Safety-netting in general practice: how to manage uncertain diagnoses (January 2023)

Summary

Many people see their GP with symptoms that could either get better without treatment, or be a sign of serious illness; their diagnosis is uncertain. This article from the National Institute of Health and Care Research (NIHR) summarises recent research looking at how GPs and patients can work together to develop follow-up plans (a process known as safety-netting).

The study highlights the importance of patients understanding:

• why they are receiving this advice
• what actions are required, and by whom.

Content

Recommendations included:

How to offer safety-netting advice

• Build safety-netting into the entire consultation; it should not be rushed at the end.
• Use simple terms and avoid jargon and abbreviations (but include appropriate technical terms); tailor advice and address potential sources of anxiety (for instance being young or a first-time parent).
• Consider grouping chunks of information to help the patient remember the advice.
• Give people the opportunity to share their expectations and concerns, and address these in the safety-netting plan.

What advice to give: the safety-netting plan

• Explain and discuss uncertainties and the follow-up plan.
• Offer an initial diagnosis, explain how long you expect symptoms to last (or how they might change), give practical tips for self-care and symptom management (which give people a sense of control) and instructions for when they should be concerned.
• Personalise someone’s risk based on their characteristics (such as age or medical history) and not on population data. The plan should also be personalised and address factors that might make an individual less likely to follow advice (for instance if they have had a previous missed diagnosis).
• Give the patient the opportunity to ask questions and to share in decision-making.
• Actively check the patient’s understanding.
• Acknowledge the patient’s ability to make judgements about their own health, and to change their mind about a plan.

Other resources, follow-up and documentation

• Enable the patient to review safety-netting information via online resources, for example, which could be audio or visual.
• Invite the patient to return for further medical advice even if it is for the same symptom(s); reassure patients that this is a valid course of action.
• Accurately include the safety-netting advice in medical records so that other clinicians seeing the patient will know what care was given.

Read the full article and access the research via the link below.