NHS launches 'Jess's Rule' urging GPs to rethink after three visits without clear diagnosis

The National Health Service has unveiled Jess's Rule, a guidance initiative encouraging general practitioners to rethink a diagnosis after a patient has three appointments without a clear diagnosis or when a patient’s symptoms are deteriorating. The measure is not a law, but a standing reminder that patient safety hinges on timely reassessment when initial assessments fail to account for potentially serious illnesses, including cancer.

The policy is named after Jessica Brady, a 27-year-old engineer who first began feeling unwell in the summer of 2020 and contacted her GP practice more than 20 times over five months. She was repeatedly told that her symptoms were related to long COVID and that she was “too young for cancer.” She was eventually diagnosed with advanced stage 4 cancer and died three weeks later, before Christmas 2020. Her family says the delay preceded a terminal illness that left her with little chance of treatment.

"She was healthy before the pandemic," her mother Andrea Brady told BBC News, describing Jess’s gradual decline that included weight loss, night sweats, chronic fatigue, a persistent cough and very enlarged lymph nodes. The family says Jess saw six different doctors and had only three face-to-face consultations with a family physician, with no referral to a specialist arranged at the time. "Her body was failing her," Andrea Brady said, adding that Jess felt she could not advocate for herself and wondered, in effect, whether anything would change.

Under Jess’s Rule, after three appointments for the same or similar symptoms where the patient’s condition does not improve or worsens, GPs should review the initial diagnosis and consider alternative approaches. This could include arranging a face-to-face consultation if the patient was previously seen only remotely, ordering additional tests, seeking a second opinion from a colleague, or referring the patient to a specialist. Health Secretary Wes Streeting described the rule as a reminder to place patient safety above all and said it would help clinicians catch potentially deadly illnesses earlier.

The Royal College of General Practitioners, which helped shape the guidance, stressed that no doctor intends to miss a serious illness and that many conditions, including cancers, present with non-specific symptoms that can resemble common, less serious conditions. Prof Kamila Hawthorne, chair of the RCGP, noted that when patients present repeatedly with the same or similar symptoms and treatment plans fail to yield improvement, it is best practice to reassess and consider alternative approaches. The college has also worked with Jess Brady’s family to develop educational resources for GPs on early cancer diagnosis in young adults, emphasizing that delays are more common among younger patients and those from ethnic minority backgrounds.

The Department of Health said many GP practices already use appropriate approaches in such cases, and Jess’s Rule would help normalize these steps across the country. Streeting thanked Jess’s family for their advocacy, calling the guidance a way to ensure every patient receives thorough, compassionate, and safe care while supporting GPs. Healthwatch England representative Paul Callaghan urged rapid and consistent implementation and noted the need for adequate resources for specialist teams if referral volumes rise as a result of the rule.

Jessica Brady’s family say her legacy is a commitment to preventing similar delays from costing others their lives. They emphasize the importance of listening to patients who describe deteriorating symptoms and the need for timely referrals when cancer or other serious illnesses could be involved. As the NHS rolls out Jess’s Rule nationwide, officials say the focus will remain on patient safety, early diagnosis, and giving clinicians the space to pursue escalation when necessary.