This chapter explores the referral process of patients and clients between one health professional and another, in particular considering the referral from primary to secondary care but also between professionals in the community. We consider the concept of continuity of care and responsibility, plus teamwork in hospital.

In those countries such as the UK and Australia where traditionally general practitioners have a gatekeeper role, the majority of patients’ first interactions for health problems and health maintenance take place in the community. The European definition of a general practitioner from 2002 is a doctor who provides both comprehensive and continuing care to every person seeking medical care. This definition stresses that first point of medical contact within general practice and the nature of the care provided in that GPs deal with all health problems (Wonca Europe, 2002). However over the last 10 years the nature of that first contact has changed. Thus the first health professional consulted could be the individual's GP, but it could also be a pharmacist, a practice nurse or nurse practitioner, an allied health professional or a complementary therapist. However, to access secondary care or hospital-based specialist services, patients still require a referral from a GP. The one exception to this is if patients access Accident and Emergency (the Emergency Department) directly.