| Dictation | No patient or type attached | Secretary opens every file to triage |
| Typing | First in, first out | Needed letters wait behind routine ones |
| Approval | Drafts buried in doctors' tasks | Days added after typing |
| Sending | Addresses looked up by hand | Wrong or outdated recipients |
| Overall | No visibility | Patients chase, staff cannot answer |
How we shorten the letter journey
- Doctors dictate through an app or phone that asks for the patient and letter type before recording, so each file arrives labelled. Existing dictation apps can often do this with the right setup.
- Audio is sent to a speech-to-text service, including medical-vocabulary options where available, to produce a first draft for the secretary to correct rather than type from scratch.
- The secretary's queue is ordered by the need-by date the doctor set, not just arrival time.
- Recipient details are pulled from the patient's record or your contacts directory, and the letter is laid out on your template.
- Drafts go to a dedicated approval queue for the doctor, on their phone or computer, where they can approve, edit or send back with a comment.
- Approved letters are sent by the route set for that recipient and logged, and the patient can be told the letter has gone.
Transcripts are drafts. Nothing leaves the clinic until a person has corrected it and the doctor has approved it. The content of every letter is the doctor's.
After the change
The secretary edits drafts rather than typing every word, and works in order of need. Doctors see a short, separate approval queue and can clear it between patients. Letters go out with the right address and a record of when. The practice manager can see how many letters are waiting at each stage, and cover can be arranged before a holiday turns the queue into a backlog.
Recognise this queue?
- Dictation files arrive with no patient or letter type attached
- Letters are typed in the order they were dictated
- Drafts wait days for a doctor's signature
- Patients ring to ask whether their letter has been sent
- Nobody can say how many letters are outstanding