Barriers and facilitators to patients and carers following safety-netting advice in UK general practice: a systematic review

Background: Diagnostic uncertainty is common in UK general practice, where early serious illness can be difficult to distinguish from self-limiting conditions. Safety-netting advice supports clinicians in managing this uncertainty by communicating risk and agreeing monitoring plans with patients and carers. While much research has focused on clinician- and system-level delivery of safety-netting advice, its effectiveness ultimately depends on patient or carer action. However, the factors shaping patients’ and carers’ agency – particularly among vulnerable or complex groups – remain poorly understood. Objective: To identify barriers and facilitators to patients and carers following safety-netting advice in UK general practice. Design: Electronic bibliographic databases and grey literature sources will be searched for qualitative, quantitative, and mixed-methods studies. Extracted data will be synthesised using content and framework analysis, with factors deductively mapped to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation–Behaviour (COM-B) model, alongside inductive identification of emergent themes. Barriers and facilitators will be examined across nested levels, including patient, carer, clinician, intervention, delivery, and wider contextual factors. Expected outcomes and conclusions: This review will provide a theory-informed synthesis of the barriers and facilitators influencing patients’ and carers’ agency in following safety-netting advice in UK general practice. Mapping these determinants to the TDF and COM-B frameworks will help identify gaps in the evidence and inform future research, implementation strategies, and intervention development, including for vulnerable and complex patient groups.