Assessing acutely unwell children in primary care is fraught with challenges. While clinicians may use objective clinical tools to support their assessment, Clark et al’s recent study highlights their limitations in general practice.1 Their evaluation of scoring tools, including The National Paediatric Early Warning System (PEWS), found they performed poorly at predicting which children would require hospital admission within 48 hours of presenting to general practice. This builds on their previous work which showed the NICE ‘Traffic Light’ system failed to reliably distinguish serious illnesses from self-limiting conditions in children.2 Thankfully, the incidence of children subsequently admitted to hospital at 48 hours in Clark’s study was low (1.6%).1 However, GPs face the ongoing challenge of identifying children who can be safely managed in the community without missing those at risk of deterioration. Alongside this, we must balance our duty to use limited healthcare resources wisely and avoid inadvertently harming our patients with unwarranted prescriptions, investigations, or referrals. One way to address the uncertainty that today’s assessment may not reflect tomorrow’s healthcare needs is to implement effective safety netting.

It has been over 15 years since Susan Almond and colleagues published their seminal Delphi consensus study on what safety-netting advice for acutely ill children should include.3 Despite the passage of time, these principles remain as relevant today.

They recommended safety-netting advice should include: