Table 2.

Electronic safety netting tool functions and associated positive and negative experiences reported by participants

Usage	Positive experiences	Negative experiences	Potential benefits to practice
Symptom-driven decision support tool
Mainly used by less experienced clinicians	Supports decision about which urgent referral pathway to use Reminder of urgent suspected referral (NG12) criteria Can support shared decision-making with patients Provides reassurance and support for taking a full history Particularly useful for patients with unusual or non-specific presentation	Decision about whether or not to refer made without needing the tool Tool is redundant for experienced clinicians with good knowledge of referral criteria Tool does not change clinical judgement Tool is too structured, and does not match clinical approach	Increase in guideline-concordant referrals Improvements in shared decision-making with patients
Electronic referral form availability and auto-completion
Widely used when whole practice adopted software	Easier and faster to generate a referral form Reduces duplication or ‘cut and paste’ in creating a referral form Automatically populates information from patient record into referral form Automatically updated to have the current forms available Reduction in rejected referrals due to out-of-date forms Only way to access non-specific symptom pathway form May increase referral rate due to ease of use		Reduction in rejected referral forms Time saved for clinicians in populating referral forms Reduction in delayed specialist appointments
Tracking dashboard
Widely used when whole practice adopted software	Automated inclusion on dashboard avoids clinician error and reduces task burden Effective visualisation Enables review of referred patients Most effective when all referrals are made using C the Signs Improvement on previous manual spreadsheet solutions for tracking referrals Easier to identify patients who have not been issued an appointment for urgent suspected referral in error Enables administrative staff to chase reports and letters from secondary care	Increased administrative burden in checking dashboard Reliant on strong administrative support for optimal outcomes Low use of dashboard for diagnostic testing (eg, blood tests, scans) aside from referral Duplicative if practice maintains another tracking database or if some referrals are made without the software Dashboard list can become unmanageably long if patients are waiting for delayed investigations Cannot move patients to a different list after initial urgent referral appointment (eg, unknown outcome of investigations) Cannot export dashboard to other software Cannot re-order list according to the type of diagnostic investigation (eg, FIT test, urgent referral)	Improved monitoring of delayed investigations or reports Facilitated sharing of responsibility for tracking and monitoring within primary care teams
Medical record integration
Widely valued except where poor information technology prevented this	Automatically saves referral information to consultation notes Populates C the Signs with consultation note information where appropriate Adds reassurance for clinicians that they are meeting standards for recording information which provides legal protection	Some details from C the Signs not recorded into medical notes depending on order of which software is opened first Saved information can be hard to interpret by other clinicians	Improved legal protection for clinicians