Do ministers understand what GPs do?

Pulse editor-in-chief Jaimie Kaffash queries whether ministers actually understand the role – and value – of a GP, as practices are asked to display posters promoting a ‘three strikes and rethink’ approach as part of Jess’s Law

If you were going to accuse me of succumbing to Betteridge’s Law of Headlines, let me say now that as an editor of numerous years, I don’t need a law or rule to tell me what I know very well thank you very much.

Which leads me neatly on to the subject of Jess’s Rule, which asks GPs to ‘think again’ if after three appointments – about the same symptoms or concerns – they have been unable to offer a ‘substantial diagnosis’ or if a patient’s symptoms have escalated.

This is a great idea. I would like to add to this with some more rules: journalists should not just write down whatever comes into their heads and publish it; police officers shouldn’t arrest people with no cause; and ministers shouldn’t introduce populist policies without thinking of the wider ramifications.

Admittedly, these are terrible examples as they are all regularly flouted. But the point is: this is stating the bleeding obvious. And, in the case of GPs, not only is Jess’s rule already an integral part of the job – as Copperfield has previously pointed out, it’s more usually a case of ‘one strike’ before they escalate.

Almost all GPs would be worried about repeated unexplained presentations. And those who aren’t – because they are too jaded, burnt out or whatever reason – would want to move on responsibility for these patients as soon as they could.

This once again suggests that ministers don’t actually understand what GPs do. I often think their knowledge of GPs is solely derived from Doc Martin or House, where the GP is usually expected to provide a diagnosis on first consult and the only thing stopping this is that, in these fictional worlds, zebras are as common as horses.

While doing our campaign around Building Better General Practice in 2021, the main point that came through was that the essence of the role is managing undifferentiated diagnoses. This is spotting red flags, or the spidey senses tingling that something isn’t quite right, knowing when to refer and – again deferring to Copperfield – knowing when not to act. The idea of drumming in that repeated unexplained symptoms require GPs to ’think again’ is not just condescending, but demonstrates that ministers do not understand this essence of the role.

What does it matter though? For GPs, not much, other than being completely misunderstood. But for patients, it gives the impression that GPs aren’t doing their job and need a rule to ensure they act professionally.

What happened to Jessica Brady – whom the rule was named after – was a tragedy. Without knowing the ins and outs of her care and treatment, we don’t know how culpable the GP was, whether there were external issues that made referral impossible, or what kind of stress the GP was under. But separate to this, there are people in every profession – including GPs – who are not competent for whatever reason. Hammering home the basics of the role while misunderstanding the essence of it will not help anyone. 

Jaimie Kaffash is editor-in-chief of Pulse