We complement and contrast your granular study of routine face-to-face GP consultations1 with our experience of unscheduled remote GP assessments in the COVID-19 Clinical Assessment Service (CCAS). A small clinical assurance team reviewed the recorded audio and written clinical notes for 5738 consults undertaken between April 2020 and May 2021 against a standardised, COVID-19-adapted version of the Royal College of General Practitioners Urgent and Emergency Care Clinical Audit Toolkit.2 Approximately 1500 GPs throughout England spanned all career stages and included those returning from retirement to support the pandemic response (Emergency Registered Practitioners). Patients across the age span presented possible COVID-19 symptoms. Safety netting was reviewed taking account of the context of the individual consult (Table 1). Integrated NHS Pathways safety-netting templates were available.3
Table 1. Review of safety netting
Safety netting may be better done here for the reasons the authors suggest: acute, first presentations, and single-problem consultations are all more likely in unscheduled settings. The 80% fully verbalised and 70% fully documented rates compare favourably with 47%–65% and 20%– 32%, respectively, in routine consultations, reflecting the additional clinical and medicolegal risk profiles of unscheduled work. We still think there is a significant continuing professional development need, with safety netting inadequately verbalised or documented in 5%–10% of calls. Disparity between verbalised and documented safety netting persists and, although narrower in our data, echoes the additional value of audio review. In common with unscheduled care settings, CCAS consultations were longer (20–25 minutes) than routine GP appointments. We think consultation length influences GP capacity to provide quality care, including safety netting.
Reviewers were also GPs and participated in standardisation processes. Clinicians were unaware which consultations would be reviewed; hence these data reflect ‘real-life’ practice. We approached the problem of defining unwarranted variation in safety-netting practice by considering proportionality in the context of the individual consultation.
- © British Journal of General Practice 2021
