The Handover Year: A Somerset Family’s Guide to Transition Appointments at 16 to 18

Moving from children’s health services to adult services is not simply a change of clinic. It is a planned handover, and in Somerset it usually begins well before a young person’s 18th birthday. For families, the process can feel reassuring one moment and unsettling the next: familiar teams step back, new teams step forward, and the young person is expected to take a larger role in their own care.

Transition appointments exist to make that change safer and clearer. They are not a single event, and they are not a test the young person has to pass. They are conversations, reviews and introductions designed to ensure that ongoing care does not stall when children’s services come to an end.

Why a handover appointment exists

Children’s services are built around the needs of a child and, usually, a parent or carer. Adult services are built around the individual patient. That shift matters. A young person may still need family support, but the NHS increasingly expects to speak with them directly, seek their consent and plan around their goals.

A transition appointment gives everyone a chance to look at the care already in place and decide what should continue, what should change and who will be responsible. For a young person with a long-term condition, a learning disability, a mental health difficulty or complex needs, the handover may involve several teams. In Somerset, that could include paediatric clinics, community children’s nursing, therapies, mental health services or specialist regional centres, alongside the GP surgery.

The aim is continuity. A well-planned handover should reduce the risk of missed prescriptions, unexplained gaps between appointments or a young person arriving in adult care with no clear point of contact.

What usually happens at a transition clinic

Transition appointments vary according to the service, but the content is often similar. A clinician will review the young person’s history, current treatment and any equipment, medication or support in use. They may talk about how often appointments will be needed in adult care and which team will provide them.

Some appointments are joint clinics, where a children’s clinician and an adult clinician meet the family together. Others are introductory appointments with the adult team. Either way, the conversation should cover more than clinical facts. It should include practical questions: how to contact the new team, what to do if symptoms worsen, how prescriptions will be issued and whether any tests or reviews are due.

For young people with an Education, Health and Care Plan, transition planning should connect with wider planning for adulthood. Health staff may contribute to reviews, and the GP can play an important role in coordinating care. If the young person has a learning disability, an annual health check from the age of 14 can also help make sure health needs are recorded and discussed before transfer.

Who can come, and what changes at 16

Parents and carers are usually welcome at transition appointments, especially when the young person wants them there. But the young person’s own voice should be central. Clinicians may offer part of the appointment for the young person to speak privately, or they may ask who they would like to have with them.

At 16, the legal position begins to shift. In England, a young person aged 16 or over is generally presumed to have the capacity to make decisions about their own treatment, unless there is evidence otherwise. That does not mean parents are excluded. It means the young person’s consent becomes the starting point, and confidentiality should be explained clearly to everyone in the room.

For younger children, clinicians assess whether the child is able to understand and make a particular decision, often described as Gillick competence. Transition planning can start before 16, but the handover years of 16 to 18 are when these questions become more practical: Who will the clinic contact? Who can see letters? Who gives consent for a procedure?

Consent, confidentiality and capacity in plain English

Consent is not a one-off signature. It is a conversation about what is being proposed, why, what the alternatives are and what it means for the young person. A transition appointment is a good place to clarify how consent will work in adult services.

Confidentiality can be a sensitive area. A young person may want their parent present but still want some information kept private. Clinicians should explain what will be shared, with whom and why. If a young person lacks capacity to make a particular decision, the Mental Capacity Act 2005 provides a framework for making decisions in their best interests, involving family and others where appropriate.

Families should feel able to ask for these points to be explained in plain language. It is not awkward to say: please tell us who will be contacted, what consent is needed and how the young person can change their mind.

Questions to take with you

A short list of questions can make a transition appointment more useful. Consider asking:

• Which adult team will take over, and when will they first make contact?
• Will there be a joint appointment before the children’s team steps back?
• How will medication, prescriptions and repeat reviews be handled during the change?
• What should the young person do if they feel unwell or worried between appointments?
• Who will coordinate care if several services are involved?
• How will consent and confidentiality be explained and recorded?
• What support is available for education, work, benefits or independent living, and who can help with that?
• If the young person needs extra support to make decisions, how will that be assessed and reviewed?

A practical preparation checklist

Before the appointment, gather any letters, clinic notes, medication lists and contact details for current teams. It can help to write down what matters most to the young person: what they want to manage themselves, what they want help with and what they are worried about.

After the appointment, ask for a clear summary of what was agreed. Note who is doing what and by when. If a referral to adult services is being made, ask how the young person will know it has been received. Keep the GP surgery informed, particularly if prescriptions or care arrangements are changing.

If the handover feels rushed

Transition should be a process, not a cliff edge. If the young person is approaching 18 and no plan has been discussed, raise it with the current clinical team or GP. In Somerset, families can also ask the service’s transition lead or patient advice and liaison service for guidance. The important point is to start the conversation early enough that questions can be answered calmly.

A good handover does not remove all change. It does make change understandable. With the right preparation, the move from children’s to adult services can become what it should be: a supported step into care that the young person can understand, question and, increasingly, lead.