Flex NHS referral letter template with GP instructions - referral letter for ECO4 Flex and Great British Insulation Scheme Flex

Sep 1, 2026

Upload by Ophelia

NHS healthcare professionals can use this structured referral letter to refer a patient for eligibility under the ECO4 Flexibility (ECO4 Flex) policy and the Great British Insulation Scheme Flex. It routes referrals via either NICE NG6 guidance for households vulnerable to the cold (Route 2) or severe/long-term ill-health conditions adversely affected by living in a cold home (Route 3). The template includes required declarations, patient and GP details, signature fields, and submission requirements such as using a valid NHS email or authenticated headed-paper letters.

LanguageEnglish

CategoryLetters

FormatDOCX

Pages4

Reading Time2 min

AccessFree to download

Referral Letter Details

Patient Information and Referral Route

Route 2 Declaration (NICE NG6)

Route 2 Eligibility and Proxy Selection

Route 3 Declaration (Severe or Long-term Ill-Health)

Route 3 Condition Confirmation

Submission Requirements

Email/Portal Options and Headed Paper Process

GP Form Instructions

Information Completion and Evidence Submission

NHS healthcare professional letter template for ECO4 and Great British Insulation Scheme Flex: Dr’s Name & Title: Dr’s GMC Number: GP’s address & postcode: Date: Patient’s name: Patient’s address & postcode: To: Shropshire Council, Having carefully considered the patient’s medical health conditions, I hereby refer [patient’s name] for the ECO4 Flexibility (ECO4 Flex) policy and the Great British Insulation Scheme Flex policy, as set out by the Department for Energy Security and Net Zero via the following route: [Please cross one box only] Route 2: Households identified as vulnerable to the cold according to NICE Guidance (NG6: Recommendation 2) As outlined in the Great British Insulation Scheme and ECO4 Flex Administration Guidance. Route 2 is applicable to a person living at the premises which is being referred to receive energy efficiency measures, who is considered to be vulnerable to the cold- under the guidance entitled “Excess winter deaths and illness and the health risks associated with cold homes” published by the National Institute for Health and Care Excellence on 5th March 2015 (NICE Guideline NG6); and for a reason other than their low income, (see recommendation 2 of the NICE Guidance NG6). Please indicate the relevant NICE proxy/proxies in the ‘Route 2’ column of the table below. The full list of NICE proxies can be found online. Route 3: Person suffering from severe or long-term ill-healthAs outlined in the Great British Insulation Scheme and ECO4 Flex Administration Guidance. Route 3 is open to people suffering from severe or long-term ill-health due to the ECO4 and Great British Insulation Scheme legislated conditions listed below in the table. Please indicate the relevant condition(s) in the ‘Route 3’ column of the table. Please sign either the Route 2 or the Route 3 declaration below: Route 2: Households identified as vulnerable according to NICE Guidance (NG6: Recommendation 2): I confirm that the named patient is vulnerable to the cold under the HYPERLINK "https://www.nice.org.uk/guidance/ng6/chapter/1-Recommendations" \l "recommendation-2-ensure-there-is-a-singlepointofcontact-health-and-housing-referral-service-for" NICE guidance: NG6, Recommendation 2, for the reason selected in the Route 2 column of the above table, and may benefit from assistance under ECO4 and Great British Insulation Scheme Flex, which aim to assist low income and vulnerable households. * All referrals must be sent from a valid NHS email address or, if provided as a physical letter, should be on headed paper and authenticated with the GP surgery stamp or similar. Name ____________________________ Signature ____________________________ Phone: ____________________________ Email: ______________________________ Route 3: Person suffering from severe or long-term ill-health: I can confirm that the named patient suffers from one of the four health conditions listed above under Route 3 and that their health condition is adversely affected by living in a cold home. * All referrals must be sent from a valid NHS email address or, if provided as a physical letter, should be on headed paper and authenticated with the GP surgery stamp or similar. Name ____________________________ Signature ____________________________ Phone: ____________________________ Email: _____________________________ GP Instructions & Information Information: This form is to allow the patient to be eligible via local authority flex route for energy efficient measures on their home. This is through the Energy Company Obligation Scheme (ECO4) or the Great British Insulation Scheme (GBIS). You can find more information about this using the links below or feel free to co

FAQs

What referral routes does the NHS letter template provide for ECO4 Flex and GBIS Flex?

It provides two routes: Route 2 for households vulnerable to the cold under NICE NG6 (Recommendation 2), and Route 3 for individuals with severe or long-term ill-health adversely affected by living in a cold home.

What information must be completed on the referral letter?

The template requires Dr’s details (including GMC number), GP address, date, patient name and address, and it includes signature, name, phone, and email fields for both Route 2 and Route 3 declarations.

How should the completed referral be submitted?

The referral should be sent from a valid NHS email; alternatively, it can be sent via a secure link from an NHS email or using the secure evidence submission portal. If email methods are unavailable, submit a physical referral letter on headed paper authenticated with the GP stamp.

Sep 1, 2026

Upload by Ophelia