Safety netting is a core skill in the MRCGP Simulated Consultation Assessment (SCA) and is essential for safe, patient-centred care. In the exam, demonstrating effective safety-netting can be the difference between a borderline pass and a high-scoring consultation. In this blog, we’ll explore what safety-netting is, why it’s crucial in the SCA, and how to do it effectively.
What is Safety-Netting?
Safety-netting is the process of giving patients clear advice on what to expect, when to seek help, and what red flags to watch for. It helps ensure patients do not come to harm if their condition deteriorates, symptoms change, or they don’t respond as expected to treatment.
In the MRCGP SCA exam, you are expected to safety-net in every consultation where it is clinically relevant. This demonstrates your ability to think ahead, manage uncertainty, and keep your patients safe.
Why is Safety-Netting So Important in the SCA?
- Patient Safety: The examiners want to see that you can manage risk appropriately, especially in cases where a diagnosis is uncertain.
- Marks for Clinical Management: Safety netting is an integral part of a safe and effective management plan, and missing it can significantly impact your score.
- Demonstrating Clinical Judgement: Knowing when and how to safety-net showcases your ability to apply clinical knowledge in a practical, patient-centred way.
- Managing Diagnostic Uncertainty: In primary care, many conditions evolve over time. Your ability to identify potential red flags and guide patients on what to do next is critical.
How to Safety-Net Effectively in the SCA
- Be Clear and Specific
Vague phrases like “Come back if it gets worse” are not enough. Instead, be precise:
“If your headache becomes severe, if you experience weakness in your arms or legs, or if you develop changes in your vision, you must seek urgent medical attention.”
- Tailor it to the Patient
Safety netting should be personalised to the patient’s condition, risk factors, and level of health literacy. For example, an elderly patient with COPD should receive different safety-netting advice than a young, otherwise healthy patient with a viral infection.
- Use a Three-Part Structure
An easy way to structure your safety-netting is:
- What to expect: “Your symptoms should improve within the next few days.”
- When to worry: “If your symptoms persist beyond a week, or if you develop a high fever or shortness of breath, this could indicate a complication.”
- What to do if things worsen: “If that happens, please call 111, book an urgent GP appointment, or seek emergency care if severe.”
- Consider the Patient’s ICE
Sometimes, patients have concerns about what might happen next. Addressing these directly can help them feel reassured:
“I understand you’re worried this could be something serious. If your symptoms don’t improve in the next few days, we can review you again to reassess.”
- Document Your Safety-Netting Advice
In real practice and the SCA exam, documentation is key. While you won’t be writing notes in the exam, verbalising safety-netting clearly demonstrates to the examiner that you are managing risk appropriately.
Examples of Good Safety-Netting in Common SCA Scenarios
Case: Child with Fever
“Most viral infections improve within a few days. However, if your child develops difficulty breathing, a rash that doesn’t fade under a glass, or becomes drowsy and unresponsive, you must seek urgent medical help by calling 999.”
Case: Suspected Gastroenteritis
“You should start feeling better in 48 hours. If you experience persistent vomiting, signs of dehydration like not passing urine for more than 12 hours, or blood in your stools, please seek medical advice urgently and if GP practice is closed ring 111 or attend A&E.”
Case: New Onset Chest Pain (ACS)
“If your chest pain becomes more severe, happens at rest, or is associated with sweating, nausea, or breathlessness, please go to A&E immediately or ring 999.”
