SJT Textbook: Delegation and Referral (GMC Guidance)
Delegation and Referral GMC
This delegation and referral GMC guide explains how doctors must safely hand over care, ensure colleague competence, and protect continuity of care in MSRA SJT scenarios.
🎥 Video Lesson (YouTube)
🎧 Podcast Lesson (Spotify / Apple / Amazon)
🎯 THE CORE PRINCIPLE
“Delegation and referral” sit at the heart of safe teamworking. Delegation means asking another colleague to provide care on your behalf. Referral means arranging for another practitioner or service to see the patient because the care needed is outside your competence or role. In both cases, you must ensure the person or service is appropriately qualified and that the transfer of information is clear and complete.
The GMC is explicit that you cannot “dump and disappear”: even when delegating you retain overall responsibility for the patient, and when you refer you must still ensure the plan is followed up and the patient is not lost between services. Good delegation and referral protect patients from delay, duplication, and unsafe gaps in care.
In MSRA SJT questions, high-scoring answers show: choosing the right professional to refer to, checking their competence when delegating, explaining to the patient what is happening, transferring relevant information (history, medications, concerns), and clarifying who is responsible for ongoing care. Poor answers overestimate others’ skills, delegate without supervision, or send a flimsy referral with minimal information.
The delegation and referral GMC guidance requires doctors to retain overall responsibility.
⚡ HIGH-YIELD ACTIONS (What Scores Points)
1. Confirm competence before delegating – check that the colleague (especially if non-registered or junior) has the skills, experience, and supervision needed for the task.
2. Match the referral to the right service – refer to a practitioner or team with appropriate expertise when the problem is outside your competence or scope.
3. Give clear, focused handover – share relevant clinical information (history, medications, allergies, recent investigations, specific question) when delegating or referring.
4. Explain the plan to the patient – tell the patient why you are delegating or referring, who will see them, and what to expect.
5. Clarify responsibility for care – agree who is responsible for which parts of care, including follow-up, monitoring, and informing the patient of results.
6. Respect confidentiality while sharing essential information – share only what is needed for safe care and seek consent wherever possible.
7. Address patient objections – explore concerns if a patient is unhappy about information sharing or referral, and explain why some information is essential for safety.
8. Support but supervise juniors and students – delegate tasks appropriately, give clear instructions, and remain available for questions and review.
9. Use accredited or commissioned providers – when referring to non-registered practitioners (e.g. some therapists), ensure they are on an accredited register or part of a safely commissioned service.
10. Follow up critical referrals – check that urgent referrals are received and acted upon, and escalate if delays put the patient at risk.
MSRA SJT frequently tests breaches of delegation and referral GMC standards.
* Failing to pass on key clinical information (e.g. allergies, significant comorbidities, red flags).
* Assuming someone else is responsible for follow-up without agreement.
* Referring to a service you know is inappropriate just to “move the problem on”.
* Ignoring a patient’s confusion about who is in charge of their care.
* Withholding necessary information because the patient does not like the recipient (where safety is at stake).
* Delegating solely to reduce your workload, disregarding safety or competence.
These traps all show abdication of responsibility, poor information sharing, or unsafe assumptions about others’ competence.
Safe handover is central to delegation and referral GMC principles.
💬 MODEL PHRASES (Use These in SJT Logic)
* “I will ask a suitably trained nurse to perform this, and I will review the results.”
* “I will include a full summary of your history, medications, and my specific question in the referral.”
* “I remain responsible for your overall care and will ensure we follow up the outcome.”
* “I understand your concerns, but some information must be shared to keep you safe.”
S – Select the right person or service
A – Agree who is responsible for what
F – Full, relevant information shared
E – Explain the plan to the patient
P – Protect confidentiality but share essentials
A – Avoid delegating beyond competence
S – Supervise and support juniors
S – Safety and continuity above convenience
Failure to check competence is a common delegation and referral GMC exam trap.
📋 QUICK FAQ
What is the difference between delegation and referral?
Delegation is asking another colleague to provide care on your behalf while you retain overall responsibility. Referral is arranging for another practitioner or service to provide care because the patient’s needs fall outside your competence or role. Do I remain responsible after delegating a task?
Yes. You retain overall responsibility for the patient’s care and must ensure the delegated person is competent and appropriately supervised. Can I delegate to non-registered practitioners?
Yes, but only if you are satisfied they are competent, appropriately trained, and (ideally) on an accredited register or part of a trusted commissioned service. You must monitor the safety and quality of care. What information must I include in a referral?
Relevant history, examination findings, current medications, allergies, key investigations, your working diagnosis, and a clear question or purpose for the referral. What if a patient objects to information sharing needed for safe care?
