GPs need more than three strikes before we’re out

Copperfield reflects on the impact of eponymous laws from grieving families on GPs, after NHS England’s primary care director spoke in favour of ‘Jess’s Law’

Another day, another eponymous law. This time, it’s Jess’s Law, the primary care version of Martha’s Rule. And that, in case you’ve forgotten, is NHSE’s guarantee that patients under hospital care can seek an urgent second opinion on request – which is most remarkable for the fact that, as a GP, I can’t get a first opinion on begging.

There’s a bit of a problem with all these laws and rules, though. Which is that no one feels comfortable criticising an idea inspired by tragedy. But grief can cloud logic, so they require more than an awkward silence and sympathetic nodding. As the legal profession says, hard cases make bad law, and so it is with sad cases. They need cool scrutiny, with all emotions checked into the baggage locker.

Take a key aspect of Jess’s Law: legislation calling for a patient’s case to be elevated for review after third contact, aka three strikes and escalate. To be fair, there’s some sense in this. My trainer always said that a third visit for the same condition = admit. Mind you, that was in 1781.

General practice nowadays is busier and more nuanced. Strike one for any presentation might be an en-passant ‘while I’m here’ after I’ve dealt with five other issues. Strike two, a subsequent in-depth exploration. And strike three, a review after initial investigation. And that may be just the beginning of the process. But under Jess’s law, it would be game over – ignoring the fact that, as we all know, conditions evolve, diagnoses are iterative, time can be diagnostic or therapeutic.

Besides, there’s a world of difference between that scenario and the genuinely ‘getting nowhere’ third consult with no-one taking responsibility or making a plan, which maybe is what Jess’s law is getting at. Those situations absolutely do need a pause, a reset, a rethink, which is what any self-respecting GP would do.

And that’s the point. The various demands in Jess’s Law are really a plea for a functioning GP service, albeit seen through an emotionally blurred lens. It boils down to a cry for protected GP time and headspace, more flexibility in referral criteria, pathways that accommodate vague symptoms and gut feeling, prompt and constructive responses from secondary care, and greater continuity and personal contact from properly trained professionals.

Which sounds like heaven. It’s the sort of primary care paradise that needs money and man/womanpower, and is what all GPs yearn for. I certainly do, and if I wish to leave any sort of legacy as I stagger towards retirement, it’s a desperate wail for proper general practice provided by proper GPs. If you like, you can call it Copperfield’s law. Actually, don’t.

Dr Tony Copperfield is a GP in Essex