Optimising GPs’ communication of advice to facilitate patients’ self-care and prompt follow-up when the diagnosis is uncertain: a realist review of ‘safety-netting’ in primary care
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests


  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on:
    General, Logistical, Red Flag and Risk (GLRR) approach to safety netting
    • Tom Mallinson, Senior Lecturer / Rural GP College of Remote and Offshore Medicine, Malta / NHS Highland

    Smith et al (2022) present an excellent review of the current state of safety netting theory and practice in Primary Care. In relation to the education of paramedics working in primary care, the General, Logistical, Red Flag and Risk approach has been suggested as a means of implementing the theory of safety netting into a clinician’s practice (Mallinson, 2023). It reminds clinicians to always give a General worsening statement, meeting Smith et al’s Recommendation No. 1. The second point is to provide clear Logistical advice to patients on how to seek help; the specifics of what phone number to call to seek or summon help. This perhaps aligns to Recommendation 9; “including a specific safety-netting plan”. Red Flag safety netting reinforces the importance of patient education in relation to possible serious deterioration which aligns to Recommendation 4 in terms of “specific situations that should be cause for concern”. The final component of Risk based safety netting relates to shared decision making and specifically situations where there is disagreement and a patient is not following medical advice. The Risk component seeks to ensure that patients are fully aware of the potential risks inherent in their chosen course to action. This is vital in relation to ensuring patients are making informed decisions about their care. There is definitely more work to be done on improving education around Safety Netting, and Smith et al’s work provides us with clear recommendati...

    Show More
    Conflict of Interest:
    None declared.