Challenges of safeguarding via remote consulting during the COVID-19 pandemic: a qualitative interview study

Abstract

Background: COVID-19 required general practice to rapidly adapt to remote consultations and assessment of patients. The pandemic created new, and exacerbated existing, vulnerabilities for many patients. Aim: To explore GP perspectives and concerns about safeguarding practice during the pandemic, focussing on challenges and opportunities created by remote consultation. Design and Setting: English general practice during the COVID-19 pandemic in 2020-2021. Method: Qualitative interview study with 18 GPs, using a flexible topic guide and fictional vignettes to explore child and adult safeguarding scenarios. Interviews were audio-recorded, thematically coded, and analysed. Results: GPs worried about missing observational information during remote consultations and that conversations might not be private or safe. Loss of continuity and pooled triage 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. Conclusion: The 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 which warrants urgent attention.

General Practice wide adaptations to support patients affected by DVA during the COVID-19 pandemic: a rapid qualitative study

“…Pre-pandemic, it was known that within the clinical encounter, continuity of care is an important component of developing the trust and rapport necessary for effective DVA care 22,34,35 . Our study shows how this remained true in the pandemic setting, including remote consulting and triage.…”

“…Many of our ndings align with research from other settings exploring professional perspectives on the interface between remote consulting and care for patients and families experiencing DVA. Concerns about the safety of phone and remote encounters have been documented by practitioners in other settings 38 , as have concerns that these consultation modalities impact adversely on interpretation of cues, on developing trust and rapport, and on assessing risks and safety 22 . Taken together, these can lead to a perceived loss of effectiveness of the therapeutic encounter, whereby these consultations are experienced as shallow, with a narrower focus 39 .…”

“…Being able to use the greater exibility these new ways of working offer to enable safe and equitable care for those in need is a potential positive learning point for practices 22 . Throughout the literature, there are pervasive concerns about those who might be digitally excluded from care, alongside exclusion because of language or other barriers to care.…”

“…There has been limited research about the impact of transitioning to remote consultations on the response to DVA in primary care 21 , though insights can be drawn from related literature. Dixon et al's study of primary care safeguarding practices during the pandemic found that clinicians worried that conversations might not be safe, and that limited continuity of care weakened safeguarding opportunities, particularly in the absence of pre-existing relationships 22 . From a patient perspective, Liberati et al's study of mental health servicer users' experience of remote consulting found that some valued the convenience of remote methods when it enabled them to maintain contact with familiar clinicians.…”

Supporting the ‘multi’ in multi-agency working: learning with and from each other could enable multi-agency safeguarding

“…A silver lining of the rapid responses to the pandemic was that moving multi-agency meetings online facilitated GPs' attendance, a valuable and valued contribution to multiagency safeguarding, noted by both social workers and GPs in research conducted independently (including by the authors of this piece). [14][15][16] This should be recognised and nurtured, but we can learn more about online multi-agency working, including how to ensure safety and develop trust and rapport. Only by reflecting critically and together can we do this.…”