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’.