Jess’s Rule Rolled Out in England to Prevent Misdiagnoses of Serious Illnesses

Hugh Johnson

Jess’s Rule establishes a “three strikes and rethink” approach for GP practices to prevent avoidable missed diagnoses deaths.

The government and NHS have launched Jess’s Rule, a new patient-safety initiative named in memory of Jessica Brady. Jessica was just 27 when she lost her life to cancer after more than 20 GP appointments failed to diagnose her illness until it was too late.

What is Jess’s Rule?

Jessica Brady was a healthy aerospace engineer when she began experiencing abdominal pain, persistent coughing, vomiting, weight loss and severe fatigue in September 2020. Over a period of five months, she saw 6 different GPs at her practice, with around 20 consultations in total. The consultations were mostly undertaken by video due to Covid-19 restrictions. The working diagnosis was long Covid, though Jessica had tested negative for coronavirus twice in that time.

It wasn’t until after her mother paid for a private referral that doctors discovered stage 4 adenocarcinoma. By then, the cancer had spread throughout her body. Jessica died just three weeks after diagnosis in December 2020.

“Three strikes and rethink”

Jess’s Rule brings in a “three strikes and rethink” policy for GPs in England and Wales. If a patient has three appointments for the same problem without getting a diagnosis, the doctor must review the case in detail.

The rule gives GPs a specific framework to follow to ensure that nothing is missed:

Reflect on what the patient said and, in particular, consider whether there have been changes between the consultations. This reflection should include, when necessary, arrangements to have continuity (i.e. the same GP) and to consider whether physical examination rather than telephone or video appointments may be needed.

Review the case with peers. By seeking second opinions GPs can consider other conditions or treatments.

Rethink the approach. If the patient is not improving, it may be appropriate to initiate more tests or to make a specialist referral.

Jess’s Rule follows Martha’s Rule, a hospital safety initiative introduced after 13-year-old Martha Mills died from sepsis in 2021. Martha’s Rule gives patients and their families the right to request an urgent review by an independent clinician if they are worried a patient’s condition is deteriorating and their concerns are not being addressed.

Between September 2024 and June 2025, Martha’s rule generated 4,906 calls to helplines, leading to 241 potentially life-saving interventions and 720 changes in patient care. We hope that Jess’s Rule will have the same positive impact.

What does Jess’s Rule mean for medical negligence claims?

Jess’s rule is an important step forward. It should mean that GPs have a lower threshold before they consider any changes to a care plan that is not working. They may choose to make earlier referrals. Ultimately, it is to be hoped that the types of patient harm we see arising from GP negligence at Osbornes are wholly avoided. That is better for patients and the NHS as a whole. Current data from NHS Resolution, the NHS body responsible for claims management, indicates that there are 2,229 new claims notified against GPs per year.

Jess’s Rule is born from a cancer misdiagnosis. Late diagnosis and cancer misdiagnosis can occur when there is unconscious bias in medical decision-making – an issue that impacts younger patients in particular. A survey commissioned by the Teenage Cancer Trust suggests that nearly half (46 percent) of young people diagnosed with cancer, report having had to attend three or more GP appointments before receiving a referral to cancer services for diagnosis, because doctors attribute their symptoms to everyday, less serious health issues.

Jess’s Rule has the potential to make a real difference to patient outcomes by:

• Triggering a rethink – the third appointment for the same symptoms is now a clear trigger point for GPs to take stock. This helps break the pattern of simply maintaining a treatment plan that is not working.
• Pushing for escalation – more tests, introducing second opinion or peer review and onward referral will become part of the standard of care.
• Ensuring continuity of care, where that is helpful to the management of a complex condition.

The law regarding medical negligence remains the same. It will be necessary to show that care provided, whether through acts or omissions fell below an acceptable standard. However, Jess’s Rule, will likely mean that GPs will now be expected to demonstrate that there has been appropriate review, reflection and referral.

From a treatment perspective, Jess’s rule may lead to the approach adopted by different GPs becoming, with time, clearer and more consistent. That would be good news for patients who want early diagnosis and the best care possible.