Delegation and referral
In Good medical practice1 we say:
15. You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must:
c. refer a patient to another practitioner when this serves the patient’s needs.
44. You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must.
a. share all relevant information with colleagues involved in your patients’ care within and outside the team, including when you hand over care as you go off duty,when you delegate care or refer patients to other health or social care.
45. When you do not provide your patients’ care yourself, for example when you are off duty, or you delegate the care of a patient to a colleague, you must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient.
In this guidance, we explain how doctors can put these principles into practice when delegating care and making referrals. You are not accountable to the GMC for the actions (or omissions) of those to whom you delegate care or make referrals. You will be accountable for your decisions to transfer care and the steps you have taken to make sure that patient safety is not compromised. You must be prepared to explain and justify your decisions and actions. Only serious or persistent failure to follow our guidance that poses a risk to patient safety or public trust in doctors will put your registration at risk.
Delegation involves asking a colleague2 to provide care or treatment on your behalf.
Anyone a doctor works with, whether or not they are also doctors.
When delegating care you must be satisfied that the person to whom you delegate has the knowledge, skills and experience to provide the relevant care or treatment; or that the person will be adequately supervised. If you are delegating to a person who is not registered with a statutory regulatory body, voluntary registration can provide some assurance that practitioners have met defined standards of competence and adhere to agreed standards for their professional skills and behaviour.
When you delegate care you are still responsible for the overall management of the patient.
Referral is when you arrange for another practitioner to provide a service that falls outside your professional competence.
Usually you will refer to another doctor or healthcare professional registered with a statutory regulatory body.
Where this is not the case, you must be satisfied that systems are in place to assure the safety and quality of care provided – for example, the services have been commissioned through an NHS commissioning process or the practitioner is on a register accredited by the Professional Standards Authority.3
You must also follow our guidance in paragraph 26 - 33 of Confidentiality on sharing information for direct care. General Medical Council (2017) Confidentiality: good practice in handling patient information London, GMC.
The following applies whether you are delegating or referring.
- You should explain to the patient that you plan to transfer part or all of their care, and explain why.
- You must pass on to the healthcare professional involved:
- relevant information about the patient’s condition and history
- the purpose of transferring care and/or the investigation, care or treatment the patient needs.
If the patient objects to a disclosure of information about them that you consider essential to the safe provision of care, you should explain that you cannot refer them or arrange for their treatment without also disclosing that information.