diff --git a/gp2gp-translator/src/main/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingService.java b/gp2gp-translator/src/main/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingService.java
index 7d26af0c5..29a478f9f 100644
--- a/gp2gp-translator/src/main/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingService.java
+++ b/gp2gp-translator/src/main/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingService.java
@@ -75,7 +75,7 @@ private InboundMessage insertSkeletonIntoInboundMessagePayload(PatientAttachment
             throw new IllegalArgumentException("inboundMessage does not contain a skeleton attachment reference");
         }
 
-        var skeletonDocumentId = ebxmlSkeletonReference.get().getDocumentId();
+        var skeletonDocumentId = ebxmlSkeletonReference.get().getDocumentId().replaceFirst("^_", "");
         var payloadXml = xPathService.parseDocumentFromXml(inboundMessage.getPayload());
         var valueNodes = xPathService.getNodes(payloadXml, "//*/@*[.='" + skeletonDocumentId + "']/parent::*/parent::*");
         var payloadNodeToReplace = valueNodes.item(0);
diff --git a/gp2gp-translator/src/test/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingServiceTests.java b/gp2gp-translator/src/test/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingServiceTests.java
index 186126ba9..ebfe1e2c9 100644
--- a/gp2gp-translator/src/test/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingServiceTests.java
+++ b/gp2gp-translator/src/test/java/uk/nhs/adaptors/pss/translator/service/SkeletonProcessingServiceTests.java
@@ -5,9 +5,11 @@
 import static org.junit.jupiter.api.Assertions.assertEquals;
 import static org.junit.jupiter.api.Assertions.assertThrows;
 import static org.mockito.ArgumentMatchers.any;
-import static org.mockito.Mockito.doThrow;
-import static org.mockito.Mockito.when;
 
+import static org.mockito.ArgumentMatchers.eq;
+import static org.mockito.Mockito.verify;
+import static org.mockito.Mockito.when;
+import static org.mockito.Mockito.doThrow;
 import static uk.nhs.adaptors.common.util.FileUtil.readResourceAsString;
 
 import java.nio.charset.StandardCharsets;
@@ -253,6 +255,43 @@ PatientAttachmentLog createSkeletonPatientAttachmentLog() {
                     .build();
     }
 
+    @Test
+    void When_SkeletonDocumentIdHasLeadingUnderscore_Expect_UnderscoreIsStrippedBeforeXPathQuery()
+            throws SAXException, TransformerException {
+
+        var inboundMessage = new InboundMessage();
+        var attachmentLog = createSkeletonPatientAttachmentLog();
+
+        inboundMessage.setPayload(readInboundMessagePayloadFromFile());
+        inboundMessage.setEbXML(readInboundMessageEbXmlFromFile());
+
+        var reference = new EbxmlReference(
+                "First instance is always a payload",
+                "mid:1",
+                "_C3866E77-41E2-4593-A133-AB622F54684F"
+        );
+        var ebXmlAttachments = List.of(reference);
+        var fileAsBytes = readInboundMessageSkeletonPayloadFromFile().getBytes(StandardCharsets.UTF_8);
+
+        when(attachmentHandlerService.getAttachment(any(), any())).thenReturn(fileAsBytes);
+        when(xmlParseUtilService.getEbxmlAttachmentsData(any())).thenReturn(ebXmlAttachments);
+        when(xPathService.parseDocumentFromXml(any())).thenReturn(ebXmlDocument);
+        when(xPathService.getNodes(any(), any())).thenReturn(nodeList);
+        when(nodeList.item(0)).thenReturn(node);
+        when(ebXmlDocument.getElementsByTagName("*")).thenReturn(nodeList);
+        when(xmlParseUtilService.getStringFromDocument(any())).thenReturn(inboundMessage.getPayload());
+        when(node.getOwnerDocument()).thenReturn(ebXmlDocument);
+        when(node.getParentNode()).thenReturn(node);
+
+        skeletonProcessingService.updateInboundMessageWithSkeleton(
+                attachmentLog, inboundMessage, CONVERSATION_ID);
+
+        var expectedDocumentId = "C3866E77-41E2-4593-A133-AB622F54684F";
+        var expectedXPath = "//*/@*[.='" + expectedDocumentId + "']/parent::*/parent::*";
+
+        verify(xPathService).getNodes(any(), eq(expectedXPath));
+    }
+
     @SneakyThrows
     private String readInboundMessagePayloadFromFile() {
         return readResourceAsString("/xml/inbound_message_payload.xml").replace("{{nhsNumber}}", NHS_NUMBER);