Delegation and Accountability

Delegation improves access and efficiency when performed within a defined competence framework.^[1] Accountability always follows the clinical decision: the registrant remains responsible for what they supervise and for the outcomes of tasks they delegate.^[6][3]

Principles for safe delegation

Assign tasks only to staff who are trained, assessed, and signed off as competent; match supervision level to risk; and ensure the supervisor can intervene before harm occurs.^[5][4]

• Clarity: written task lists per role; competence checklists; visual role identifiers for patients.^[8]
• Capability: skills assessed initially and re-validated; supervised practice before independent work.^[4]
• Control: escalation rules (e.g., child, vulnerable adult, acute symptoms) trigger direct supervision or handover.^[2]

Communicating boundaries to patients and teams

Patients should know who is providing care and who is responsible. Staff should know when to pause and call a registrant. Scripts can help teams avoid drift into clinical judgement by non-registrants (e.g., receptionists avoid diagnosing over the phone).^[3][8]

Record who supervised, what was delegated, and any advice provided. Where a mistake occurs, disclose promptly, correct safely, and review training and supervision to prevent recurrence.^[2][4][7]

References (numbered in text) Why we include references

1. Task shifting in primary care to tackle healthcare worker shortages: An umbrella review — Siew Lian Leong; Siew Li Teoh; Weng Hong Fun; Shaun Wen Huey Lee; European Journal of General Practice (2021) Find (opens in a new tab)
2. 3.3 Staff are adequately supervised and supported — General Optical Council Find (opens in a new tab)
3. Delegation — College of Optometrists Find (opens in a new tab)
4. Supervision — College of Optometrists Find (opens in a new tab)
5. Standards of conduct, performance and ethics — Health and Care Professions Council (2024) Find (opens in a new tab)
6. Arrangements for delegation and joint exercise of statutory functions — NHS England (published 19 February 2024) Find (opens in a new tab)
7. Openness and honesty when things go wrong: The professional duty of candour — General Medical Council Find (opens in a new tab)
8. Example triage flowcharts — Care navigation and triage in general practice — British Medical Association (updated 13 April 2023) Find (opens in a new tab)