Clinical Negligence Letter of Claim Template
Draft a UK Clinical Negligence Letter of Claim under the CPR Pre-Action Protocol for the Resolution of Clinical Disputes — the mandatory first step before issuing clinical-negligence proceedings against an NHS Trust, GP practice or other healthcare provider. Triggers the Defendant's 4-month Letter of Response window. Covers Bolam, Bolitho, Montgomery, Wilsher, Bailey, Khan v Meadows, JC Guidelines, Limitation Act 1980 and the statutory Duty of Candour.
This is a Letter of Claim under the Pre-Action Protocol for the Resolution of Clinical Disputes (the "Protocol"). It concerns the treatment provided by an NHS Trust (NHS Resolution responsibility) to Jennifer Eleanor Whitaker (date of birth 1978-03-14), NHS Number 485 297 6314. Please treat this letter as commencing the formal pre-action process under paragraph 5.1 of the Protocol.
1.3 Healthcare provider: Royal Free London NHS Foundation Trust, of Pond Street, Hampstead, London NW3 2QG.
1.4 Treatment dates: 2024-09-08 to 2024-09-22.
1.5 Treatment setting: Inpatient — Royal Free Hospital, Hampstead.
1.6 Presenting complaint:
Acute severe abdominal pain, vomiting, fever 39.4°C, raised inflammatory markers (CRP 218, WCC 18.7). Admitted via AandE on 8 September 2024 with suspected appendicitis.
8 September 2024, 22:14 — Admitted to AandE. Initial assessment by FY2 Dr Aaron Levi. CT abdomen ordered.
8 September 2024, 23:51 — CT report by radiology registrar suggested phlegmon around appendix, possible early perforation. Antibiotic management commenced; surgical review deferred to morning ward round.
9 September 2024, 06:00 — Claimant reports worsening pain. Out-of-hours surgical SHO reviewed, did not escalate.
9 September 2024, 09:30 — Consultant ward round. Decision to "watch and wait" with IV antibiotics. No senior surgical opinion sought.
9 September 2024, 16:00 — Significant clinical deterioration: BP 87/45, HR 134, temp 39.8°C, peritonism. Sepsis-six bundle initiated.
9 September 2024, 19:45 — Emergency laparotomy. Perforated gangrenous appendix with generalised peritonitis and abscess formation.
9-22 September 2024 — Prolonged inpatient recovery including 6 days in HDU; small-bowel resection on 14 September due to ischaemia from sepsis; wound infection requiring antibiotics through to discharge.
3.2 Expert evidence on prognosis and ongoing care needs will be obtained and disclosed in due course in accordance with the Protocol.
4.2 The particular allegations of breach are:
(a) Failure to escalate care to a consultant surgeon on the night of 8/9 September 2024 despite CT findings of possible early perforation and rising inflammatory markers.
(b) Failure to perform emergency surgery within a reasonable time of the CT findings — appendicectomy should have been carried out within 6-12 hours, not 21 hours later.
(c) Failure of the out-of-hours surgical SHO at 06:00 on 9 September to escalate when the Claimant reported worsening pain.
(d) The decision to "watch and wait" with IV antibiotics on 9 September 09:30, in the face of CT findings of phlegmon and clinical deterioration, fell outside any responsible body of competent practice.
(e) Failure to apply the Royal Free's own internal Sepsis Pathway in a timely fashion.
4.3 Bolam / Bolitho framework — basis for the allegations:
The Claimant relies on the report of Mr Henry Davenport FRCS (consultant general surgeon) dated 4 April 2026, who opines that no responsible body of consultant general surgeons in 2024 would have managed the Claimant's presentation as the Royal Free did. The CT findings, clinical course and inflammatory marker trajectory mandated emergency surgery within 6-12 hours; the "watch and wait" approach is not supported by any logical analysis (Bolitho) and fell outside the range of reasonable surgical practice.
5.2 The particular causation case is:
But for the breaches of duty: (a) earlier surgical intervention (within 8-12 hours of admission) would have prevented perforation, gangrene, generalised peritonitis and the small-bowel ischaemia that necessitated bowel resection; (b) the Claimant would have undergone a routine appendicectomy (3-5 day inpatient stay, recovery in 2-3 weeks); (c) the Claimant would not have developed adhesional bowel obstruction requiring further admissions; (d) the Claimant would not have suffered the chronic pain and psychological sequelae attributable to the protracted complicated recovery.
Material contribution causation is relied on in the alternative — Bailey v MoD [2008] EWCA Civ 883.
Physical: (a) emergency laparotomy with 22cm midline scar (cosmetically significant); (b) small-bowel resection with permanent altered bowel function; (c) recurrent adhesional bowel obstruction (2 admissions, ongoing risk); (d) chronic abdominal pain managed by gabapentin.
Functional: 4 months off work; permanent restriction on heavy lifting; reduced exercise tolerance.
Financial: loss of earnings (consultant fees in private practice); ongoing prescription and care costs; estimated future care needs.
Psychological: PTSD-like symptoms following near-death sepsis; clinical psychology referral; ongoing therapy.
