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Abstract
BackgroundThe COVID-19 pandemic required general practice to rapidly adapt to remote consultations and assessment of patients, creating new, and exacerbating existing, vulnerabilities for many patients.AimTo explore GP perspectives and concerns about safeguarding practice during the pandemic, focusing on challenges and opportunities created by remote consultation.Design and settingQualitative interview study.MethodEighteen GPs from Oxford, London, Southampton, Liverpool, Manchester, and Reading were interviewed between June and November 2020, using a flexible topic guide and fictional vignettes to explore child and adult safeguarding scenarios. Interviews were audio-recorded, thematically coded, and analysed.ResultsGPs worried about missing observational information during remote consultations and that conversations might not be private or safe. Loss of continuity and pooled triage lists were seen as further weakening safeguarding opportunities. GPs experienced remote consulting as more ‘transactional’, with reduced opportunities to explore ‘other reasons’ including new safeguarding needs. However, they also recognised that remote consulting created opportunities for some vulnerable patients. While supporting known vulnerable patients was difficult, identifying new or unknown vulnerabilities was harder still. Most reported that remote consulting during COVID-19 was harder, riskier, and emotionally draining, contributing to increased GP anxiety and reduced job satisfaction.ConclusionThe GPs interviewed raised important concerns about how to identify and manage safeguarding in the context of remote consultations. Current guidance recommends face-to-face consultation for safeguarding concerns, but pressure to use remote forms of access (within or beyond the pandemic) and the fact that safeguarding needs may be unknown makes this an issue that warrants urgent attention.
Highlights
Before the COVID-19 pandemic, most UK NHS primary care was delivered face-toface.[1]
By focusing on GPs’ use of remote consultations in the context of safeguarding concerns in the pandemic, this study describes the losses and gains that occurred in relation to initial contact, through the consultation, and after its completion
Safeguarding losses and gains in the pandemic Analysis reveals how GPs weighed up the potential losses and gains that occurred from initial contact, through the consultation, and after its completion
Summary
Before the COVID-19 pandemic, most UK NHS primary care was delivered face-toface.[1]. Prior to 2019, few UK practices were using video consultations.[1,5] Evaluation of video consultations showed that they tended to be shorter than face-to-face consultations, cover fewer topics, and be less ‘information rich’.4 This has been shown for telephone consultations.[6] While offering some advantages of convenience and access, for example, for long-term condition follow-up,[7,8] face-to-face was generally considered more appropriate for complex or highly sensitive consultations.[2,3] Developing trust and rapport has been considered to be more difficult using remote consultations.[3,9]. 19 pandemic required general practice to rapidly adapt to remote consultations and assessment of patients, creating new, and exacerbating existing, vulnerabilities for many patients
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