Jess's Rule: NHS introduces three-strikes approach to prompt diagnosis

England's National Health Service announced a formal, nationwide adoption of a 'three strikes and rethink' approach, known as Jess's Rule, requiring GPs to seek a second opinion if they cannot diagnose a patient after three appointments. The policy, rolled out across England, aims to speed up diagnoses and reduce avoidable deaths after concerns that symptoms were repeatedly dismissed or overlooked until it was too late for effective treatment. The rule is named in tribute to Jessica Brady, a 27-year-old Airbus engineer from Stevenage who died of cancer in 2020 after more than 20 GP visits over six months without a diagnosis. Brady reported abdominal pain, coughing, vomiting and weight loss but was offered virtual appointments and given several medications, including antibiotics and steroids; she was told she had long Covid and that her symptoms could not be serious because of her age. She was finally diagnosed with adenocarcinoma only after her mother arranged a private consultation. She died three weeks later in hospital.

Under Jess's Rule, a GP must rethink the case when a patient has attended three appointments without a substantiated diagnosis or when symptoms have escalated. This could involve arranging a face-to-face consultation if prior appointments were remote, conducting a thorough physical examination, or ordering additional diagnostic tests. The approach also calls for a comprehensive review of patient records, seeking a second opinion from colleagues, and considering specialist referrals where appropriate.

The policy comes amid evidence that younger patients and those from ethnic minority backgrounds often experience delays in diagnosing serious conditions, as their symptoms may not fit common patterns seen in older or white patients. A report from the Nuffield Trust and the Health Foundation found that half of 16 to 24-year-olds required three or more interactions with a health professional from a GP practice before being diagnosed with cancer, compared with about one in five across the general population. Healthwatch England policy manager Paul Callaghan said Jess's Rule should bring relief to patients living with the anxiety of worrying symptoms but unable to secure a diagnosis. He noted the need for rapid, safe diagnosis and urged quick, consistent implementation while ensuring that specialist services have the capacity to handle potential increases in referrals.

The initiative has broad political and professional support. Health secretary Wes Streeting wrote in the Daily Mail that Jessica Brady's death was preventable and that Jess's Rule would help ensure every patient receives thorough, compassionate, and safe care. He argued that the government would learn from tragedies like Jessica’s and work to improve patient safety. Professor Kamila Hawthorne, chair of the Royal College of General Practitioners, said that while many conditions are hard to diagnose in primary care, formalizing the three-strikes approach helps remind GPs to review and adjust their diagnoses when a patient does not improve.

NHS England's national medical director Dr. Claire Fuller said she was humbled by the Brady family's advocacy and stressed that the rule will save lives by avoiding missed or delayed diagnoses and ensuring patients receive the right treatment at the right time. While many clinicians already apply a version of this approach in complex cases, Jess's Rule standardizes the practice to support timely action and consistent patient safety across the NHS.

Supporters argue the policy complements ongoing NHS reforms, including actions meant to boost front-door access and triage. They point to the broader plan to improve cancer diagnosis timelines, with early-stage detection delivering better outcomes and reducing downstream NHS costs. In that context, officials note that the policy is not merely about more testing, but about ensuring patients receive the right test, at the right time, by the right clinician, with proper follow-through and coordination across care teams.

Officials also emphasize that the change is part of a broader effort to address disparities in care and to shorten the time to diagnosis for all patients. If applied consistently, Jess's Rule could translate into faster cancer diagnoses and better management of other serious conditions, potentially reducing the number of patients diagnosed at advanced stages. The policy aligns with NHS goals to improve diagnosis rates, expand primary care capacity, and enhance patient safety while maintaining a high standard of care for all communities.

From August 2024 to July 2025, NHS data shows a measurable improvement in cancer diagnostic timelines, with about 160,000 more people being diagnosed or ruled out within 28 days compared with the previous 12 months. The NHS notes that this progress comes alongside recruitment of more than 2,000 additional GPs and record funding for general practice in 2025-26, aimed at stabilizing access and improving patient satisfaction. While money alone cannot solve all challenges, officials say reforms like Jess's Rule are essential to rebuilding public trust and ensuring that the NHS treats every patient with prompt, evidence-based care.