Referrals vs Transfer of Care

What is the difference between a ‘Referral’ and a ‘Transfer of Care’?

The phrases “Transfer of Care” and “Referral” are used frequently, all over the NHS and they feature especially often when talking about interoperability between IT systems.

Sometimes the two concepts are conflated and the terms used interchangeably; they both involve passing the responsibility of care for a patient to someone else but the nature of the responsibility and the way it is resolved is different.

Here is an attempt at describing the difference between the two:


A referral is a request made by one clinician or organisation to another clinician or organisation for them to take responsibility for part of a patient’s care.

This part responsibility might be for a specific problem the patient has, or for a particular activity (e.g. medical imaging and other diagnostic tests) to assist the GP with further diagnosis.

The referral, and therefore the responsibility, will often have a defined end point – for example until a particular activity has been completed (or ‘discharged’), or until a particular problem has been resolved. In other cases it might be an ongoing responsibility – for instance management of a Long Term Condition.


A patient has visited their GP because with a painful back. The GP feels that they may need some further investigations, for example an MRI scan, to find out what is going on.

The GP makes a referral for the patient to the radiology department at the local hospital asking that they use medical imaging to help diagnose the patient’s back problems. The patient is told that the referral has been made and to wait to be contacted by the hospital.

The patient receives an appointment from the radiology department. They attend the appointment and the appropriate scans are taken of their back.

The consultant radiologist then produces a report describing the results of the scan which is sent back to the GP who made the referral. This particular referral is then completed and responsibility for the next steps are back with the patient’s GP.


Transfer of Care

A ‘Transfer of Care’ is where a clinician or organisation passes the overall responsibility for a patient’s care to another clinician or organisation.

This is often related to a patient moving to a different stage in an overall pathway of care, or to a change in their condition which requires a different type or level of care.


A patient is feeling unwell on a Saturday evening, and calls NHS 111 to get some help. They have a conversation with a nurse who feels that they really need to see an out of hours doctor in their area.

The nurse takes some more details from the patient and searches for an out of hours service near to the patient. He finds an appropriate service and advises the patient that he will arrange for them to see a doctor within the next 4 hours.

Once all confirmed, he initiates a transfer of care from NHS 111 through to the out of hours service, sending all of the details he has recorded about the patient through to the out of hours service.

The out of hours service accepts the transfer of care and is now responsible for the ongoing care of that patient.

The nurse in the NHS 111 service is no longer responsible for that patient’s ongoing care, and moves on to look a new patient.


Is this right? Views and comments welcome.