How GPs can use safety nets to navigate the tightrope walk of patient advice

Dr Peter Edwards

15 November 2018

‘Safety-netting advice’ is information given by a healthcare professional to a patient or their carer designed to help them know when they need to seek further medical help. This might be because their symptoms are not getting better, they are getting worse or they have further concerns or worries about their health. It can occur in a variety of contexts and in a variety of ways, but oversight into how and when this type of advice is given to patients in routine practice is limited.

Dr Edwards had previously started to develop a coding tool - a method of assessment - which, thanks to the Elizabeth Blackwell Institute Clinical Primer scheme, he was able to finish, and put into practice. This tool is used to record the ‘safety netting’ type and frequency as well as other factors. He ran a Patient and Public Involvement seminar, where members of the public were able to comment on the project, and assess the coding tool, which led to further improvements.

After the tool was tested for reliability with appropriate statistical models, Dr Edwards then got to work coding 318 GP consultations contained within the University of Bristol ‘One in a Million’ GP consultation video archive. This included 555 medical problems and 390 separate episodes where the GP gave ‘safety-netting’ advice.

High-level statistical processing indicated that patients with acute problems and problems raised first in consultations were more likely to receive safety-netting advice, but overall this advice was often not recorded by GPs in the patients’ medical notes. Dr Edwards hopes that the tool he’s developed can assist GPs and supporting bodies in the best way to administer and document such advice.

This important diagnostic strategy is studied in two papers in the British Journal of General Practice by Peter Edwards and colleagues from Bristol Medical School, University of Bristol. Edwards and colleagues, in an accompanying paper, report the development of a coding tool, which enables the recording of how GPs have provided safety netting advice, noting the symptoms or conditions the patient was advised to look out for, the actions that they should take, when and how urgently, along with any plans for further follow-up. Formalising and recording safety netting may be particularly important in patients with low risk but not no risk symptoms suggestive of cancer.

Dr Edwards also hopes that he and other researchers can use the safety-netting tool to assess how healthcare professionals give advice in different clinical settings in his new role as a GP Academic Clinical Fellow, and in the future as he applies for PhD funding.

In the video below Dr Edwards explains findings of research into when and how GPs give safety-netting advice. Read the full open access research in the BJGP: https://doi.org/10.3399/bjgp19X706601 and https://doi.org/10.3399/bjgp19X706589

Dr Edwards also credits the Clinical Primer scheme with assisting him in attaining his Academic Clinical Fellowship training:

“I applied for this post before receiving my EBI fellowship and was unsuccessful. The skills and training I received as part of my EBI fellowship allowed me to develop as a researcher and achieve my goal of obtaining an academic training number when I reapplied. I am extremely grateful to have been awarded this fellowship as it has really helped me further my career as a clinical researcher.”