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

Background In 2024, one-third of NHS GP consultations in England were by telephone. While 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 Evaluate the communication, documentation, and patient recall of safety-netting advice in GP telephone consultations. Design and setting Observational study of 96 recorded telephone consultations from seven practices in South West England during 2023-24. Method Consultations were coded using a 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% (58/96) of consultations applying to 43.4% (72/166) of problems. Safety-netting advice was mostly GP-initiated (95.7%, 89/93), delivered during treatment planning (66.7%, 62/93), and included specific elements (64.5%, 60/93). Delivered safety-netting advice was documented in 64.2% (34/53) of consultations with notes available. Written advice was rarely used (4/96 consultations, all text messages). 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 (<45 years; OR=5.09, p=0.011). Conclusion Safety-netting advice was common but inconsistently delivered, documented, and recalled in GP telephone consultations. Opportunities exist to improve the consistency, documentation, and use of written advice to support patient understanding, recall, and safety in remote care.