TELESAFE: Understanding how clinicians in general practice make safe follow-up plans in telephone appointments

Project description

Before the Covid-19 pandemic, there had been a gradual increase in the use of telephone consultations in primary care, representing about 14% of general practice consultations. This rapidly accelerated during the pandemic so that the majority of consultations were conducted by telephone. Although the number of face-to-face consultations has now increased, about a third of consultations are now conducted by telephone and this seems likely to continue.

An important aspect of any GP consultation, whatever the mode, is ‘safety-netting advice’ – providing patients with clear advice about what to look out for and when to seek further medical help if their condition changes, fails to improve or if a patient has further concerns about their health. For example, a doctor might inform a patient “if your cough is not better in 3 weeks or you start coughing up blood I need to see you again to consider if we need to get any more tests”. We have previously studied how this advice is given in face-to-face consultations, and have developed a tool to assess how and when safety-netting advice is given. Telephone consultations tend to be shorter and more focused than face-to-face consultations, and lack non-verbal cues, so there is good reason to believe that this will alter the ways in which GPs and other primary care clinicians give safety-netting advice. It is arguable that providing safety-netting advice is particularly important in telephone consultations where the GP is unable to see the patient. It is therefore important for patient safety to understand how, and how often, GPs and other primary care clinicians provide this advice in telephone consultations.

Another relevant change in primary care is that an increasing proportion of consultations are now conducted by clinicians other than doctors, such as nurses and clinical pharmacists. In this study we will consider including these other primary care clinicians if they are conducting a substantial number of telephone consultations in our study practices. We would then assess how they offer safety-netting advice and how this compares with GPs.

Our earlier research on safety-netting was conducted using the ‘One in a Million’ archive of general practice consultations, consisting of recorded consultations along with linked medical record entries and patient surveys. We created this archive in 2014 to provide a resource for a range of research projects and also for teaching and training health professionals and medical students. More than 71% of eligible patients having face-to-face consultations agreed to have their consultations recorded. This has been a very successful initiative, and the archive has supported more than 20 research projects conducted by researchers from many different universities. Given the changes in the nature of general practice, it is important to add a sample of telephone consultations to the archive. This will make it possible to compare the nature of telephone and face-to-face consultations in future projects.

What is the aim of the project?

To understand how GPs and other primary care clinicians provide, and patients respond to, safety-netting advice in telephone consultations and to provide an archive of telephone consultations in general practice for further use in research and training.

What are we doing?

We will invite patients who have had a recent telephone consultation to give consent for their recorded consultations to be anonymised and used for research and the teaching and training of health professionals. This will include asking them to complete a questionnaire about their experiences in the consultation and permission to use extract relevant information from their medical records. We will analyse these consultations to understand whether, how and in what circumstances GPs and other clinicians provided safety-netting advice, how patients responded to this advice, and whether this has an impact on subsequent consultations. We will remove any information that might identify participants from the medical record entries, survey data and transcripts and remove spoken identifiers from the recordings. Where participants have given separate consent to do so, the data we collect will be made available to other bona fide researchers to conduct further research which meets legal, ethical and data protection standards. 

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