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Implementation guidance for the Transfer of Care use cases

In addition to the API technical specifications, there are tools and resources to facilitate delivery. Find out more about them.


Adoption of Transfer of Care FHIR structured messaging is applicable to any organisation providing either inpatient, daycase, emergency care or outpatient services under the terms of the NHS Standard Contract.

There are 4 specific correspondence use cases:

  • inpatient and daycase discharge (eDischarge) for acute care providers
  • emergency care discharge
  • mental health discharge
  • outpatient clinic attendance

Each use case has its own specific payload technical specification, and this must be combined with the ITK3 message distribution specification to construct a viable FHIR message to send over MESH.

Specific queries on interpretation of the payload and ITK3 specifications can be sent to

General queries on Transfer of Care can be raised through

Timescales – NHS Standard Contract requirements

The progressive change to structured correspondence and its delivery to improve handover of care has been shaped by successive ratcheting up of the requirements in the NHS Standard Contract.

Notable changes in date order  

From 1 October 2015, the Technical Guidance (section 34.27) in the 2015/16 Standard Contract required secondary care to use secure email or direct electronic transmission to replace secure fax as the transport route for discharge summaries to any GP or NHS Trust/NHS Foundation Trust.

By no later than 1 December 2016, for Inpatient and Daycase Discharge (only), the Technical Guidance (section 39.22) in the 2016/17 Standard Contract required providers to implement the Academy of Medical Royal Colleges (AoMRC) clinical headings.

By 1 October 2018, in addition to Inpatient Discharge, the 2017/19 contract required that Emergency Care Discharge and Clinic Letters used the AoMRC clinical headings.

In addition, from 1 October 2018, the above 2017/19 guidance document required direct electronic transmission only with the elimination of secure email and paper from 1 October 2018 onwards.

By no later than 30 September 2021, and annually after, the secondary care provider and co-ordinating commissioner need to assess interface working (including discharge and clinic letter communication) and implement an action plan to address any deficiencies, and report this to their respective boards. Relevant areas of the 2021/22 Standard Contract for Transfer of Care include sections 2.6, 39.15, 39.16, 39.21, 39.22 and 39.23.

FHIR structured messaging

Transfer of Care FHIR structured messaging is an England wide requirement, and each secondary care provider’s correspondence solution must cover residents either inside or outside of its normal catchment area.  During the financial year 2021-22, if secondary care providers have not yet gone live with Transfer of Care FHIR structured messaging then they should have well developed plans that would allow this to happen imminently.


NHS Digital has defined a conformance certification process for those NHS or commercial organisations wanting to send correspondence via the Transfer of Care APIs. To register an interest in progressing certification for your organisation please contact

Although sender-side conformance certification is optional, from a due diligence perspective it is highly recommended for those NHS organisations developing in-house or who are working with commercial suppliers without previous certification.

Conformance consists of providing a statement, evidence, or statement and evidence as a response to individual requirements collectively held in a spreadsheet. Evidence can be gathered against a Test Harness accessible from multiple environments maintained by NHS Digital.

GP Foundation IT suppliers have been asked to keep their applications stood-up in the INT environment, after they have been awarded full rollout approval, to allow secondary care providers to test against these systems as part of a separate INT end-to-end testing process. This activity should only be done by secondary care organisations after competence has been gained against the Test Harness.  

Queries on INT end-to-end testing can again be taken through For those senders wanting to use the MESH API, there is an additional and separate conformance certification process that can be pursued via

After sufficient confidence has been gained by a secondary care provider that they are ready to use their solution in the live environment, then they would need to enlist an initially small set of willing GP Practices, ideally representative of all GP Foundation IT suppliers within their local area to go live with.  

After a period of local piloting in which feedback is obtained and assessed to satisfy clinical assurance, a decision to turn it on for all GP Practices in England can be made.  

Further information

Last edited: 15 June 2021 3:44 pm