Factors affecting the documentation of spoken safety-netting advice in routine GP consultations: a cross-sectional study

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Background: Previous studies have reported how often safety-netting is documented in medical records, but it is not known how this compares to what is verbalised and what factors might influence the consistency of documentation.

Aim: To compare spoken and documented safety-netting advice (SNA) and explore factors associated with documentation.

Design and setting: Secondary analysis of GP consultations archive.

Method: Observational coding involving classifying and quantifying medical record entries and comparison with spoken SNA in 295 video / audio recorded consultations. Associations were tested using logistic regression.

Results: Two-thirds of consultations (192/295) contained spoken SNA which applied to less than half of problems assessed (242/516). Only one-third of consultations (94/295) had documented SNA which covered 20% of problems (105/516). The practice of GPs varied widely from those that did not document their SNA, to those that nearly always did so (86.7%). GPs were more likely to document their SNA for new problems (p=0.030), when only a single problem was discussed in a consultation (p=0.040) and when they gave specific, rather than generic SNA (p=0.007). In consultations where multiple problems were assessed (n=139), the frequency of spoken and documented SNA decreased the later a problem was assessed.

Conclusion: GPs frequently do not document safety-netting advice they have given to patients which may have medico-legal implications in the event of an untoward incident. GPs should consider how safely they can assess and document more than one problem in a single consultation and this risk should be shared with patients to help manage expectations.
Original languageEnglish
Pages (from-to)E869-E876
JournalBritish Journal of General Practice
Issue number712
Early online date25 Jun 2021
Publication statusPublished - Nov 2021

Bibliographical note

Funding Information:
Peter J Edwards is National Institute for Health Research (NIHR)-badged GP academic clinical fellow funded by Health Education England South West/ Severn Postgraduate Medical Education (ACF-2018-25-502). Ian Bennett-Britton is a clinical research fellow funded by Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group research capability funding (RCF 19/20-64E). Matthew Booker’s academic clinical lecturer position is supported by NIHR funding. Matthew J Ridd and Rebecca K Barnes declare no funding related to this project. The One in a Million study was funded by the NIHR School for Primary Care Research (208) and the South West GP Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2021 Royal College of General Practitioners. All rights reserved.


  • clinical (general)
  • diagnosis
  • international
  • clinical (physical)
  • cancer
  • education and standards
  • patient safety
  • research methods
  • epidemiology


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