Explore their concerns, explain why sharing is important, and try to reach agreement. If they still refuse and non-disclosure would place them or others at serious risk, you may need to share limited essential information in line with confidentiality guidance.
📚 GMC ANCHOR POINTS
* Safe transfer of care – Good Medical Practice, delegation and referral duties.
* Competence and supervision – duties around working within competence and supervising others.
* Confidentiality and information sharing – sharing only what is necessary for safe care.
* Raising concerns – if delegation or referral systems are unsafe, act on concerns.
* Leadership and management – ensuring systems support safe handover and continuity.
Safe handover is central to delegation and referral GMC principles.
💡 MINI PRACTICE SCENARIO
A busy GP asks a new healthcare assistant (HCA) to run an asthma review clinic alone, including changing inhaler doses. The HCA has basic training in peak flow measurement but no prescribing or independent review training. Best action: Explain that asthma medication changes must be reviewed by an appropriately trained clinician, arrange for the nurse or GP to run the clinic, and provide the HCA with a clearly defined, supervised role (e.g. measurements, questionnaires). Why: Delegation to someone without the right training or authority is unsafe; you must match tasks to competence and maintain responsibility for treatment decisions.
🎯 KEY TAKEAWAYS
✓ Delegation = task on your behalf; referral = care outside your remit
✓ You must ensure colleagues are competent for delegated tasks
✓ Clear, complete information sharing is essential for safe referrals
✓ You retain overall responsibility for your patient’s care
✓ Confidentiality still applies, but safety-critical information must be shared
✓ Good delegation and referral prevent gaps, duplication, and unsafe delays
✓ In the SJT, choose options that emphasise competence, clarity, and continuity over convenience
🔗 RELATED TOPICS
* → Good Medical Practice (four domains)
* → Leadership and Management for All Doctors
* → Raising and Acting on Concerns About Patient Safety
* → Confidentiality and Information Sharing
* → Supervision, Teaching, and Training
Urgent referrals must be followed up under delegation and referral GMC guidance.
📖 FULL PRACTICE QUESTIONS
Example SJT — Best of 3 (8 options; choose three)
You are an FY2 on a busy medical ward. A nurse asks if a healthcare assistant can complete all the discharge summaries for stable patients so that discharges are not delayed. The HCA has no training in clinical documentation. The consultant is in clinic and difficult to contact.
Options:
A. Agree and ask the HCA to draft and sign the discharge summaries to save time.
B. Ask the HCA to collect basic non-clinical information (address, next of kin) while you complete the summaries.
C. Explain that only appropriately trained clinicians can complete discharge summaries and offer to stay late to finish them.
D. Ignore the request and hope the day team will cope.
E. Escalate to the ward sister/registrar to explore temporary support or redistribution of work.
F. Ask the HCA to prescribe the take-home medications as you are too busy.
G. Ask the nurse to sign off the discharge summaries without reviewing the notes.
H. Delay all discharges until the consultant returns from clinic.
Correct three: B, C, E
• B: Uses the HCA appropriately for non-clinical data, supporting safe delegation.
• C: Recognises that discharge summaries are a clinical responsibility and accepts appropriate responsibility.
• E: Sensible escalation to find safe system-level solutions without unsafe delegation.
Why others are weaker/wrong:
• A/F: Delegates clinical duties far beyond the HCA’s competence, unsafe.
• D: Avoidant and unprofessional; ignores a patient flow/safety issue.
• G: Asks someone to sign off without appropriate review, unsafe and dishonest.
• H: Overly rigid and may cause unnecessary delay; better to use the team and escalate.
Example SJT — Rank 5 (best → worst)
You are a GP registrar. A patient with suspected temporal arteritis needs urgent specialist input. You are unsure of the local pathway and your trainer is in surgery.
Options:
A. Look up the local urgent referral pathway, call the on-call ophthalmology/medical team, and arrange an urgent same-day assessment, documenting clearly.
B. Ask reception to book a routine outpatient appointment and prescribe no treatment while waiting.
C. Tell the patient to attend A&E without any letter or communication.
D. Delay referral until you can discuss it at the next tutorial with your trainer.
E. Provide steroids for a week but make no referral as symptoms have slightly improved.
Ideal order: A (1) > C (2) > B (3) > D (4) > E (5)
• A: Safest option – urgent, structured referral with clear information and documentation.
• C: At least ensures urgent assessment, but lacks documentation and direct handover.
• B: Inappropriately delays assessment for a potentially sight-threatening condition.
• D: Avoids responsibility and risks harm through delay.
• E: Treats without arranging specialist review; unsafe and contrary to good referral practice.