Jess’s Rule: NHS launches three-strikes-and-rethink guidance to speed diagnoses and save lives

England’s National Health Service on Wednesday rolled out a new patient-safety guideline aimed at speeding up diagnoses and reducing avoidable deaths, by requiring general practitioners to seek a second opinion if they cannot diagnose a patient after three appointments. The policy, officially named Jess’s Rule in memory of Jessica Brady, takes effect across England today and is designed to standardize a practice already used in some complex cases. It follows concerns that symptoms are too often dismissed or not followed up promptly, allowing disease to progress to advanced stages.

Jess’s Rule instructs GPs to revisit a case after three visits if a substantiated diagnosis has not been reached or if a patient’s condition has worsened. The approach could involve arranging face-to-face consultations instead of remote or telephone contacts, conducting thorough physical examinations, ordering additional diagnostic tests, reviewing patient records more comprehensively, seeking colleagues’ second opinions, and considering referrals to specialists when appropriate. The guidance was developed with input from the Chair of the Royal College of General Practitioners and NHS England as part of a broader push to improve patient safety and diagnostic accuracy.

Jessica Brady, an Airbus engineer from Stevenage, sought medical help repeatedly during 2020 for abdominal pain, coughing, vomiting and weight loss. She was given multiple courses of antibiotics and steroids and told her symptoms were due to long Covid or to be unlikely to indicate a serious disease, before her family privately arranged a consultation that led to a cancer diagnosis. Brady, aged 27, died three weeks after receiving the diagnosis, with her mother Andrea Brady leading a campaign to prevent similar tragedies. "Jess lived for just three short weeks following her terminal cancer diagnosis," Andrea Brady said in a statement, noting that it has taken nearly five years to secure Jess’s Rule and that the initiative honors those who advocated for better care. The policy, she said, is a tribute to all the young people who have been diagnosed too late and to the many who supported the campaign." Andrea Brady emphasized that the policy could help other patients avoid late-stage outcomes by ensuring timely review and action when symptoms persist or escalate.

The rule’s rationale is supported by research showing that younger patients and people from ethnic minority backgrounds often face delays in diagnosis because their symptoms do not match classic presentations among older or white patients. A joint report by the Nuffield Trust and the Health Foundation found that half of 16- to 24-year-olds required three or more interactions with a GP before cancer was diagnosed, compared with about one in five in the overall population. Healthwatch England policy manager Paul Callaghan said Jess’s Rule could relieve anxiety for patients with troubling symptoms who have not yet received a diagnosis, and could improve safety by enabling more rapid identification of cancer and other illnesses. He cautioned that the rule must be implemented quickly and consistently, with adequate resources to accommodate increased referrals.

Health leaders framed Jess’s Rule as part of a broader reforms agenda. Writing in the Daily Mail, Health Secretary Wes Streeting argued that Jessica Brady’s death was preventable and that the NHS must learn from tragedies to safeguard patients moving forward. Streeting described the rule as a means to ensure every patient receives thorough, compassionate, and timely care, while also supporting GPs in managing rising demand. NHS England’s national medical director, Dr Claire Fuller, said the measure would formalize a practice already used by many clinicians and lend a consistent framework to reflection and timely action when symptoms persist despite treatment. Kamila Hawthorne, chair of the Royal College of GPs, acknowledged that diagnosing certain conditions remains challenging, but she stressed that repeated presentations with similar symptoms require a fresh evaluation and consideration of alternative diagnoses. She noted that the rule should reinforce best practices by encouraging GPs to reexamine the case, particularly when the initial plan fails to improve the patient’s condition.

Officials pointed to ongoing investments intended to support faster, safer diagnoses. The government’s Plan for Change is cited as contributing to a boost in cancer diagnostics and primary care capacity, with 160,000 more people diagnosed or ruled out within 28 days from August 2024 to July 2025 compared with the prior year. Additional resources include recruitment of more than 2,000 GPs this year and record funding of more than £1 billion for GP practices in 2025-26, aimed at strengthening the NHS front door and reducing time to diagnosis. While these investments are intended to improve patient experience and outcomes, health advocates said meaningful progress will depend on consistent policy application and the availability of testing and specialty services to meet increased demand.

The policy echoes a broader public health push to reduce diagnostic delays and improve patient safety. Streeting and other officials argued that early detection, particularly for cancers, can have a butterfly effect on outcomes and resource use across the NHS. Still, advocates stressed that the rule must be part of a broader system-wide effort to address disparities in care, including outreach to communities and better access to multidisciplinary teams.

The initiative is expected to influence how GPs manage patients who present with persistent or worsening symptoms, including those who may not fit typical risk profiles. As Jess’s Rule rolls out, clinicians will be asked to document their decision processes more rigorously and to ensure that a second clinical perspective is sought when appropriate. For families and patients, the policy aims to reduce the fear of delayed diagnoses by providing a clear pathway to escalate care when initial assessments fail to yield answers. The move reflects a longstanding NHS commitment to root out misdiagnoses and delays that can lead to advanced-stage illnesses and avoidable deaths.