Letters Safety netting

Time for guidelines on safety netting?

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6411 (Published 05 December 2016) Cite this as: BMJ 2016;355:i6411
  1. Peter J Edwards, research associate,
  2. James O Seddon, academic clinical fellow GP specialist trainee year 4,
  3. Rebecca K Barnes, senior research fellow in applied conversation analysis
  1. Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
  1. peter.edwards{at}bristol.ac.uk

Nicholson and colleagues say that safety netting “has come to be regarded as ‘best practice’ in relation to cancer diagnosis in non-specialist settings.”1 Safety netting is widely endorsed across a range of conditions by multiple professional institutes, but there is limited research evidence to guide clinicians and no widely accepted definition. NICE provides two different definitions in separate guidelines,2 3 which both differ from that of the RCGP curriculum.4

One possible solution is to make a clear distinction between safety netting as an all encompassing term, which could include the three levels described by Nicholson and colleagues, and safety-netting advice, which is information shared with a patient about what action they should take if their condition fails to improve, changes, or if they have further concerns about their health in the future. The two terms are currently used interchangeably, leading to vague statements that are vulnerable to misinterpretation.

Another area of concern is that safety netting is rarely documented in medical notes.5 The parliamentary and health service ombudsman has been critical of GPs who fail to provide and document safety-netting advice.6 Guidelines could be developed alongside standardised patient information leaflets that, when printed, are automatically coded into the medical notes. This time saving measure could protect both patients and doctors.

Guidelines might not be required if GPs performed safety netting routinely. But initial screening of video recorded consultations indicates otherwise.7 We have found that safety-netting advice is not always performed intuitively, gets minimal uptake from patients, and is absent from many consultations.

As clinicians report a lack of training in safety-netting methods,5 and patients say that safety netting is often too vague to be useful,8 could national guidelines help resolve some of the uncertainties around safety netting and improve patient care?


  • Competing interests: RKB was the principal investigator of the National Institute for Health Research School for Primary Care Research (NIHR SPCR) funded One in a Million study. PJE is an honorary research associate working on a project using the archive. JOS has no competing interests. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS, or the Department of Health.

  • Full response at: http://www.bmj.com/content/355/bmj.i5515/rr.


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