A powerful new patient safety initiative, known as Jess's Rule, is being promoted to every GP practice in England this week. The rule urges family doctors to formally reconsider a diagnosis when a patient returns multiple times with unresolved symptoms, aiming to prevent avoidable deaths.
What is Jess's Rule and Why Was It Created?
The system is named in memory of Jessica Brady, a 27-year-old engineer from Airbus who tragically died in 2020. In the six months leading to her death, she contacted her GP surgery around 20 times reporting symptoms including abdominal pain, coughing, vomiting, and weight loss. During the pandemic, she was largely offered virtual appointments, prescribed antibiotics and steroids, and told she might have long Covid. She was also informed she was too young for her symptoms to be serious.
It was only after her mother, Andrea Brady, paid for a private consultation that Jessica was diagnosed with advanced cancer that had spread throughout her body. She died in hospital three weeks later.
How the 'Three Strikes and Rethink' System Works
Officially introduced in September 2025, Jess's Rule provides clear guidance for medical professionals. It prompts a formal review when a patient has attended three appointments for the same symptoms without a clear diagnosis, or if their condition has deteriorated.
Under this new protocol, GPs are actively encouraged to:
- Seek a second opinion from a colleague.
- Conduct a comprehensive, face-to-face physical examination.
- Order additional diagnostic tests to investigate further.
Posters outlining the rule have been distributed to all 6,170 GP practices in England, designed to be displayed in consultation rooms. The materials were co-designed by the Department of Health and Social Care (DHSC), NHS England, and Jessica's parents, Andrea and Simon Brady.
National Support and a Campaigner's Hope
Health Secretary Wes Streeting stated: "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 emphasised that the initiative is a fitting tribute to Jessica and her parents' tireless campaigning.
Andrea Brady, speaking through the Jessica Brady CEDAR Trust charity, said they have been "heartened" by the response from primary care to the "three strikes and rethink" approach. "Many have committed to developing further training, while others have written to patients to endorse the initiative... This level of engagement has been profoundly encouraging," she said.
She expressed hope that by supporting clinicians to take a "fresh eyes" approach, the rule will ensure serious illnesses like cancer are identified and treated earlier.
Dr Claire Fuller, NHS England's national medical director, added that encouraging GP teams to challenge a diagnosis when it matters most "could save lives by avoiding missed or late diagnoses."
Professor Victoria Tzortziou Brown, chair of the Royal College of GPs, noted that Jess's story is a crucial reminder that a rare diagnosis can sometimes be the right one. She stated the rule formalises existing best practice, underlining the importance of review and reflection when a treatment plan isn't working.
The need for such measures is underscored by research from the Nuffield Trust and the Health Foundation, which found that half of 16 to 24-year-olds required three or more GP interactions before a cancer diagnosis, compared to just one-in-five across the general population.
