Jessica Brady: What is Jess's Rule? GPs will have to look again at patients who have three appointments without a diagnosis

The government has announced that Jess’s Rule will be applied to GPs in England in a bid to reduce the number of avoidable deaths.

GPs will be told to take a “three strikes and rethink” approach to patients who have had three appointments already, to prevent missing serious illnesses such as cancer. The rule is named after 27-year-old Jessica Brady, an engineer for Airbus, who had repeated GP appointments in the months leading up to her death in 2020.

What happened to Jessica Brady?

Ms Brady 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.

Ms Brady was finally diagnosed with cancer that had spread throughout her body – but only after her mother paid for her to see a doctor privately. She was placed on oxygen and died in hospital three weeks later, in December 2020.

What is Jess’s Rule?

Under the new rule, doctors will be asked to think again if people have already had three appointments for their symptoms with no substantial diagnosis having been made, or symptoms having got worse.

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

The Department of Health and Social Care (DHSC) said many GP practices already used similar approaches in complex cases, but Jess’s Rule would make this standard practice across the country. The rule has been brought in in partnership with the Royal College of GPs (RCGP) and NHS England.

What has Jess Brady’s mum Andrea said?

Jess’s mum, Andrea Brady, who has campaigned for the rule, 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. 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.”

What have health officials said about Jess’s Rule?

Health and Social Care 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’s 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.”

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.

A report from the Nuffield Trust and the Health Foundation found that half of 16 to 24-year-olds required three or more interactions with a GP surgery before being diagnosed with cancer, compared with one-in-five across the population.

In September, it was announced that Martha’s Rule, which enables worried families and patients to seek a rapid second opinion, is being rolled out to every acute hospital in England. The scheme was set up after the death of 13-year-old Martha Mills, who developed sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London in 2021.