A guide to clinical handovers, delegation and referral

An update on the latest medical practice guidelines on delegation and referral, and guidance on delivering and receiving clinical handovers.

As part of its recently revised Good medical practice, the GMC has updated its guidance on handover, delegation and referral, underlining how important good clinical handovers and communication are to ensuring safe continuity of care.

In this guide, we explain the importance of handovers, key points to note from the updated GMC guidance on delegation and provide useful handover checklists to help you in practice.

Why are handovers so important?

All clinicians will be involved in handing over patients, whether that is within your own team, when a patient’s care is being taken on by another team, or where they are being transferred between organisations, such as between primary and secondary care. A good handover is essential for continuity of care, maintaining patient safety, avoiding errors, and preventing harm caused by missed diagnoses and inappropriate investigations or treatments. 

Unfortunately, under an increasingly strained health service handover failures are all too common. Studies have found that up to 6% of patients admitted to hospitals across England and Wales experience a patient safety incident, with communication between teams being a common contributory factor. 

A recent Health Services Safety Investigations Body (HSSIB) report on Continuity of care: delayed diagnosis in GP practiceshighlighted that handover and transfer of care are also key risk areas for patient safety in primary care settings. This is often because there is no formal system or framework for safe continuity of care, leading to errors, such as missed prescriptions and failure in follow-ups.

In our experience at MDDUS, poor communication during handover is a common factor in complaints, clinical negligence claims, and disciplinary or regulatory actions. To avoid unnecessary risk, all clinicians should work collaboratively with colleagues and make sure they contribute to the safe handover of patients. 

New guidance on supporting continuity of care

The updated GMC guidance places a larger emphasis on supporting patients less able to advocate for themselves in their healthcare journey and the importance that continuity brings. Continuity is particularly important when patient care is shared between teams, between different members of the same team, or when patients are transferred between care providers.  

As a healthcare professional, it is your responsibility to make sure that information necessary for a patient’s ongoing care is shared with those taking over care:

• before you go off duty 
• before you delegate care
• before you refer the patient to another health or social care provider (see paragraph 65 of the guidance).

You must also check, where practical, that a named clinician or team has taken over responsibility when your role in a patient’s care has ended.

You must share information with patients (or their representative) appropriately. 

The GMC also updated its more detailed guidance on Delegation and referral in January 2024. This provides more specific guidance on your duties when referring a patient or delegating care, as well as setting out your obligations when taking over responsibility for some or all aspects of a patient's care.

Your responsibilities when delegating care

The key points from the guidance to note when delegating responsibility of a patient’s care or treatment to someone else are that you must:

• be confident that the colleague you delegate to has the necessary knowledge, skills, and training to carry out the task
• give clear instructions, including about what needs to be done, by whom and by when
• encourage colleagues to ask questions so they understand what they’re being asked to do
• encourage them to seek support or supervision if they need it at any point after the task has been delegated
• make the patient aware that another colleague is taking over part or all of their care and explain why.

Your responsibilities when accepting delegated tasks

The key points from the guidance to note when you are taking over some or all aspects of a patient’s care or treatment are that you must make sure you: 

• understand exactly what you’re being asked to do and ask questions if you don’t 
• are capable of carrying out the delegated task, under supervision where necessary 
• have an understanding of the patient and put their safety before all other considerations. 

Accountability for delegation

The updated, more detailed guidance also clarifies what you are accountable for if delegating, referring or accepting the care of a patient.  
When delegating or referring, you’re accountable for:  

• the decision to delegate or refer care 
• the steps you take to ensure patient safety isn’t compromised 
• the information and instructions you give 
• the overall management of a patient if you’re the responsible consultant or clinician.  

You are not however, accountable for the actions or omissions of those to whom you delegate or refer care. If you are the person taking responsibility for a delegated task, you’re accountable for the steps you take to prioritise patient safety. 

Getting handovers right: practical tips

The style of a handover will vary depending on the clinical setting and the number of people who need to be involved. However, handovers must be structured and follow an agreed appropriate format to avoid miscommunication or preventable errors. For more on this, see NICE guidance on Organising ward rounds, handovers and transfers (from 1.2.10 to 1.2.12). 

Key points to consider during handover: 

• Ensure you have sufficient time, free from interruptions, such as calls/bleeps for routine work 
• Handover in an appropriate environment where everyone involved can hear what is being said and where you have access to the relevant information you require, for example, patient notes, blood results, X-rays 
• Provide information in a structured way. Consider the use of a template and/or also providing the information in a written format 
• Relevant information might include:
  - Patient name and age 
  - Date of admission, location, responsible clinician 
  - Patient’s current condition, any diagnoses made
  - Patient’s concerns and expectations
  - Relevant past medical history and allergy status and any significant social history
  - Results of significant investigations, pending investigations 
  - Management plan including any decisions made regarding CPR
  - Outstanding tasks and requirement for review and their urgency
  - Any important ‘what to do ifs….’ 
  - Involvement of any other individuals or teams in the patient’s care
• Don’t assume other members of the team will pass on information
• Ensure a two-way process with one person speaking at a time – encourage questions and communication
• At the end, check the handover recipient understands the information given and accepts responsibility for the patient’s care. 

Please note that the above tips are general and the specifics of what you need to include in your handover will vary depending on the clinical setting you work in. Most medical royal colleges produce their own handover guidance, such as the Royal College of Surgeons of England (2007) and Royal College of Obstetricians and Gynaecologists Guidance (2010)

Please contact MDDUS to discuss a particular case or query. Email us on advice@mddus.com or have a look at our medio-legal advice pages for more information.

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Some training you might find helpful

Clinicians working in a secondary care environment might also be interested in the following upcoming three-hour CPD course on Team communication: Safer MDT working in secondary care which includes tips and tools to improve handovers and delegation.  

We also have a free on demand webinar for our members providing an overview of the new professional standards set out in the revised Good Medical Practice 2024.