A new NHS patient safety initiative called Jess’s Rule has been announced with the aim to encourage GP’s in England to “think again” if they have seen a patient more than three times with the same complaints or their symptoms are getting worse.

Named in memory of Jessica Brady, a 27-year-old who tragically died from cancer after her symptoms were repeatedly dismissed even after attending 20 appointments, Jess’s Rule is designed to ensure that patients’ concerns are not ignored and that everyone receives the same level of care regardless of their age or background and can hopefully prevent avoidable deaths.

What is Jess’s Rule?

Jess’s Rule is a “three strikes and rethink” approach for GPs to ‘reflect, review and rethink’, if they are still uncertain about a patient’s condition.

If the patient has been seen more than three times and has still not been presented with a diagnosis or their symptoms have worsened the GP will:

• Take time to reconsider the patients’ medical history and any changes to their symptoms.

• Seek a second opinion if feel necessary.

• Consider further tests or referrals.

Many GP practices use a similar approach, but this rule would make it standard practice across England to catch serious illness especially in younger patients that often face barriers to timely diagnosis.

The Royal College of General Practitioners (RCGP) worked with NHS England to put the guidance together and has also worked closely with Jessica’s family on developing educational material for GPs to recognise the early signs of cancer in young adults.

Why Jess’s Rule matters

As clinical negligence solicitors, we often see first-hand the devastating consequences when GPs or other clinicians fail to act upon symptoms and data indicates that younger patients often face delays in being diagnosed with a serious condition.

I have also come across cases where concerns of parents of very young patients are not acted upon even after a few attendances to their GP. Jess's Rule will ensure parents/carers’ insights into their child’s symptoms are listened to and acted upon. For example considering whether innocuous signs could be something more when a parent is particularly concerned and a child is not acting as they usually would.

It is of course clear that the vast majority of clinicians want to ensure all serious conditions are acted upon without any delay. I hope it gives GPs and other primary care clinicians reassurance that seeking further investigations will be supported by hospitals and other providers, for example tests and investigations will be expedited. I also hope that this approach can be extended into hospital or out of hours settings so clinicians will take into consideration the number of previous attendances before the patient has reached them when considering further investigations and treatment.

Jess’s Rule mandates that when a patient continually expresses that something “doesn’t feel right,” GPs must pause, listen, and act accordingly. It will empower patients to speak up if something is wrong and be persistent if their symptoms don’t improve, after all they know their own bodies.

Listening also fosters trust between patient and GPs. Jess’s Rule is not just a tribute to a life lost it’s a reassurance that peoples voices matter and a certain standard of care is being delivered.