GPs were less likely to provide safety-netting advice when a patient presents with more than one problem in a single consultation, a study has found.
Published in the British Journal of General Practice (BJGP), the study noted that the later a problem was assessed in a consultation, the ‘less likely there was to be spoken or documented safety-netting advice’.
By contrast, it found that GPs were more likely to document their spoken safety-netting advice when the guidance they had given was specific to a single problem presented during the consultation.
The study authors said that the finding should prompt GPs to consider how safely they can assess and document more than one problem in a single consultation.
GP consultations in the UK involve 2.5 problems on average, with appointments only increasing by two minutes per additional problem raised, it said.
‘This may not be sufficient time to comprehensively assess, safety-net and document all problems,’ it said.
‘Our findings suggest patterns of prioritisation in documentation of both clinical problems and safety-netting advice which may be a response to such time pressures.’
The latest figures from NHS Digital show GP practices in England carried out 31.5 million recorded patient appointments in April.
BMA GP committee chair Dr Richard Vautrey said the numbers demonstrated the ‘immense pressures’ facing GPs, who are also tasked with an ever-increasing backlog of care.
Half of safety-netting advice not recorded
The study – which was the first to detail how GPs record safety-netting and assessed a sample of 295 consultations – also found that more than half of the advice given goes undocumented.
Of the 242 consultations where safety-netting advice was given, there were only 99 instances of it being recorded in a medical record.
It said that this indicates retrospective reviews of medical records are likely to ‘under report the frequency’.
The authors also said their study displayed ‘a common disparity between what is said and what is documented in primary care consultations’, adding that this ‘potentially’ leaves GPs who provide incomplete documentation vulnerable to any challenge to their practice.
Jo Wadey, practice business manager at St Lawrence Surgery, West Sussex, said that her practice is seeing patients come forward for multi-problem consultations, after not having been to the GP since before the pandemic.
‘I think the GPs are finding it tougher to get through their consultations,’ she said, adding that ‘it must be difficult for them to address everything and document everything they said in a 15-minute consultation.’
Ms Wadey, who is also a co-founder of the Institute of General Practice Management (IGPM), also said: ‘Patients seem to have this thought that they haven’t been able to get to us or that we’ve been closed, but we’ve never been closed.’
She said that practice managers have told the IGPM that the increase in demand now is ‘unprecedented’.