OET Writing: 10 Common Reasons Candidates Lose Marks Despite Good English

Here is a pattern we see again and again. A nurse with eight years on a busy ward, comfortable in English, opens her OET result and finds Listening 380, Reading 370, Speaking 360 and Writing 290. She reads the last number twice. Then comes the question everyone asks: “How can my writing score be that low? My English is fine.”

Her English is fine. That is exactly the problem. OET Writing does not check whether your English is good. It checks whether you can write one particular kind of letter, for one particular reader, in about 45 minutes, using only the details that reader needs. Good grammar helps with one of the six marking criteria. The other five are about judgement, selection and layout.

Below are ten reasons candidates lose marks in OET Writing even when their English is strong. A few are five-minute fixes. A few take real practice. All of them show up regularly in the letters submitted by nurses and doctors preparing with JG Language Academy.

How OET Writing Is Marked (Short Version)

You get five minutes to read the case notes and forty minutes to write the letter. The assessor scores it out of 38 across six criteria, and that total is then converted to the 0 to 500 OET scale. Here is what each criterion is really asking.

Look at the last row. Only one criterion out of six is about English as such. That is why a candidate with a 7.5 in IELTS Writing can still land on C+ in OET.

It matters because the pass marks are tight. In the UK, the NMC asks nurses for Grade B (350) in Listening, Reading and Speaking and C+ (300) in Writing, while the GMC asks doctors for B in all four. Other regulators set their own numbers and revise them from time to time, so check your regulator’s current page before you book.

10 Reasons Candidates Lose Marks in OET Writing

1. The purpose is buried, vague or missing

Purpose is worth only three marks, but it colours how the assessor reads everything after it. If your first line is “I am writing to you about Mr Peter Collins, who was in our ward for some time,” the reader still has no idea what you want from them.

• Weak: “I am writing about Mr Peter Collins, who was in our ward for some time.”
• Stronger: “I am writing to refer Mr Peter Collins, 72, for community wound care following his discharge from Ward 6 on 14 March.”

State who the patient is and what you need within the first two sentences. Then keep tying details back to that request as the letter goes on, so the purpose is expanded and not just announced.

2. Retelling the case notes instead of choosing from them

Most case notes run to thirty lines or more, and every line looks important when the clock is running. So candidates start at the top and work down. What comes out is a timeline, not a letter. Your reader is a GP or a community nurse who wants to know what happens next, not everything that happened.

Before you write a single sentence, spend two minutes marking each note: needed by this reader, or not. It feels slow. It is the fastest way to protect your Content and Conciseness marks.

3. Including the noise and missing the one thing that mattered

Case notes contain distractors on purpose. A patient’s hobbies, a normal blood result from last year, a note about a relative’s visit. Put them all in and your letter gets long and loses focus. The opposite mistake hurts just as much: leaving out the allergy, the follow-up date or the specific care instruction that the reader cannot do their job without.

A good test is to ask, “Can the reader act on this, or do they need it to understand the patient?” If the answer to both is no, cut it.

4. Writing to the wrong reader

The same notes can produce very different letters. A referral to a GP can use standard clinical terms and abbreviations. A letter to a patient’s daughter needs plain words. A letter to a physiotherapist needs functional detail, such as how far the patient walked and with what aid.

Candidates who memorise one template tend to use one voice for everyone. Genre & Style is where that habit gets punished. Read the task instruction line first and ask who is going to open this envelope.

5. Opinion, emotion and chatty phrasing slip in

A clinical letter reports facts. Words like “unfortunately”, “poor compliance”, “I am very concerned” or “the patient was difficult” are judgements, and they do not belong. Strong speakers of English fall into this trap because natural English is full of opinion and small talk.

• Instead of “He is a non-compliant patient”, write what happened: “He did not take two of his prescribed doses during admission.”
• Avoid contractions (“doesn’t”, “she’s”) and casual phrases such as “a lot of” or “find out”.
• Use abbreviations only when the reader will certainly know them.

6. Opening and closing the letter the wrong way

This one is easy to fix and still costs marks every week. A few things to check each time:

• “Dear Dr Patel” is closed with “Yours sincerely”. “Dear Sir or Madam” is closed with “Yours faithfully”. Mixing them up is a layout error.
• Date, recipient’s name and address, and a “Re:” line with the patient’s full name and date of birth should all be in place before the first paragraph.
• End with a short, polite line that tells the reader what to do or who to contact. Do not trail off after the last clinical detail.

7. Paragraphs that do not hold together

A wall of text with the present condition in line two, the history in line six and then the present condition again in line nine is hard to scan. The Organisation & Layout criterion is really asking whether a busy reader can find what they need in ten seconds.

