Incorporate safety-netting advice into the whole consultation, GPs advised

GPs should consider discussing safety-netting advice with patients throughout a consultation and not just as a rushed add on at the end of an appointment, a team of researchers has found.

It is one of 15 recommendations for GPs been made by a team at Oxford University after a review on the evidence of the best approach to safety-netting in patients where a diagnosis is uncertain.

The researchers, who said this was the first general guide for GPs on the topic, also concluded that people are more likely to follow safety-netting advice if they understand why it is being given, what the actions are and who is responsible for follow up.

Longer appointment times could also improve safety-netting, the researchers found, but acknowledged this is unlikely to be implemented at present.

The National Institute for Health and Care Research funded researchers said that while many of their recommendations also apply to remote consultations, more research is needed to see if people’s understanding and acceptance of safety netting is different than with face-to-face appointments.

It is best to personalise a patient’s risk based on their characteristics rather than population data and the plan should also be personalised taking into account factors such as whether they have had a previous missed diagnosis, the researchers said.

GPs should use simple terms and avoid jargon and abbreviations while at the same time including appropriate technical terms, they reported in BMJ Quality and Safety.

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A good safety-netting approach would also address potential sources of anxiety for the patient and give them the chance to share their expectations and concerns, they said.

It is also worth chunking groups of information to help the patient remember the advice, they concluded.

But reduced continuity of care and increasing multimorbidity both have implications for GPs use of safety-netting and proper records of advice given was vital, they added.

Study leader Claire Friedemann Smith, from the University of Oxford, said: ‘Safety-netting is an enormous and frequent part of primary care practice, but there is no general guidance on how it should be done.

‘There is only some guidance for GPs caring for people with suspected cancer and for childhood health, which is helpful in some cases but since safety-netting is meant to help deal with uncertainty we felt this was too narrow.

‘Patients often don’t understand what safety-netting is and many feel it is a way of getting them out of the door. We wanted to look at existing research on communication of risk, and come up with some practical guidance about how to do it,’ she said.

Trainees could particularly benefit from the recommendations which could help them structure consultations and weave safety netting into discussions with patients, the researchers said.