A Conversation Analytic (CA) study of Diagnostic Safety-Netting Practices in Primary Care Consultations

PhD project (3/4 yr research project leading to independent research at the doctorate level)

Dr Rebecca K Barnes, Dr Matthew Ridd

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Roger Neighbour was the first to describe the term ‘safety-netting’ in the primary health care setting and considered it an essential component of all patient consultations. [1] Safety-netting is verbal, visual and/or written information given to a patient or their carer to help manage clinical uncertainties which may include advice about what action they should take if their condition fails to improve, changes or if they have further concerns in the future. Despite safety-netting being endorsed by the RCGP, NICE [2] and many other professional institutions, no accepted gold standards exist detailing what safety-netting information should include. Most claims about the importance of safety-netting come from expert opinions about what should be done and how it should be done. There have been numerous calls for further research [3] but no studies have yet directly and independently assessed how and when GPs use safety-netting in real-world consultations.

Aims & objectives

1. To develop a conversation analytic (CA)-grounded interaction coding scheme to describe the nature and extent of safety-netting communication practices in GP consultations with adult patients across a range of conditions
2. To understand of what changes in safety-netting practices, if any, might be optimal and how those changes might be measured and achieved in a next stage study


1. To use CA methods to develop and apply an interaction-based coding scheme to describe safety-netting communication practices between GPs and adult patients in primary care consultations. Data will be drawn from an existing source - the ‘One in a Million’ archive of 327 video-recorded consultations with 23 GPs from 12 practices collected between 2014-2015 in the South-West of England.
2. To explore any associations with linked data including: patient, GP and practice demographics; patient and GP questionnaire data; and primary care medical records data.
3. To share the findings with groups of patients and GPs to understand what changes in safety-netting communication practices, if any, might be optimal and how those changes might be meaningfully measured.


1. Neighbour R. The Inner Consultation. 2nd ed. Oxford: Radcliffe Publishing, 2004.
2. NICE. Suspected cancer: recognition and referral [NG12]. London: NICE, 2015.
3. Almond S, Mant D, Thompson M. Diagnostic safety-netting. Br J Gen Pract 2009;59(568):872-4.

Created on Oct. 24, 2016, 5:54 p.m.

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