NHS primary care lead supportive of GP ‘three strikes and refer’ rule
An NHS England primary care director has spoken out in support of a proposed ‘three strikes and escalate’ law, which would generate an automatic patient review after the third contact with their GP surgery about a specific symptom or condition.
Speaking at the NHS Confederation conference in Manchester this week, NHS England’s co-national medical director (primary care) Dr Claire Fuller said that patient safety was her main priority, and cited ‘Jess’s Rule’ as a means of improvement.
Jessica Brady was 27 when she died from metastatic adenocarcinoma in 2020, having been ill for six months. She suffered from symptoms – including a nasal drip and persistent cough – but had been unable to have physical consultations because this was in 2020, and doctors had said she was likely suffering from Long Covid.
Her parents have since been petitioning for ‘Jess’s Rule’ to be implemented, which would involve:
- Legislation calling for a patient’s case to be elevated for review after the third contact with their GP surgery about a condition or symptom.
- Funding to be ring-fenced to allow GPs to respond with utmost urgency in referring all patients.
- Steps taken to facilitate an increase in face-to-face consultations.
- Once referred, hospitals requiring specialist staff and equipment to make the immediate and necessary diagnosis.
- Campaigns aimed at GPs to increase awareness about the incidence of cancer in people in their 20s, 30s and 40s.
Dr Fuller told delegates that ‘Jess’s Law’ was a primary care version of ‘Martha’s Rule’, which was adopted by NHS England to ensure patients and families can seek an urgent review if their or their loved one’s condition deteriorates and they are concerned this is not being responded to.
Referencing the Primary Care Patient Safety Strategy published last September, she said: ‘As part of the patient safety strategy, we worked really closely with the family of Jessica Brady. She died at the age of 27 from a metastatic adenocarcinoma having had 20 different appointments.
‘Jessica’s family are actually petitioning for a thing called Jess’s Law. This is basically three strikes and you are out, so if a patient comes in and sees you three times, if they’ve not got a diagnosis or they are getting worse, please think again. And that might be to refer them or to actually ask a colleague. But just stop and think again.’
The petition currently has 438,000 signatures. The petition states: ‘Adults aged 25-49 contribute around a tenth of all new cancer cases, with double the incidence in females than males.
‘Currently, this age group is not prioritised although many cancers are aggressive and require immediate treatment. Despite being too young to be ignored they often are. They are the forgotten generations. Too old for their diagnosis to be truly shocking and too young to be deemed at serious risk. Covid is undoubtedly exacerbating the situation.’
Dr Steve Taylor, a GP spokesperson for Doctor’s Association UK, who was at the talk, said: ‘Anything that puts the patient at the the centre is a good thing, especially due to the lack of continuity of care. This is less likely to happen in practices that are able to have good continuity of care.
‘We all want to do more, we all want better access. To do this, we need more GPs and an increased number of experienced, qualified professionals in general practice.’
Last month, Pulse exclusively revealed that diagnostic services for GPs to refer patients with non-specific cancer symptoms are facing closure around the country – after a report did not find clear evidence of their cost effectiveness or impact.
The evaluation commissioned by NHS England concluded ‘it is not possible to say with certainty whether NSS pathways are cost-effective or not’.
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READERS' COMMENTS [8]
Please note, only GPs are permitted to add comments to articles
Adenocarcinoma of what I wonder? I worry this will open the floodgates for all our worried well who want their minor symptoms investigated. Thankfully these sad cases tend to be rare so not sure changing the goalposts is the right thing to do in an already broken system.
I firmly support Rebecca’s Law, as above!
it will make GP decisions easier though, as either the GP will be the third person to speak to the patient, so knows they have to refer everyone, and let the hospital worry about over-investigation;
Or the patient will have to be referred to hospital before seeing the GP, so the Noctor will get told off for a silly referral instead of the GP.
but is the nhs primary Care lead Amanda Doyle Wes et all supportive of General practice Remains to be seen
20 different appointments does sound a bit ridiculous: what on Earth was going on? and Covid should not be an excuse not to see someone who needs seeing: could be construed as lazy decision-making or jumping to unwarranted conclusions in someone aged just 27 especially.
If just one life is saved by these measures, it could be your young sister, your niece or anyone. When you save one life, you save Mankind.
So three visits with back pain and you get an Mri or referred to orthopaedics?
Well it would reduce my workload hugely, but I don’t think the current system can cope.
So can anyone predict what will happen when patients find out they need 3 appointments and then are guaranteed a referral? Have fun with 3 consults in a week because they want a referral. I’m not sure you can legislate your way out of every issue.
My thoughts…… my fears : Terrible things happen to good people. Medicine can’t stop every tragedy, and when the NHS is publicly funded and resources are tight, we must be honest about what makes the biggest difference for the most people.
Too often, emotion drives decisions. The newly proposed ‘Jess’s Rule’, automatic referral after three GP contacts for the same symptom may be another example. It comes from a heartbreaking story, but will it truly save lives, or will it flood the system with unnecessary referrals, increase anxiety, and push waiting times up for everyone?
As Ben Goldacre warned in Bad Pharma, emotionally driven decisions….. like the approval of weak Alzheimer’s drugs or the MMR scare….. can cause real harm and drain resources from proven care.
The NHS risks becoming a self-fulfilling prophecy: spending money on symbolic measures, leaving less for what works. Continuity of care, well-funded diagnostics, and enough skilled staff do far more to prevent missed diagnoses than blanket rules.
We owe it to patients like Jessica Brady to learn lessons, not repeat mistakes. If we want to prevent avoidable deaths, we need evidence-based policies…….not just well-meant promises.
NHSE Primary care director inadvertantly let’s slip how little she knows about how much GP practices are seeing patients…