Safety Netting

In this step, we will be discussing safety netting in the context of a remote consultation.

Safety netting as a concept was introduced almost 30 years ago by Roger Neighbour [1]. He defined it as a process whereby the GP answers three questions: ‘If I’m right, what do I expect to happen? How will I know if I am wrong? And what would I do then?’ [2]. Safety netting is included in Neighbour’s own model of the consultation as well as the Calgary–Cambridge model, which includes safety netting in the section ‘closing the session’ [3].

Safety netting is about giving information to a patient or their carer during a consultation, about actions to take if their condition changes or fails to improve. You might also give safety netting information to a patient or their carer in case they have any further concerns about their health in the future.

An example of a safety netting statement would be “please make another appointment or seek medical attention if your symptoms do not improve within the next 2 weeks”. There is currently no set gold standard for what form safety netting advice should take, or how it should be delivered to patients. We will explore what information is delivered in practice and how it is delivered; and later we will look at how safety netting advice should be documented in your consultation notes.

It is essential to incorporate the principles and practices of effective safety netting into the patient management plan that you negotiate with the patient during the handover phase. This is to protect both the patient and the clinician.

In his article titled ‘Effective safety netting in prescribing practice’, Silverston [4] suggests the ‘5 C approach’ for safety netting as a way to help determine whether a patient can be safely managed at home with the advice given, or whether it would be more appropriate for patient to be seen face to face, referred or admitted to secondary care.

The ‘5 C’s’ approach

• Is the patient capable of performing a reassessment, in terms of their mental and medical ability are they legally competent to do so?
• Can the patient comply with the instructions that have been given, in terms of their practical and logistical ability to perform the tests required?
• Can the patient comprehend the instructions required for the reassessment, in terms of their ability to understand the instructions, as well as to interpret the results and has their comprehension been confirmed by the clinician?

Be particularly careful to summarise key points and explain the next steps in language that will be clear to the patient. You can do this by:

1. Explicitly checking understanding.
2. Providing clear safety netting instructions.
3. Actively signposting for support, e.g. to social prescribing link workers.

Breaking down safety netting information in the following way can ensure it is clear concise and memorable for the patient:

• Explain to the patient exactly what to look out for.
• Describe any recognised complications that could develop, then say what they are and what to look for.
• Say what to expect about the time course. When should the patient improve? For example, if they are not better in 2 days or 2 weeks is this going to be a problem?
• Tell them how to seek help. For example, what type of symptoms would need an A+E attendance.

[1] Jones, D., Dunn, L., Watt, I. and Macleod, U., 2019. Safety netting for primary care: evidence from a literature review. British Journal of General Practice, 69(678), pp.e70-e79.

[2] Neighbour R. The inner consultation. Radcliffe Publishing Ltd: London, 1987

[3] Kurtz SM, Draper J, Silverman JD. Teaching and learning communication skills in medicine. CRC Press, Oxford. 1998

[4] Silverston P. Effective safety-netting in prescribing practice. Nurse Prescribing. 2014;12(7):349-352