For many letters, a workable order is: purpose, then current condition and treatment, then relevant history, then social or functional details, then the plan or request. Letter types differ, so treat that as a starting point, not a rule. One idea per paragraph, four or five paragraphs in total, is usually enough.

8. Tense and time-reference errors

These catch strong speakers because the wrong version often sounds right. Two common ones:

• “He has been admitted on 2 March.” A finished event with a fixed date takes the past simple: “He was admitted on 2 March.”
• “She is on warfarin since 2019.” An ongoing situation that started in the past takes the present perfect: “She has been on warfarin since 2019.”

Also drop words like “yesterday”, “today” and “three days ago”. The reader opens the letter later, so use dates or phrases such as “on the day of discharge”.

9. Small language slips that slow the reader down

The Language criterion is not asking for perfect English. It is asking whether errors get in the way of the message or make the reader slow down. The trouble is that small slips add up in a letter of roughly 180 to 200 words, which is the body length OET suggests.

• Missing articles: “patient was discharged” instead of “the patient was discharged”.
• Wrong prepositions: “allergic with penicillin” instead of “allergic to penicillin”.
• Uncountable nouns treated as countable: “advices”, “informations”.
• Inconsistent details: the patient’s name spelt two ways, a drug name misspelt, units that change halfway through.

10. Practising without a clock and without feedback

Writing ten letters alone at home is not the same as ten rounds of practice. Without a timer, you never find out that you run out of time before the last paragraph. Without someone marking against the six criteria, the same mistakes repeat because you cannot see them in your own writing.

This is the reason many candidates sit OET Writing two or three times and land on nearly the same score. The effort was there. The feedback loop was not.

A Typical Case: Same English, Different Letter

Here is a composite example based on patterns we see often. Take a nurse, Anita, who has strong everyday English and has already sat OET once with a Writing score just under C+. Her first draft was well written in the sense that almost every sentence was grammatical. The assessor’s problem was with what the sentences were doing.

Nothing about Anita’s English changed between the left column and the right. What changed was what she chose to include, how she described it and the tone she used. After a few rounds of corrected practice, her letters started to read like a clinician writing for another clinician, which is what the assessor is looking for.

A Quick Checklist Before You Submit Any Practice Letter

• Is the reason for writing clear in the first two sentences?
• Can I name the reader and say why each detail is in the letter for them?
• Did I cut everything that does not help the next step of care?
• Are there any opinions, contractions or casual phrases left?
• Do the greeting and the sign-off match, and are the date, address and “Re:” line there?
• Are all dates, names, drug names and units consistent, with the right tenses?
• Did I finish within the 40 writing minutes, with a minute left to proofread?

How to Fix These Habits Faster

Some of the points above you can fix on your own with the checklist. Selection and tone are harder, because they are difficult to spot in your own writing. A second pair of eyes that knows the marking criteria makes a bigger difference than another ten self-checked letters.

That is how our OET preparation online programme at JG Language Academy is built. It starts with a diagnostic across all four sub-tests, so you know whether Writing is really your weak spot. Nurses and doctors then follow separate tracks for Writing and Speaking, because a nursing referral letter and a medical discharge summary are not the same task. Every letter you submit is corrected against the actual OET marking criteria, and the course ends with a full timed mock and an estimated score. Batches run between 7 AM and 9 PM, so shift workers can fit them in, and most working nurses and doctors we coach need somewhere between four and eight weeks.

Not sure where your Writing marks are going?
Book a free OET assessment with JG Language Academy. We will check all four sub-tests, show you what the Writing result is telling you and recommend the right batch. Start here: OET preparation online at JG Language Academy

FAQs on OET Writing

What Writing score do I need?

It depends on your regulator. The NMC currently asks for C+ (300) in Writing and B (350) in the other three sub-tests, while the GMC asks for B in all four. Always confirm the latest requirement on your regulator’s own website before booking.

How many words should the letter be?

OET suggests about 180 to 200 words for the body of the letter. If you are going far over, it usually means irrelevant detail has crept in, which is a Conciseness & Clarity problem more than a word-count one.

Can I move from C+ to B in Writing?

Often, yes, especially when the issue is selection, tone and layout and not basic grammar. How long it takes depends on your starting point and how much corrected practice you can fit in around work.

Is OET Writing the same for nurses and doctors?

The six criteria are the same, but the letters, the readers and the clinical detail are different. That is why practice should be profession-specific.

The Short Version

Good English gets you into the exam room. It does not, on its own, get you the grade. OET Writing rewards candidates who read the case notes like a clinician, pick what the reader needs, set the letter out cleanly and keep the tone factual. If you have been told your English is fine and your Writing score still disagrees, one of the ten points above is probably the reason.

If you want help finding which one, talk to the team at JG Language Academy and start with a free assessment.