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Transfer of Care Initiative

To support the delivery of high quality care, there's an increasing need to share information more efficiently and consistently across health and social care.

The Transfer of Care Initiative aims to improve patient care by promoting and encouraging the use of professional and technical document standards.

Professional standards

Professional record standards for electronic record keeping are a fundamental element of successful IT enabled care and interoperability.

In order to record, share and access health data consistently across care settings, the structure and content of electronic health records needs to be standardised. The Professional Record Standards Body (PRSB) produce standards for the way care records should be structured.

The PRSB has published the PRSB Standards for the Structure and Content of Health and Care Records which replaces the Academy of Medical Royal Colleges publication ‘Standards for the Clinical Structure and Content of Patient Records’ published in 2013.

The PRSB standards have been updated to reflect current professional practice and incorporate new or changed structured content resulting from the development of detailed transfer of care standards. They have been developed with input from thousands of professionals from all health and social care specialities, carers and people who access services. They agreed what information is essential to share in order to provide timely, high-quality care efficiently that is well-coordinated and meets an individual’s needs.

This is the first major release since 2013 and PRSB has produced guidance, frequently asked questions and other materials to help organisations and system suppliers replace previous versions of the standards in their information systems.

Technical standards

The long-term strategy is to send Transfer of Care documents by direct electronic transmission, nationwide, including SNOMED CT encoded diagnosis, procedures, allergies and dm+d encoded medication information.

Providers are reminded that as detailed in the NHS England Standard Contract (technical guidance section 39.22) that by 1 October 2018, they must have aligned their acute inpatient and day case discharges, Emergency Care discharges, Mental Health discharges and OutPatient Clinic Letters with the nationally published specifications and be sending these by electronic transmission using a structured message specification.

NHS Digital has taken the decision to move directly to Fast Healthcare Interoperability Resources (FHIR) based structured document standards for Transfer of Care.

FHIR has become the international industry standard so the decision has been taken to migrate to FHIR now to prevent a more complex migration in the future which would result in greater clinical risk and higher costs for NHS providers and NHS clinical system suppliers.

The Transfer of Care FHIR messages will use the ITK3 (Interoperability Toolkit) specification

Because the existing set of Transfer of Care Workflow IDs and matching Acknowledgement Workflow IDs have now been adopted for messages other than FHIR, we have decided to create a new set specifically for Transfer of Care FHIR structured messages.  The new set is defined as follows:

Use Case

Workflow ID

Workflow ID for Responses

IP and DC (Acute) Discharge Summary



IP and DC (MH) Discharge Summary



EC Discharge Summary



Outpatient Attendance



The above IDs can be currently used with the Test Harness and can be adopted in the live environment when the relevant FHIR capability becomes available in principal GP Practice systems. 

To assist organisations considering what they should be doing for Transfer to Care to satisfy the NHS Standard Contract in the absence of FHIR receive and process capability at the GP Practice end, a new guide has been approved by NHS England and NHS Digital called Guidance to secondary care service providers for the sending of interim Transfer of Care messages.

For further advice and support, contact

Clinical Safety Case

NHS Digital in collaboration with INTEROPen has produced the following documents:

  • Clinical Safety Case  for the Curation of National CareConnect FHIR Interoperability Standards as used in Transfer of Care and GP Connect
  • Hazard Log - Identified risks and issues for development and implementation of FHIR Resources for Transfer of Care and GP Connect.
  • Clinical safety group endorsement - This endorses the clinical safety management approach following by NHS Digital Integration Projects in support of development and planned deployment of FHIR Interoperability Standards as used in Transfer of Care and GP Connect.

Benefits of standards

Using standards in electronic healthcare records allows clinical information to be recorded, exchanged and accessed consistently to deliver high quality care to patients. Other benefits include:

  • improved patient care and safety due to the availability of complete, accurate and timely information
  • reduction in the risk of missing or inappropriate critical clinical information
  • reduction in costs by removing the administrative task of correcting information

Latest news and updates

August 2018

Transfer of Care BETA Technical Specifications now published

The BETA versions of the Transfer of Care message specifications are now published; these are sufficiently mature to enable suppliers to development against. There are no plans to change the specifications other than to react to defects reported by implementers. Read the transfer of care specification versions.  

The Transfer of Care FHIR messages will use the ITK3 (Interoperability Toolkit) specification.

Contact details

For more information, or to register on our mailing list, contact

Join our NHS Interoperability Toolkit group on LinkedIn.

Further information

internal Outpatient Clinic Letter

Find out about Outpatient Clinic Letters including advice on how they should be implemented in England.

internal eDischarge summaries

Find out about eDischarge summaries, along with advice on how to implement them.

internal Assessment Discharge and Withdrawal - FHIR API

The Assessment Discharge and Withdrawal (ADW) specification defines a number of messages to support the exchange of structured information between healthcare and social care organisations.

Last edited: 21 September 2020 2:44 pm