A new policy known as Jess’s Rule is being introduced across all GP surgeries in England this week, designed to improve patient safety and reduce missed diagnoses. Named in memory of 27-year-old Jessica Brady, who tragically died in 2020 after 20 GP visits with undiagnosed symptoms, this ‘three strikes and rethink’ approach requires GPs to reconsider their clinical decisions when a patient has had three consultations without a clear diagnosis.
Since its launch in September, Jess’s Rule encourages physicians to take a fresh look at cases where symptoms persist or worsen across three appointments. GPs are advised to consider second opinions, face-to-face examinations, or additional diagnostic tests. The goal is to ensure serious illnesses, including cancers, are identified earlier and treated more effectively.
Andrea Brady, Jessica’s mother, expressed gratitude for the positive response from primary care teams adopting the initiative. Posters promoting Jess’s Rule have now been distributed to every one of the 6,170 GP practices in England. These materials, developed collaboratively by the Department of Health and Social Care, NHS England, and Jessica’s parents, aim to prompt doctors to question initial assumptions and improve care pathways.
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Health Secretary Wes Streeting commented, “Every patient deserves to be heard, and every serious illness deserves to be caught early. Jess’s Rule makes that possible—reminding clinicians to take a fresh look when symptoms persist and empowering patients to speak up about their care.” He praised the bravery and determination of Jessica’s family in turning tragedy into lasting reform.
Jessica Brady, an Airbus engineer, sought medical help around 20 times over six months before her death. Despite reporting severe symptoms such as stomach pain, cough, weight loss, and sickness, her condition was misunderstood amid pandemic restrictions. She was initially treated remotely with antibiotics and steroids and was suspected of having long COVID. A cancer diagnosis, revealing advanced metastatic disease, was only made after a private consultation funded by her family. Jessica passed away three weeks later.
Andrea Brady reflected on her daughter’s legacy: “Jess was determined that her experience would lead to meaningful change. The support from primary care practitioners in embracing the three strikes and rethink strategy has been deeply encouraging. Many have committed to ongoing training and patient communication to strengthen the initiative.”
Correspondence endorsing Jess’s Rule is being sent to surgeries by both Health Secretary Wes Streeting and Dr Claire Fuller, NHS England’s national medical director. Dr Fuller added, “Encouraging GPs to challenge diagnoses at critical moments can save lives by preventing late or missed diagnoses. We thank the Brady family and the Jessica Brady CEDAR Trust for their vital contribution.”
Professor Victoria Tzortziou Brown, Chair of the Royal College of GPs, highlighted that Jess’s experience serves as a crucial reminder: “Sometimes rare diagnoses are the correct ones. Jess’s Rule formalises best practice by promoting reflection and review if treatments do not work. It encourages deeper conversations, second opinions, or referrals to specialists.”
She further noted that diagnosing serious conditions, especially cancers, in younger people can be challenging due to symptom overlap with common illnesses. The College has worked with Jessica’s family to develop educational resources for GPs to aid earlier identification of cancer in younger patients.
Supporting this initiative, research from the Nuffield Trust and the Health Foundation found that 50% of individuals aged 16 to 24 required three or more GP consultations before being diagnosed with cancer, compared to only 20% for all age groups, underscoring the need for more vigilant assessment.
Jess’s Rule represents a significant step toward improving early diagnosis in primary care, aiming to save lives by ensuring patients are heard and their symptoms thoroughly investigated.