by Dr Peter Edwards
Research Associate/Academic Foundation Year 2 doctor
Centre for Academic Primary Care
Patients can deteriorate rapidly.
I know this from working in both general practice and as a hospital doctor in A&E.
During the early stages of an illness it can be difficult for even the most experienced healthcare professionals to determine whether a patient has a minor self-limiting illness or is harbouring a more serious condition. In addition, growing problems such as antibiotic resistance and multimorbidity mean that sometimes even when a doctor makes a correct diagnosis, patients do not always get better with the first round of treatment and may require further medical help.
We cannot, and it is not clinically appropriate, to admit everyone to hospital to observe them until they feel 100% better.
That is why it is important that healthcare professionals provide patients with safety-netting advice. Safety-netting advice is information shared with a patient or their carer, designed to help them identify the need to consult a healthcare professional in the future.1 This may be because their symptoms do not improve, their symptoms change, or because they develop further concerns about their health.2
For example, most coughs are caused by viral infections, which usually get better without any specific treatment, but sometimes they can be a sign of a more sinister condition such as pneumonia or lung cancer. As such, a doctor might provide the following safety-netting advice to a patient:
“If your cough is not better in 3 weeks, if you feel a lot worse, or if you start coughing up blood, you need to make an urgent appointment to see me.”
As part of my Academic Foundation Programme I have been using a selection of consultations from the NIHR-SPCR funded One in a Million Primary Care Archive – a collection of video-recorded GP consultations and linked data – to develop an interaction coding tool which can assess how and when GPs provide safety-netting advice. As the second official user of this archive, I feel privileged and excited to work with such an exceptional and extensive research resource. The archive contains recorded consultations from 23 GPs working in 12 diverse practices located in the South West of England and linked data in the form of patient, practice and GP questionnaires and associated medical records. Of the 327 patients included in the original study, 300 kindly gave consent for their data to be used by other researchers, subject to further NHS ethical approval. The full study was recently published in the British Journal of General Practice.
The Academic Foundation Programme in the South West has allowed me to combine my passion for research with the continued development of my clinical skills and patient management. It has been a great experience to not only be taught by some of the UK’s top researchers, but also to apply these research methods for myself. For the first time in my career, I have managed to navigate the NHS ethical approval process and had the opportunity to write my own research protocol. This was a great learning experience and provided me with a better insight into how NHS ethics committees are designed to protect patients, the public and doctors. Overall, I would thoroughly recommend the Academic Foundation Programme in the South West to all medical students who are interested in research and teaching (and Bristol is also a great place to live!).
I am incredibly grateful to the Elizabeth Blackwell Institute at the University of Bristol for recently awarding me a Clinical Primer Fellowship, which will allow me time to utilise my safety-netting tool to analyse all 300 consultations in the One in a Million Archive and further develop as a clinical academic.
As there has been minimal research into the topic of safety-netting, this study might uncover new, important information on how safety-netting advice is delivered in primary care. I strongly believe that understanding current practice is key to making both meaningful and beneficial changes to our pressured health services. Ultimately, I hope that my research at CAPC will lead to better and safer primary care.
- Roland D, Jones C, Neill S, et al. Safety netting in healthcare settings: what it means, and for whom? Archives of Disease in Childhood – Education and Practice 2014;99:48-53. doi: http://dx.doi.org/10.1136/archdischild-2012-303056
- Edwards PJ, Seddon JO, Barnes RK. Time for guidelines on safety netting? BMJ 2016;355 doi: https://doi.org/10.1136/bmj.i6411