6.2 Particulars of past and future financial loss will be served as a Schedule of Loss in the usual way (general damages by reference to the Judicial College Guidelines, 17th edition; future loss using Ogden Tables at the prevailing discount rate).
7.3 Experts instructed (General surgery, colorectal surgery, psychiatry):
1. Mr Henry Davenport FRCS — consultant general surgeon, breach of duty (report dated 4 April 2026).
2. Mr Peter Lambert FRCS — consultant colorectal surgeon, causation and condition/prognosis (report awaited; expected June 2026).
3. Dr Sarah Kapoor MBBS MRCPsych — consultant psychiatrist, psychological sequelae (report dated 22 April 2026).
7.4 Expert evidence has been or is being obtained on breach of duty, causation, condition and prognosis in accordance with paragraph 4.3 of the Protocol.
• General damages (pain, suffering, loss of amenity): £55,000.00
• Past special damages (loss of earnings, care, expenses): £28,500.00
• Future special damages (future care, loss of earnings, equipment): £115,000.00
• Provisional total estimate: £198,500.00
8.2 Settlement proposal:
The Claimant invites the Defendant to consider settlement of this Claim on a global basis. The Claimant is prepared to consider any reasonable Part 36 or without-prejudice settlement offer. The Claimant's opening position, without prejudice to the contents of the Schedule of Loss to be served, is £200,000 inclusive of interest and costs.
8.3 The Defendant's response to this settlement proposal should be included in the Letter of Response. Any Part 36 offer must comply with CPR Part 36 to have the costs consequences provided for in that Part.
What Is a Clinical Negligence Letter of Claim?
A Letter of Claim is the formal first step under the UK Pre-Action Protocol for the Resolution of Clinical Disputes (the "Protocol"). It is sent by a claimant or their solicitor to the healthcare provider — an NHS Trust handled by NHS Resolution, a GP practice, a private hospital, or an individual clinician — setting out the factual basis of the claim, the alleged breaches of duty, the alleged causation, the injury and consequences, and an outline of the loss sought.
Once the Letter of Claim is received and acknowledged, the British Defendant has FOUR MONTHS under paragraph 6.1 of the Protocol to provide a Letter of Response stating whether liability is admitted or denied, addressing the allegations of breach and causation, and responding to any settlement proposal. Failure to comply with the Protocol can lead to costs sanctions under CPR Practice Direction — Pre-Action Conduct & Protocols paragraph 13, and adverse inferences at trial.
In the United Kingdom — England, Wales and Scotland — clinical negligence claims are governed by a strict body of statute and common law. The Limitation Act 1980 sets a three-year time limit from the date of the cause of action or the claimant's date of knowledge under s.14. The Compensation Act 2006 s.3 confirms that an apology is not an admission of liability. The statutory Duty of Candour under Regulation 20 of the Health and Social Care Act 2008 Regulations 2014 obliges British healthcare providers to inform patients of notifiable safety incidents and apologise where appropriate, independently of any litigation.
What's Covered in This Template
Our UK Clinical Negligence Letter of Claim template generates the formal pre-action letter with all the components required by paragraph 5.1 of the Protocol.
Sender — Solicitor or Claimant
The letter is typically sent by a UK solicitor on the claimant's behalf, but the template also supports a direct claimant letter for cases where representation has not yet been instructed.
Patient Identification
Full name, date of birth, NHS Number, address — the identifiers any British healthcare provider needs to locate the patient's records.
Minor / Litigation Friend
Where the patient is a minor (under 18), the claim is brought by a litigation friend under CPR Part 21. The s.28 Limitation Act paused-clock framework applies.
Healthcare Provider Type
Five provider types: NHS Trust (handled by NHS Resolution), GP Practice (NHS-contracted), private hospital, individual clinician, or other. Body text adapts.
Chronology of Treatment
Date- and time-stamped chronology with citations to medical records — the spine of the Letter of Claim. Critical for British clinical-negligence practice.
Breach of Duty — Bolam / Bolitho
Particular allegations of breach pleaded under the Bolam standard refined by Bolitho — the standard of an ordinary skilled clinician, subject to logical analysis.
Causation — Wilsher / Bailey / Khan
But-for causation under Wilsher v Essex AHA, with material contribution under Bailey v MoD and scope-of-duty under Khan v Meadows pleaded in the alternative.
Informed Consent — Montgomery
Optional Montgomery v Lanarkshire HB [2015] UKSC 11 informed-consent case for risk-disclosure failures.
Records Request
Formal request for medical records under Article 15 UK GDPR / DPA 2018 (or Access to Health Records Act 1990 for deceased patients).
Experts Instructed
Identification of medico-legal experts (FRCS / consultant specialists) with discipline. Signals the strength of the British claim and shapes the Defendant's response.
Provisional Quantum
Preview of general damages (Judicial College Guidelines, 17th ed), past special, future special damages (Ogden Tables) and total provisional estimate.
PAP 4-Month Response Deadline
Auto-calculated deadline for the Defendant's Letter of Response (4 months from acknowledgement). Compensation Act 2006 s.3 apology note and Duty of Candour acknowledgement included.
