Jess’s Rule: GPs to re-check some patients for deadly ‘misses’

GPs in England are being urged to “think again” if they see a sick patient three times and can’t pin down a diagnosis, or find their symptoms are getting worse.

The new NHS initiative, called Jess’s Rule, is named after Jessica Brady who contacted her GP on more than 20 occasions after starting to feel unwell in the summer of 2020.

She was told her symptoms were related to long Covid and that she was “too young for cancer”. She died from advanced stage 4 cancer later that year, aged 27.

Health Secretary Wes Streeting said her death was “a preventable and unnecessary tragedy” and the rule would improve patient safety by helping GPs “catch potentially deadly illnesses”.

Jessica Brady was a talented engineer at Airbus, involved in the design of satellites.

Her mum, Andrea, told Radio 4’s Today programme that Jess was a very healthy young woman when the pandemic hit in 2020.

But in July of that year, she didn’t feel right and contacted her GP practice repeatedly over the next five months about her symptoms.

Over time they became “increasingly debilitating”, Andrea says.

“She had unintentionally lost quite a lot of weight, had night sweats, chronic fatigue, a persistent cough and very enlarged lymph nodes.

“But because of her age, it was obviously considered there wasn’t anything wrong.”

Jess had contact with six different doctors at her GP surgery and three face-to-face consultations with a family doctor, but no referral to a specialist was made.

“Her body was failing her,” says Andrea.

“It was hard for Jess to advocate for herself. She was saying ‘What’s the point? Nothing will happen.'”

When the family decided to arrange a private appointment and she was referred to a specialist, it was too late.

Jess was given a terminal cancer diagnosis in November and died three weeks later – just days before Christmas 2020.

The family hopes Jess’s Rule will help to increase awareness of the importance of GPs acting quickly for patients who are steadily deteriorating.

“She wanted to make a difference,” Andrea says.

“Jess knew her delayed diagnosis was instrumental in the fact she had no treatment options open to her, only palliative care.

“She felt strongly she didn’t want this to happen to other people.”

Jess’s Rule is not a law, but a strong reminder to GPs to take a “three strikes and rethink approach”. That means taking action after three appointments with a patient whose condition isn’t improving, to prevent avoidable deaths.

This could mean arranging face-to-face consultations with a patient previously only spoken to on the phone, ordering extra tests or asking for a second opinion from a colleague. GPs should also consider referring patients to a specialist.

The Royal College of General Practitioners (RCGP), which was involved in drawing up the guidance, said no doctor ever wanted to miss signs of serious illness, such as cancer.

“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,” said Prof Kamila Hawthorne, chair of RCGP.

“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.”

Research suggests younger patients and people from ethnic minority backgrounds often face delays before being diagnosed with a serious condition, because their symptoms aren’t similar to those of white or older patients.

RCGP has worked with Jess Brady’s family to develop an educational resource for GPs on the early diagnosis of cancer in young adults.

The Department of Health said many GP practices already used the correct approach, but that Jess’ s Rule would make this “standard practice across the country”.

Health and Social Care Secretary Wes Streeting thanked Jess’s family, saying they had 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,” he said.

Paul Callaghan, from Healthwatch England, which represents people who use health and social care services, said the rule should be implemented “quickly and consistently”.

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