On 23 September, the DHSC and NHS England announced the implementation of Jess’s Rule: Three strikes and we rethink. Under Jess’s Rule, GP teams are encouraged to critically re-evaluate a diagnosis if a patient presents three times with the same or escalating symptoms or concerns and an existing treatment plan that is not working.
Jessica Brady passed away due to cancer in December 2020 at the age of 27. In the five months leading up to her death Jess had over 20 consultations with her GP practice, and her cancer had not been diagnosed. Jess was then admitted to hospital with stage 4 adenocarcinoma and passed shortly afterwards. Since then, Jess’s family have campaigned for GPs to elevate a patient’s case for review after their third contact with their GP about a condition or symptom.
“Jess lived for just three short weeks following her terminal cancer diagnosis. Despite her shock and devastation, she showed unfailing courage, positivity, dignity, and love. Jess was determined that people should understand how desperately she had tried to advocate for herself and seek a resolution for her declining health.
In the bleak weeks following the loss of Jess, I realised it was my duty to continue what she had started. It has taken nearly five years to bring about Jess’s Rule. I would like to dedicate this initiative to all the young people who have been diagnosed too late. It has only been made possible because of the people who have listened — politicians, medics, and the nearly half a million who supported the campaign.”
– Andrea Brady, mother of Jessica Brady
Under Jess’s Rule, if a patient presents three times with the same symptoms or concerns, particularly if symptoms unexpectedly persist, escalate, or remain unexplained, it’s time to rethink.
Rethink: If appropriate, refer onwards for further tests or for specialist input.
Reflect: Think back on what the patient has said and consider what has changed or been missed. Offer ongoing episodic continuity of care. If previous consultations have been remote, see the patient face-to-face and conduct a physical examination.
Review: Where underlying uncertainty exists, consider seeking a view from a peer and review any red flags that may suggest another diagnosis, regardless of the patient’s age or demographic.
