• Peter Jonathan Edwards, Samuel J Finnikin, Fay Wilson, Ian Bennett-Britton, Andrew Carson-Stevens, Rebecca Barnes, and Rupert A Payne.
• University of Birmingham Institute of Applied Health Research, Birmingham, United Kingdom peter.edwards@bristol.ac.uk.
• Br J Gen Pract. 2024 Jul 1.

BackgroundProviding safety-netting advice (SNA) in out-of-hours primary care is a recognised standard of safe care but it is not known how frequently this occurs in practice.AimAssess the frequency and type of SNA documented in out-of-hours primary care and explore factors associated with its presence.Design And SettingRetrospective cohort using the Birmingham Out-of-hours General Practice Research Database.MethodA stratified sample of 30 adult consultation records per month from July 2013 to February 2020 were assessed using a safety-netting coding tool. Associations were tested using linear and logistic regression.ResultsThe overall frequency of SNA per consultation was 78.0%, increasing from 75.7% (2014) to 81.5% (2019). The proportion of specific SNA and the average number of symptoms patients were told to look out for increased with time. The most common symptom to look out for was if the patients' condition worsened followed by if their symptoms persisted, but only one in five consultations included a time-frame to reconsult for persistent symptoms. SNA was more frequently documented in face-to-face treatment-centre encounters compared to telephone-consultations (Odds Ratio [OR]=1.77, p=0.02), for possible infections (OR=1.53, p=0.006), and less frequently for mental (vs. physical) health consultations (OR=0.33, p=0.002) and where follow-up was planned (OR=0.34, p<0.001).ConclusionThe frequency of SNA documented in OOH was higher than previously reported during in-hours care. Over time, the frequency of SNA and proportion that contained specific advice increased, however this study highlights potential consultations where SNA could be improved, such as mental health and telephone consultations.Copyright © 2024, The Authors.

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