Prescribing drugs of dependence in general practice, Part A

3. General practice systems of care
3.6 Coordination of care
☰ Table of contents

Clinical handover needs to occur whenever care is to be delivered by different providers. Within general practices there should be an effective handover system that ensures safe and continuing healthcare delivery for patients in the event of staff absences.

Failure of, or inadequate transfer of, care is a major risk to patient safety and a common cause of serious adverse patient outcomes. Inadequate handover can also lead to wasted resources, delayed treatment, delayed follow up of significant test results, unnecessary repetition of tests, medication errors and increased risk of medico-legal action.20

It is recommended that general practices and GPs insist on high standards for referral letters for clinical handover or shared care arrangements from secondary care before accepting the ongoing care of a patient. This facilitates the continuity of care and transfer back to higher levels of care if the need arises.

A practice or GP should not accept the ongoing management of a high-risk patient referred from a public sector facility, unless there is:

  • a medical summary consistent with the Australian Commission on Safety and Quality in Health Care (ACSQHC) handover standards38
  • a clear management plan
  • patient-specific instructions, including specific clinical issues that would prompt referral back to secondary care
  • contact details of a case manager and a clinically responsible person
  • documentation that details mechanisms for rapid transfer back to specialty care if deterioration occurs.

This requirement should be supported by practice policies and communicated to referral agencies if information does not meet required standards.

It may be useful to document non-attendance by patients.

Refer to Appendix E.2 in the PDF version for a sample letter to referral agencies.

  1. The Royal Australian College of General Practitioners. Standards for general practices, 4th edition. Melbourne: RACGP; 2013.
  2. Australian Commission on Safety and Quality in Health Care. Safety and Quality Improvement Guide Standard 6: Clinical Handover (October 2012). Sydney: ACSQHC; 2012.