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

Background In 2024, one-third of NHS GP consultations in England were conducted by telephone. Although remote consulting can be convenient for patients and GPs, it may increase diagnostic uncertainty. Safety-netting advice (guidance on when, and how, patients should seek further medical help) is a tool used to mitigate clinical risk, but its delivery during telephone consultations has not been studied in detail. Aim To evaluate the communication, documentation, and patient recall of safety-netting advice in GP telephone consultations. Design & setting Observational study using data from seven GP practices in south west England. Method Practices routinely recording telephone consultations were invited to participate. Patients with a recent telephone consultation with a participating clinician were invited to consent to consultation recording retrieval, medical record extraction, and completion of a post-consultation questionnaire. Recordings of 96 telephone consultations were obtained and coded using the validated Safety-Netting Coding Tool. Regression models explored factors associated with safety-netting advice. Patient recall was assessed using post-consultation questionnaires. Results There were 93 instances of safety-netting advice, delivered in 60.4% ( n = 58) of 96 consultations applying to 43.4% ( n = 72) of 166 identified problems. Instances of safety-netting advice were mostly GP initiated (95.7%, n = 89), delivered during treatment planning (66.7%, n = 62), and included specific elements (64.5%, n = 60). Delivered safety-netting advice was documented in 64.2% ( n = 34) of 53 consultations with notes that were available. Written advice was rarely used: only four out of 96 consultations contained written advice, which was delivered via text message. Patients correctly recalled the presence of safety-netting advice in two-thirds of consultations when it was given. Safety-netting advice was more likely to be provided by younger GPs (aged