NHS announces Jess' Rule after woman whose 20 GP visits failed to diagnose her cancer

GPs are being ordered to implement a new ‘Jess’s Rule’ to stop cancer diagnoses being missed.

Jessica Brady died of cancer aged 27 after twenty appointments at her GP surgery failed to diagnose her condition. Now family doctors across England must take “three strikes and rethink approach” after three appointments. GPs are being asked to “think again” if after three appointments they have been unable to provide a diagnosis or the patient’s symptoms have escalated.

Jess’s mum Andrea Brady said: “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.

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“Jess was determined that people should understand how desperately she had tried to advocate for herself and seek a resolution for her declining health.”

Jessica, an engineer for Airbus, contacted her GP surgery around 20 times over a six-month period, with symptoms including abdominal pain, coughing, vomiting and weight loss.

She was offered virtual appointments due to Covid restrictions and given numerous medications including antibiotics and steroids. She was also told she was suffering from long Covid and that she was too young for her symptoms to be anything serious.

Eventually mum Andrea paid for her to be seen privately and she was finally diagnosed with stage 4 adenocarcinoma and the cancer had spread throughout her body. She was placed on oxygen and died in hospital three weeks later in December 2020.

Andrea said: “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.”

Doctors will now be expected to consider a second opinion, see people face-to-face for physical examinations, order more tests and make specialist referrals where appropriate.

Health Secretary Wes Streeting said: “Jessica Brady's death was a preventable and unnecessary tragedy. I want to thank her courageous family, who have campaigned tirelessly through unimaginable grief to ensure Jessica’s legacy helps to save the lives of others.

“Patient safety must be the bedrock of the NHS, and Jess’ Rule will make sure every patient receives the thorough, compassionate, and safe care that they deserve, while supporting our hard-working GPs to catch potentially deadly illnesses.

“I don’t want any family to endure the pain Jessica’s family have been through. This government will learn from such tragedies and is taking decisive action to improve patient safety.”

A report from the Nuffield Trust and the Health Foundation found that half of 16 to 24-year-olds required at least three appointments with a GP practice before being diagnosed with cancer. This compared to one in five across the whole population.

Jess’s Rule emphasises the need to remain alert to symptoms that might suggest serious conditions, regardless of a patient's age or ethnicity. It has been designed in collaboration with the Chair of Royal College of General Practitioners (RCGP) and NHS England to help to catch serious conditions earlier. It encourages GPs to reflect, review and rethink if they are uncertain about a patients' condition.

Dr Claire Fuller, England’s National Medical Director said: “I am very humbled by the efforts of Andrea and Simon Brady, who have campaigned for this important initiative which will undoubtedly save lives by avoiding missed or delayed diagnoses and ensuring patients receive the right treatment at the right time.

“Many clinicians already apply a version of “three strikes and rethink” in their routine practice, but Jess’s Rule formalises this instinctive approach, providing a consistent structure to support reflection and timely action for patients.”

Jess's Rule could support GPs to ensure continuity of care for patients with persistent health concerns. This could involve arranging face-to-face consultations if previous appointments were remote, conducting thorough physical examinations, or ordering additional diagnostic tests.

Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: “No GP will ever want to miss signs of serious illness, such as cancer. Ensuring a timely diagnosis often means better outcomes for patients - but many conditions, including many cancers, are challenging to identify in primary care because the symptoms are often similar to other, less serious and more common conditions. Alternative diagnoses are often more likely, particularly when considering risk factors such as age.

"If a patient repeatedly presents with the same or similar symptoms, but the treatment plan does not seem to be making them better - or their condition is deteriorating - it is best practice to review the diagnosis and consider alternative approaches. We hope that by formalising this with Jess's Rule, it will remind GPs to keep this at the forefront of their minds.”

The RCGP has helped create an educational toolkit for GPs on the early diagnosis of cancer in young adults.

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Paul Callaghan, policy manager at Healthwatch England, said: “The news that Jess’s Rule is being introduced into the NHS will come as a relief to those living with the anxiety of worrying symptoms, but are unable to get a diagnosis.

"Jess’s Rule will also improve patient safety by ensuring more rapid diagnosis of cancer and other illnesses, and provide clarity to those experiencing sickness or ill health. It is vital that the rule is implemented quickly and consistently, and people can make informed decisions about their care.

"It’s also imperative that specialist teams have the resources to deal with potential increases in demand, resulting from increased referrals.”