Why aren’t all GP consultations being recorded?

Problem

Recording audio content of telephone consultations is mandatory in Out-of-Hours general practice (GP), as it is perceived to improve quality and patient safety. One may therefore question why it is not standard practice to record all GP telephone encounters in-hours, and indeed all face-to-face GP consultations.

Approach

A literature review was undertaken to assess the advantages and disadvantages of recording GP consultations along with an assessment of barriers and enablers, and an analysis of current evidence pertaining to the usage of this technology.

Findings

Recording consultations provides evidence that could from part of a mechanism for proactive, demonstrable clinical governance and meaningful appraisal in a specialty that relatively isolated from regular peer review. It promotes accountability and strengthens legal protection for both doctor and patient. It potentially enables new methods of data-sharing with patients, and could help promote information retention following patient contacts. It could be used as an evidence base to assess quality and safety of new methods primary care delivery such as the extended roles of nurse practitioners.

Audio recording of professional communication is widespread both in the Out-of-Hours GP setting and other professional areas, such as law and insurance. Costs of implementation are potentially minimal as required hardware such as computers, phone and microphone are native to the GP consultation room, software to link recordings to electronic records is readily available and secure cloud data storage is already used for electronic data records.

There is little quality evidence available surrounding the acceptability, benefits and cost-effectiveness of GP consultation audio recording both in, and out of hours.

Consequences

If the benefit of consultation recording is evidenced it would have national policy implications for strengthening mechanisms of clinical governance to ensure patient safety in primary care, with potential impacts on clinical audit standards and the quality of the validity of the appraisal process.

Routine recording of consultations would also support evaluation of the different models of primary healthcare delivery that have emerged as a consequence of unrivalled system demands.

Clinical trials are required to assess the feasibility, acceptability and cost-effectiveness of recording patient consultations and crucially effective utilisation the content generated to improve patient care.