Managing handovers and transitions of care
Good regular handovers of care are crucial. It is an essential part of good practice to make sure you contribute effectively to these transitions.
In transferring clinical responsibility, it is necessary for you to share all the relevant information about a patient with the person taking over their care.
A good handover enables your colleagues to provide good ongoing care for the patient. In the information you share, include any reasonable adjustments and communication support preferences for that patient.
The Royal College of Obstetricians and Gynaecologists have produced a good practice paper on improving patient handover.
Transferring and sharing care between primary and secondary care settings
When discharging patients from the maternity service into primary care, let the patient know who will be responsible for which aspect of their care, as well as including the details on the GP letter.
Doing this helps make sure that patients understand the next steps in their care and can raise any issues that concern them with the appropriate service.
On our useful resources page, you can find information on transferring and sharing care between primary and secondary care settings. These have been split by countries in the UK.
You can also find case studies from midwives and patients about effective handovers and record keeping on the NMC website.
Perinatal mental health
The Care Quality Commission’s (CQC) 2024 National maternity survey found that women with long-term mental health conditions reported poor experiences around feeling listened to during their antenatal care.
Difficulty in accessing and receiving mental health care may be particularly acute for certain patient groups. The Mental Health Foundation highlight that Black mothers experience unique challenges that contribute to higher rates of mental health issues and face greater barriers to accessing mental health care. A 2019 BMJ article on barriers to accessing mental health services for women with perinatal mental illness also highlighted language as a barrier.
LGBT Foundation’s 2022 report on trans and non-binary experiences of maternity services found that these patients experienced unequal support in postnatal mental health and were less likely to be given information about potential mental health changes after giving birth.
In Scotland, the Maternal Mental Health Alliance published a 2024 briefing on specialist perinatal mental health services. It showed that people living in remote and rural areas have worse access to specialist perinatal mental health care compared to those living in more densely populated areas.
Ockenden review: summary of findings, conclusions and essential actions
‘Care and consideration of the mental health and wellbeing of mothers, their partners and the family as a whole must be integral to all aspects of maternity service provision.’
How to support your patient’s mental health
Shortcomings in mental health care can be the result of confusion about whose responsibility it is to support a patient’s mental health. Gaps in care can appear when patients are transferred during the postnatal period back to primary care. This can be because those transferring care sometimes assume that a patient’s mental health needs will be automatically followed up by those taking over their care. In thinking it will be picked up automatically, they may not take action to make sure this is made clear during handover.
The responsibility for mental health care should be judged on a case-by-case basis. However, it’s crucial that it does not fall through the gaps and that colleagues communicate effectively.
In their position statement on the role of the GP in maternity care, the Royal College of General Practitioners (RCGP) highlight continuity of care. Specifically, they reference the value of patients retaining relationships with their GPs during pregnancy if they have other medical conditions or mental health problems. This can enable those providing maternity care to assess the patient’s risk and make decisions about how to tailor their care most effectively. In their safeguarding toolkit, RCGP also identify pre-existing mental health issues as a risk factor to consider in terms of perinatal safeguarding.
NICE guidance on antenatal and postnatal mental health includes information on postpartum psychosis and the need to make prompt referrals for patients. Being alert to early symptoms of psychosis includes considering information passed to you by colleagues as well as any concerns raised by those close to the patient about their mood or behaviour.
On our useful resources page, you can find information for supporting your patient’s mental. These have been split by countries in the UK.
The professional standards
65. Continuity of care is important for all patients, but especially those who may struggle to navigate their healthcare journey or advocate for themselves. Continuity is particularly important when care is shared between teams, between different members of the same team, or when patients are transferred between care providers.
- You must promptly share all relevant information about patients (including any reasonable adjustments and communication support preferences) with others involved in their care, within and across teams, as required.
- You must share information with patients about:
- the progress of their care
- who is responsible for which aspect of their care
- the name of the lead clinician or team with overall responsibility for their care.
- You must be confident that information necessary for ongoing care has been shared:
- before you go off duty
- before you delegate care, or
- before you refer the patient to another health or social care provider.
- You must check, where practical, that a named clinician or team has taken over responsibility when your role in a patient’s care has ended.
