A potentially life-saving new rule is being introduced to GP surgeries across England this week, designed to prevent missed diagnoses and save lives. The initiative, known as Jess's Rule, urges doctors to completely reassess their approach if a patient attends three appointments without receiving a clear diagnosis.
What is Jess's Rule and why was it created?
The rule is named after Jessica Brady, a 27-year-old engineer from Airbus who died in 2020. In the six months before her death, Jessica contacted her GP surgery around 20 times with symptoms including stomach pain, coughing, vomiting, and weight loss. Due to pandemic restrictions, she had virtual appointments and was prescribed various medicines, including antibiotics and steroids, and was told she might have long Covid.
It was only when her mother arranged a private consultation that Jessica was diagnosed with cancer, but by then it had spread throughout her body. She passed away in hospital three weeks later. Jess's Rule was formally launched in September 2025 to ensure such tragedies are not repeated.
How the 'Three Strikes' initiative will work
From this week, promotional posters outlining Jess's Rule are being placed in all 6,170 GP surgeries in England. The core principle is simple: if a patient returns for a third time with the same or worsening symptoms and no diagnosis, clinicians are prompted to 'think again'.
The framework encourages GPs to take specific actions, which may include:
- Requesting a second opinion from a colleague.
- Arranging a face-to-face consultation.
- Commissioning further tests or investigations.
The materials have been jointly created by the Department of Health and Social Care (DHSC), NHS England, and Jessica's parents, Andrea and Simon Brady.
National rollout and support from health leaders
Health Secretary Wes Streeting has written to all GP surgeries alongside NHS England's national medical director, Dr Claire Fuller, to underscore the rule's importance. Mr Streeting stated the rule ensures 'every patient deserves to be heard, and every serious illness deserves to be caught early.'
Dr Fuller added that encouraging GP teams to challenge a diagnosis 'could save lives by avoiding missed or late diagnoses.' She thanked the Brady family and the Jessica Brady CEDAR Trust for funding and providing insights to develop the campaign posters.
Andrea Brady, Jess's mother, said the charity had been 'heartened' by the reception from primary care practitioners adopting what some call the 'Three Strikes and We Rethink' approach. She expressed hope that the rule would ensure serious illnesses like cancer are identified and treated earlier.
Professor Victoria Tzortziou Brown, chair of the Royal College of GPs, noted that Jess's story is a vital reminder that a rare diagnosis can sometimes be correct. She said the rule formalises best practice, emphasising the need to reflect and review if a treatment plan isn't working.
Research from the Nuffield Trust and the Health Foundation highlights the particular need for such vigilance with younger patients. It found that half of 16 to 24-year-olds needed three or more GP appointments before a cancer diagnosis, compared to just one in five across the wider population.
