GP surgeries across England are implementing a significant new patient safety protocol known as Jess's Rule, which mandates a formal clinical review for any patient who attends three appointments without receiving a diagnosis for their symptoms.
What is Jess's Rule and why was it created?
The rule, which began its rollout in September 2025, is a direct response to the tragic case of 27-year-old Jessica Brady. In the six months before her death from cancer in 2020, Jess contacted her GP practice around 20 times, reporting symptoms including abdominal pain, coughing, vomiting, and weight loss.
During the pandemic, she was largely offered virtual appointments and prescribed medications like antibiotics and steroids. By the time she received a diagnosis—after her mother paid for a private consultation—the cancer had spread throughout her body. She died in hospital just three weeks later.
Jess's Rule, named in her memory, embodies a 'three strikes and rethink' approach. Its core aim is to prevent similar avoidable deaths by ensuring persistent symptoms trigger a fresh clinical assessment.
How will the new system work in practice?
From this week, posters explaining the rule are being displayed in all 6,170 GP practices in England. The protocol instructs that if a patient has had three appointments for the same or worsening symptoms without a clear diagnosis, clinicians must actively reconsider the case.
This 'rethink' could involve several actions, including:
- Seeking a second opinion from a colleague.
- Ensuring the patient is seen face-to-face for a physical examination.
- Ordering further investigations or tests.
The initiative has been formally endorsed by Health Secretary Wes Streeting and NHS England's National Medical Director, Dr Claire Fuller, who are sending a joint letter to all surgeries to stress its importance.
A legacy of campaigning for change
Jess's parents, Andrea and Simon Brady, established The Jessica Brady CEDAR Trust to campaign for systemic change. Andrea Brady stated that the charity has been 'heartened' by the positive response from primary care practitioners.
'Throughout her illness, Jess showed a quiet determination that her experience should lead to meaningful change,' Andrea said. 'I am so incredibly proud of my caring and courageous daughter.'
She added that the distribution of the posters and the commitment from many practices to develop further training has been 'profoundly encouraging'.
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. This is a fitting tribute to Jessica Brady and the tireless campaigning of her parents.'
Dr Claire Fuller emphasised that 'encouraging GP teams to challenge a diagnosis when it matters most could save lives' by avoiding missed or late diagnoses.
