Moving from children’s to adult health services

The move to adult healthcare is often described as though one team hands a complete file to another on a young person’s eighteenth birthday. In practice, each service has its own age boundary, referral route and adult equivalent. A young person may transfer in one specialty, return to their GP for another and remain with a young-person service elsewhere.

Prepare service by service. The aim is not to make the young person manage alone. It is to make responsibility, information and support clear before the familiar team steps away.

Transition and transfer are different

Transition is the period of preparation before, during and after a move. Transfer is the point at which responsibility passes to an adult provider. NICE recommends a gradual, person-centred process rather than a rigid age-only handover ^[1].

Some services use transition clinics or joint appointments. Others send a referral and discharge later. Adult mental health transition may happen anywhere between 16 and 25 depending on the service and local arrangements; NHS guidance says the young person should be told about a proposed move at least six months beforehand ^[3]. Do not turn those descriptions into a guaranteed local timetable. Ask the current service what applies here.

List every service separately

Make a table for paediatrics, CAMHS or another mental health service, ADHD medication, speech and language therapy, occupational therapy, physiotherapy, continence, dietetics, learning-disability support and any specialist condition team involved.

For each one, record:

• the current clinician and contact details;
• the usual end date;
• whether an equivalent adult service exists;
• who must refer and when;
• whether the adult service has accepted the referral;
• the first appointment date;
• who remains responsible before that appointment;
• who prescribes, monitors and responds to deterioration;
• what happens if the adult service declines the referral.

A referral sent is not the same as a referral accepted. Ask for the outcome and the plan in writing.

Begin with the young person’s priorities

Ask what they want to understand and what they want help with. They may care about whether a parent can stay, whether the appointment is in a new building, whether they must repeat their history or whether a familiar medicine will continue.

Agree how they want information presented and how they will communicate during appointments. A young person might speak for themselves but want a parent to remember dates. Another may want questions in writing, extra processing time or an advocate.

“Please ask me the question first. My parent can add information after I have answered.”

“I want my parent copied into appointment letters because I need help organising dates.”

NHS England’s 2026 guidance says the young person should be asked regularly how they want parents and carers involved and that communication and reasonable-adjustment needs should be considered throughout transition ^[2].

Ask what the adult service does differently

The adult team may have different appointment lengths, contact methods and thresholds for ongoing care. It may expect the patient to arrange appointments, request prescriptions or explain consent for family involvement.

Ask before transfer:

• How are appointments booked and changed?
• Are reminders available?
• Can the service communicate by email or text?
• How does the young person request an adjustment?
• Is there a named contact between appointments?
• What counts as urgent, and which service responds out of hours?
• How are missed appointments followed up?
• How can the young person give permission for family involvement?

Do not describe adult care as automatically less supportive. Find out which tasks are changing and put support around those tasks.

Prepare a short health summary

A useful summary belongs to the young person and can be updated. Keep it to one or two pages:

• current conditions and the questions still being investigated;
• medicines, doses, timing and prescriber;
• allergies and important adverse reactions;
• monitoring currently required;
• communication and processing needs;
• sensory or access adjustments;
• early signs that health is worsening;
• what helps during examinations or procedures;
• key professionals and emergency contacts;
• how the young person wants family involved.

Check it with the current team. The GP and NHS Prep Pack helps organise the information without asking the young person to retell their whole childhood at every appointment.

Protect medication and monitoring

Do not assume the GP can take over a specialist prescription or that a shared-care arrangement will continue unchanged. Before discharge, ask who will issue each prescription, who orders and reviews monitoring and what happens if the adult appointment is delayed.

Request enough notice to resolve disagreements between services. Do not change or stop medicine to bridge an administrative gap without medicine-specific advice. The guide to understanding medication decisions explains how to record benefits, unwanted effects and questions for the prescriber.

If supplies or monitoring may run out, contact the current team and GP promptly. Keep dates, names and the response rather than relying on one telephone conversation.

Track tests and referrals that are still in progress. A scan may have been ordered by the children's team while the result will arrive after transfer; a referral may sit between services with no first appointment. For each item, record who ordered it, where the result should go and who is responsible for acting on it.

Ask how the young person will receive results and what happens if nobody contacts them. Do not assume that the adult service automatically inherits every open action from the children's record. If a result is expected by a stated date and does not arrive, use the named contact and keep a record of the follow-up.

Bring unresolved symptoms into the first adult appointment even when they are already documented. The purpose is not to repeat every investigation. It is to confirm that a live clinical question has an owner after transfer.

When there is no equivalent adult service

A young person may not meet the adult team’s criteria even though the children’s service has been useful. NICE says transition planning should identify alternative support when a young person is not eligible for statutory adult services, and emphasises GP involvement where specialist adult healthcare is not available ^[1].

Ask the children’s team to explain:

• why the referral was declined or why no referral was made;
• which needs still require support;
• what the GP is being asked to manage;
• which community, primary-care or voluntary services may be relevant;
• how re-referral works if needs change;
• what the urgent or crisis route is.

“Discharged to the GP” needs a clinical handover, not only a final letter copied to the family.

Mental health transitions need an explicit safety plan

Ask who the young person contacts if their mental health worsens before the adult service begins. Record crisis numbers, current coping and safety plans, medication responsibility and what family should do if the young person cannot seek help themselves.

Do not wait for a routine transition meeting when risk is rising. In England, NHS 111 can connect callers to urgent mental health support. Call 999 or go to A&E if life is at risk or somebody cannot be kept safe. Other UK nations publish their own urgent routes, and 999 applies throughout the UK for immediate danger.

Prepare the first adult appointment

Ask for the appointment format, location, expected length and names or roles of the people attending. Check parking, public transport, reception and waiting arrangements. If the young person needs written information, a quieter wait, a supporter in the room or another communication adjustment, request it early and ask for confirmation.

Before the appointment, choose no more than three priorities. These might be keeping medication safe during transfer, understanding who to contact between appointments and agreeing family involvement. Bring the health summary and current prescription list, but do not assume the new clinician has received every historic record.

Useful questions include:

• What information have you received from the children’s team?
• Which parts of my care will this service take responsibility for?
• What further assessment or monitoring is needed?
• Who should I contact with a medicine question or worsening symptom?
• How will results and appointment letters be sent?
• When is the next review?

Afterwards, write down the decisions and unresolved actions. Ask the clinician to correct any significant factual error in the record. If the young person found the format inaccessible, request a specific change for next time rather than concluding that they cannot engage with adult care.

Keep the GP in the picture

The GP may hold the most complete view when several specialist services are changing. Check that the practice has received key discharge and referral letters. Book a planned appointment if responsibilities are unclear; an urgent slot is rarely long enough to reconstruct a complicated handover.

Ask who at the practice should be contacted about prescriptions, physical-health monitoring and new referrals. A GP cannot create an unavailable specialist service, but clear records can prevent the young person being sent repeatedly between teams without anybody naming the gap.

Check the first months after transfer

Transition is not complete because one adult appointment took place. After the first visits, ask the young person:

• Did the clinician have the essential information?
• Were agreed adjustments available?
• Do you know how to contact the team?
• Is prescription and monitoring responsibility clear?
• Do you want family involvement changed?
• Is any previous support now missing?

Keep the answer focused on what needs action. A new clinician will not work exactly like the old one, but the young person should not be left without essential care because every service thought another was responsible.

Use the wider preparing-for-adulthood plan to keep healthcare beside education, money and daily life. The systems may be separate, but the young person lives all of the changes at once.