How to Create a Clinical Negligence Letter of Claim
Follow these steps to draft a UK Pre-Action Protocol compliant Letter of Claim.
- 1
Identify the Sender and the Claimant
Enter the sender (solicitor or claimant direct), sender address, reference, and letter date. Provide the patient's full name, date of birth, NHS Number and address. Where the patient is a minor or lacks capacity, identify the litigation friend acting under CPR Part 21.
- 2
Identify the Defendant Healthcare Provider
Select the provider type — NHS Trust (handled by NHS Resolution as the standard British NHS defendant), GP Practice, private hospital, individual clinician, or other. Enter the full legal name and address. For NHS Trusts, the letter typically goes to the Legal Department via NHS Resolution.
- 3
Build the Chronology
Draft a date- and time-stamped chronology of treatment, citing the source of each entry (medical records, contemporaneous notes, witness recollection). The chronology is the spine of the Letter of Claim — every later allegation references specific events at specific times. Include presenting complaint and current condition / prognosis.
- 4
Plead Breach + Causation + Injury (Expert)
In Expert mode, plead the particular allegations of breach (Bolam standard refined by Bolitho — no responsible body of practitioners would have managed the patient as the Defendant did), causation ("but for" under Wilsher, material contribution under Bailey, scope-of-duty under Khan v Meadows), and the injury, loss and damage with reference to the Judicial College Guidelines. Add the optional Montgomery informed-consent case if applicable.
- 5
Add Records, Experts, Quantum, Limitation (Expert)
In Expert mode, identify experts instructed (e.g. consultant surgeon for breach + condition / prognosis), formally request any outstanding medical records under Article 15 UK GDPR, provide a quantum preview (general + past special + future special damages totalling the provisional estimate), state your settlement proposal opening figure, identify the funding arrangement (CFA / Legal Aid / private / BTE), confirm the limitation position (in time / s.14 date of knowledge / s.33 discretion / s.28 minor), and calculate the 4-month Letter of Response deadline. Download as PDF and serve on the Defendant by recorded delivery.
Legal Considerations
UK clinical-negligence claims operate within a strict procedural framework combining the CPR Pre-Action Protocol, the Limitation Act 1980, and substantive case-law standards.
This template is for informational purposes only and does not constitute legal advice. Clinical negligence is a specialist area — consult a qualified UK clinical-negligence solicitor for advice specific to your case.
Reviewed for England & Wales clinical-negligence practice
The Pre-Action Protocol — Mandatory Compliance
The CPR Pre-Action Protocol for the Resolution of Clinical Disputes governs the pre-action conduct of UK clinical-negligence claims. Paragraph 5.1 lists the contents required in a Letter of Claim. Paragraph 6.1 fixes the four-month period within which the British Defendant must serve a Letter of Response. Paragraph 4.3 anticipates the identification of expert evidence. Non-compliance can lead to costs sanctions under CPR PD — Pre-Action Conduct & Protocols paragraph 13, and adverse inferences at trial. The Protocol applies to all claims against NHS Trusts, GP practices, private healthcare providers and individual clinicians in England and Wales.
Standard of Care — Bolam Refined by Bolitho
The standard of care in UK clinical-negligence cases is set by Bolam v Friern Hospital [1957] 1 WLR 583 — the standard of the ordinary skilled clinician exercising and professing to have a particular skill. This was refined in Bolitho v City and Hackney HA [1998] AC 232: a body of practice on which the British Defendant relies must withstand logical analysis. Where the Bolam test conflicts with logic, the British court can reject the Bolam defence. Montgomery v Lanarkshire HB [2015] UKSC 11 imposed a separate, patient-centred duty to disclose material risks and discuss reasonable alternative treatments — relevant whenever consent is at issue.
Causation — Wilsher, Bailey, Khan v Meadows
Causation in UK clinical-negligence claims is normally tested on the "but for" basis (Wilsher v Essex AHA [1988] AC 1074) — but for the breach, would the injury have been avoided? Where but-for causation cannot be established (especially in multifactorial injury cases), British claimants may rely on material contribution (Bailey v Ministry of Defence [2008] EWCA Civ 883) and the scope-of-duty principles in Khan v Meadows [2021] UKSC 21. The pleading framework in our template covers all three.
Limitation — 3 Years, with Extensions
The Limitation Act 1980 s.11 sets a three-year limit for UK personal-injury (including clinical-negligence) claims running from the later of (a) the date of the cause of action or (b) the claimant's date of knowledge under s.14. For minors, the three-year clock starts at age 18 (s.28). The British court has discretion under s.33 to disapply the time limit, weighing prejudice to the claimant against prejudice to the defendant. For deceased patients, the personal representative has three years from the death (s.11(5)) and may invoke the Access to Health Records Act 1990 for records (rather than UK GDPR Article 15).
Frequently Asked Questions
Draft Your UK Clinical Negligence Letter of Claim Now
Use our free CPR Pre-Action Protocol template to draft a complete Clinical Negligence Letter of Claim. Triggers the Defendant's 4-month Letter of Response window. Includes the Bolam / Bolitho / Montgomery framework and the full British clinical-negligence pleading structure.
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