Delegation and referral

Delegation involves asking a colleague to take responsibility for providing care or treatment on your behalf. Accountability for safe delegation is shared between the colleague delegating and the colleague to whom care or treatment is delegated. You must work collaboratively with colleagues to make sure delegation is appropriate.  

You must be confident that the colleague you delegate to has the necessary knowledge, skills, and training to carry out the task, or that they will be adequately supervised to ensure safe care. 

Usually, you’ll delegate to a colleague who is a medical, health or social care professional registered with a statutory regulatory body. If a colleague is not registered with a statutory regulatory body, registration on a managed voluntary register can give some assurance that they’ve met defined standards of competence, and that they adhere to agreed standards for their professional skills and behaviour. Information about accredited registers can be found on the website of the Professional Standards Authority. Until statutory regulation is in place, physician associates can join the Physicians Associate Managed Voluntary Register and anaesthesia associates can join the Royal College of Anaesthetists voluntary register.

The colleague’s role, grade and training can also provide some reassurance of their level of competence.

You should help to create a compassionate and supportive working and training environment – where less experienced colleagues can feel safe to ask questions and supported when they express uncertainty or a lack of confidence. 

You must give clear instructions when delegating, including about what needs to be done, by whom and by when. 

You must encourage colleagues to:

1. ask questions so they understand what they are being asked to do 
2. familiarise themselves with organisational protocols or guidelines concerning treatment escalation or senior review
3. seek support or supervision if they need it at any point after a task has been delegated. 

You should check that colleagues understand what they are being asked to take responsibility for, and when to seek input from a more experienced colleague.

You must respond constructively to any concerns colleagues have and make sure they know where they can find support or access supervision.¹ 

When accepting responsibility for delegated tasks, you must prioritise patient safety over other considerations such as training opportunities or performance assessments. 

You must make sure you:

1. understand what you are being asked to do, by when, and ask questions if you don’t
2. are capable of carrying out the delegated task, under supervision where necessary  
3. have an understanding of the patient, which may involve reading notes and reviewing test results where applicable.

When accepting responsibility for delegated tasks, or at any point after this, if you become concerned that you may not be able to carry them out safely you must seek help or ask a more experienced colleague to take over.

Referral is when you arrange for another medical, health, or social care professional or a service to take over part or all of the care of a patient. 

Usually, you will refer the patient to a regulated service, or to a medical, health, or social care professional who holds current registration with a statutory regulatory body. If you are aware that a medical, health, or social care professional has been erased from a professional register or suspended from practice, you must not refer patients to that professional. If you are considering referring the patient to a service or professional based overseas, you must be confident it would be safe and appropriate to do so.

If you want to refer a patient to an unregulated professional or service, you must be confident that systems are in place to verify the safety and quality of the care they provide. For example, voluntary registration can provide some assurance that a practitioner has met defined standards of competence, and that they adhere to agreed standards for their professional skills and behaviour (see paragraph 6).  

When referring a patient to a colleague or service in any situation you should make sure the patient knows:

1. who is responsible for their overall care if this is not you 
2. why you have referred them and what should happen next
3. when they can expect to see the new professional 
4. who to contact if they have questions or concerns about their care.

The following paragraphs apply whether you are delegating or referring.

You should explain to the patient that another colleague or service will provide part or all of their care and explain the reasons why.

You must pass on to the medical, health, or social care professional or service provider involved:

1. relevant information about the patient’s condition and history
2. the purpose of transferring care and/or the investigation, care or treatment the patient needs.

You should check that the patient understands what information you will pass on and why. 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 can’t refer them or arrange for their treatment without also disclosing that information. You must follow paragraphs 26–33 of Confidentiality: good practice in handling patient information.

You must record your work in line with paragraphs 69–71 of Good medical practice and use the systems available to you effectively, particularly when you will not see the patient again.

When you delegate or refer care you are accountable for: 

1. your decision to delegate or refer care 
2. the steps you take to make sure patient safety isn’t compromised
3. the instructions you give 
4. the overall management of a patient if you’re the responsible consultant or clinician.² 

When you delegate or refer a patient’s care to a colleague or service in line with the principles set out in this guidance, you are not accountable for the actions (or omissions) of those to whom you delegate or refer care. 

When you accept responsibility for a delegated task you are accountable for the steps you take to prioritise patient safety. 

If there is ambiguity or uncertainty about who has responsibility for a task in a multidisciplinary or multi-agency team, you should follow the guidance in paragraph 17 of Leadership and management.