Jess’s Rule: advocating for continuity, ownership, and generalism in general practice

Emilie Couchman

doi:10.3399/BJGP.2025.0632

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Continuity in general practice: time for a broader definition
Louisa Polak

Published on: 30 November 2025

Published on: (30 November 2025)
Page navigation anchor for Continuity in general practice: time for a broader definition
Continuity in general practice: time for a broader definition
Louisa Polak, retired GP, visiting researcher, Primary Care Unit, University of Cambridge, UK
While there is little to disagree with in Couchman’s editorial, I finished it still waiting for a clear statement of what seems to me to be the central point here: to provide safe care, a clinician needs some background knowledge about the patient in front of them. Of course, we all think the best way to ensure the clinician has this knowledge is to ensure that they have seen the patient before, but unfortunately, we all know that such relational continuity is never going to return to being the norm. Surrogates for this ideal form of continuity seem problematic substitutes for the good old days of “the usual doctor”; episodic continuity assumes that someone can identify a series of appointment requests as parts of the same episode, and “ownership” is hard to operationalise when, for instance, test results often need to be acted upon on days when the clinician who requested the test is not working.

The way to make care safer and more effective is indeed to improve continuity, but in a broader sense than relying on seeing the same person each time. The goal must be to make sure that the clinician begins every consultation with enough knowledge about their patient to place today’s story in context. To achieve this, we need to advocate for two related changes to what is often the status quo in primary care: first, better recording of “the story so far”, and second, enough time for today’s clinician to read the recor...
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While there is little to disagree with in Couchman’s editorial, I finished it still waiting for a clear statement of what seems to me to be the central point here: to provide safe care, a clinician needs some background knowledge about the patient in front of them. Of course, we all think the best way to ensure the clinician has this knowledge is to ensure that they have seen the patient before, but unfortunately, we all know that such relational continuity is never going to return to being the norm. Surrogates for this ideal form of continuity seem problematic substitutes for the good old days of “the usual doctor”; episodic continuity assumes that someone can identify a series of appointment requests as parts of the same episode, and “ownership” is hard to operationalise when, for instance, test results often need to be acted upon on days when the clinician who requested the test is not working.

The way to make care safer and more effective is indeed to improve continuity, but in a broader sense than relying on seeing the same person each time. The goal must be to make sure that the clinician begins every consultation with enough knowledge about their patient to place today’s story in context. To achieve this, we need to advocate for two related changes to what is often the status quo in primary care: first, better recording of “the story so far”, and second, enough time for today’s clinician to read the record before encountering the patient and then to add a clear note about today’s consultation. Adequate recording takes thought and time – my instruction to GP trainees used to be “make sure you leave the patient’s notes tidy – someone has to use them after you” – even before one includes making all pertinent information, wherever it originates from, easily visible in the GP record.

Allocating ten minutes per consultation just about worked back in 1987 when I began as a GP, for two reasons: I knew almost every patient, and the surgery had enough appointments for me to book follow-ups or to tell someone to come back and see me (sic) next week if things didn’t improve. Now that neither of these is common, clinicians need much longer to familiarise themselves with vital background information before meeting the patient, and then to document today’s encounter well enough to maintain a continuous story ready for the next consultation. This form of continuity might have saved poor Jess Brady.
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Competing Interests: None declared.