Starting this week, every GP surgery across England will introduce a new policy known as “Jess’s Rule,” a system designed to improve diagnosis accuracy and patient safety after multiple consultations. This initiative is named in memory of Jessica Brady, a 27-year-old whose tragic death in 2020 followed numerous GP visits without a clear diagnosis.
Jess’s Rule requires GPs to pause and reconsider their approach if a patient returns three times with unresolved or worsening symptoms. This reassessment may involve seeking a second opinion, conducting face-to-face examinations, or ordering further tests to avoid missed or delayed diagnoses of serious illnesses such as cancer.
The policy was launched nationally in September with the goal of preventing avoidable fatalities and ensuring patients’ concerns are thoroughly addressed. Posters detailing the rule have been distributed to all 6,170 GP practices in England, developed collaboratively by the Department of Health and Social Care (DHSC), NHS England, and Jessica’s parents, Andrea and Simon Brady. These materials encourage clinicians to challenge initial assumptions and consider alternative diagnoses.
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Health Secretary Wes Streeting praised the initiative: “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. This is a fitting tribute to Jessica Brady and the tireless campaigning of her parents, whose determination to turn tragedy into lasting change will help protect patients and save lives for years to come.”
Jessica Brady’s experience was marked by persistent symptoms such as stomach pain, a chronic cough, sickness, and weight loss. Over six months, she contacted her GP around 20 times but was mostly treated remotely due to pandemic restrictions. Initial diagnoses included long Covid, and she received various medications including antibiotics and steroids. It wasn’t until her mother privately funded a specialist consultation that Jessica was diagnosed with advanced metastatic cancer, passing away three weeks later.
Andrea Brady, founder of the Jessica Brady CEDAR Trust, expressed profound hope that Jess’s Rule will save lives. “The adoption of the ‘Three Strikes and We Rethink’ approach within primary care has been very encouraging, with many practitioners committing to additional training and patient communication,” she said. “By encouraging fresh scrutiny when symptoms persist beyond three visits, Jess’s Rule aims to identify serious diseases earlier and improve treatment outcomes.”
The initiative has received strong support from NHS leadership. National Medical Director Dr Claire Fuller commented, “Encouraging GPs to rethink diagnoses at critical moments can save lives by preventing late identification of serious illnesses. We thank the Bradys and the CEDAR Trust for their invaluable contributions.”
Professor Victoria Tzortziou Brown, chairwoman of the Royal College of GPs, highlighted Jess’s Rule as an essential reminder of diagnostic vigilance. “Sometimes rare diagnoses are the correct ones,” she said. “Jess’s Rule formalizes best practices in general practice, emphasizing reflection and review when treatment plans don’t work. It encourages deeper patient conversations, second opinions, and appropriate referrals – all crucial to timely diagnosis.”
Supporting this approach, a study by Nuffield Trust and the Health Foundation found that half of people aged 16 to 24 required three or more GP consultations before receiving a cancer diagnosis, compared to only one in five across all age groups, underscoring the need for greater diagnostic attentiveness in younger patients.
As the ‘three strikes’ rule rolls out nationwide, it stands as a powerful tribute to Jessica Brady’s legacy and a vital step toward safer, more responsive primary care for all.