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Creating a new NHS England: NHS England and NHS Digital merged on 1 February 2023. More about the merger.

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 standards, combined within NHS Digital defined Application Programming Interfaces (APIs) to achieve interoperability of systems across different care settings.

The focus of this work is on the digital sharing of structured discharge and clinic attendance documents sent from secondary care to primary care.

Use of the APIs ensure that information follows the person and continuity of care is maintained because services are better connected.

When secondary care suppliers correctly implement against the Transfer of Care APIs for discharge and clinic attendance, the resulting correspondence will be compatible with the receive capability that GP Foundation IT suppliers in England are obliged to provide. Long-term this will create a number of benefits for secondary care, primary care and patients.


Transfer of Care API adoption optimises patient care through the improved timely availability of complete and accurate digital care records at the point of use. The formation of inappropriate care decisions due to missing or erroneous clinical information is less likely to occur and this in turn reduces the potential to harm a patient.

API adoption also imposes greater control on how correspondence is created, sent, received, and processed. This can reduce the administration burden and associated costs for both primary and secondary care settings, whilst improving correspondence trackability, so problems with correspondence can be spotted.

It also allows effective alignment of local and national systems. Considering support for these APIs better guides the investment in new systems.

Find out more about correspondence problems and opportunities.

The future of the initiative

Secondary care organisations must implement against the published STU3 API standards now. The APIs do not cover all correspondence types, such as ad-hoc letters, and exceptions do exist within the included use cases. Routine maternity discharges and paediatric mental health discharges are excluded from this initiative at present. Secondary care correspondence solutions would need alternative arrangements to handle these exceptions.

In future years, additional use cases may be progressed to create APIs across any health and social care setting. This could also see existing APIs uplifted to include one or more changes to the layers making up the APIs.

Previous interoperability work between secondary care and social care organisations is covered separately in the Assessment Discharge and Withdrawal (ADW) specification.

Information for primary care

You do not have to take any specific action to receive FHIR based discharge and outpatient attendance letters directly into your clinical system but you should look out for them in GP workflow. User guides should be available from your clinical system supplier. If your practice wishes to view workflow correspondence via a third party document management system, this should be raised with both the clinical system and specialist system supplier. 

Transfer of Care APIs

The make-up of the Transfer of Care APIs can be described in terms of a set of layered standards. A fully compliant Transfer of Care solution treats these layers as indivisible.

Latest news and updates

Contact details

General Transfer of Care enquiries can be sent to

Progress updates can be obtained by joining our NHS Interoperability Toolkit group on LinkedIn.

Further information

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: 27 July 2022 11:55 am