Safety-netting communication during telephone consultations: an observational study using recorded consultations

Area of Science:

• Primary Care Medicine
• Health Services Research
• Patient Safety

Background:

• Telephone consultations are increasingly common in UK general practice (GP), accounting for one-third of NHS GP consultations in England in 2024.
• While convenient, remote consulting may increase diagnostic uncertainty for both patients and GPs.
• Safety-netting advice, crucial for mitigating clinical risk, has not been extensively studied in telephone consultations.

Purpose of the Study:

• To evaluate the communication, documentation, and patient recall of safety-netting advice during GP telephone consultations.
• To identify factors influencing the provision of safety-netting advice in remote primary care settings.

Main Methods:

• An observational study analyzed 96 recorded telephone consultations from seven GP practices in South West England (2023-24).
• Consultations were coded using a validated Safety-netting Coding Tool.
• Patient recall of advice was assessed via post-consultation questionnaires, and regression models identified factors associated with advice delivery.

Main Results:

• Safety-netting advice was provided in 60.4% of consultations, addressing 43.4% of patient problems.
• Advice was primarily GP-initiated (95.7%) and delivered during treatment planning (66.7%).
• Documentation occurred in 64.2% of cases with available notes, and patient recall of advice was approximately two-thirds.

Conclusions:

• Safety-netting advice is frequently given in GP telephone consultations but its delivery, documentation, and patient recall are inconsistent.
• Younger GPs (<45 years) were more likely to provide safety-netting advice.
• Improvements in consistency, documentation, and the use of written advice are needed to enhance patient understanding and safety in remote healthcare.