New Rule Demands Action from GPs After Three Patient Visits

A new rule aimed at improving patient safety will be implemented across all GP surgeries in England starting this week. Dubbed Jess’s Rule, the initiative encourages family doctors to reconsider diagnosis and treatment options if a patient has attended three appointments for the same symptoms without a definitive diagnosis. This measure is named after Jessica Brady, a 27-year-old woman who tragically died in 2020 after contacting her GP surgery approximately 20 times regarding persistent health issues.

The rule was introduced in September 2022 as a response to avoidable deaths and to assist medical professionals in identifying serious conditions, such as cancer, at an earlier stage. Under Jess’s Rule, GPs are prompted to seek second opinions, conduct in-person examinations, or order additional tests when patients return multiple times without a clear diagnosis.

Andrea Brady, Jessica’s mother, expressed her gratitude for the support from the primary care sector. She stated that the Jessica Brady CEDAR Trust, a charity established in her daughter’s memory, has received positive feedback regarding the “three strikes and rethink” approach. Posters promoting Jess’s Rule have been sent to all 6,170 GP practices in England, co-designed by the Department of Health and Social Care, NHS England, and Jessica’s parents.

Health Secretary Wes Streeting emphasized the importance of the initiative, saying, “Every patient deserves to be heard, and every serious illness deserves to be caught early. Jess’s Rule makes that possible.” He praised Jessica’s parents for their commitment to turning their personal tragedy into a system designed to protect patients and save lives.

Jessica Brady, who worked as an engineer for Airbus, experienced a range of troubling symptoms including abdominal pain, coughing, and weight loss. During the COVID-19 pandemic, her access to healthcare was primarily through virtual appointments, where she was prescribed various medications and told she might be suffering from long COVID. Tragically, she was only diagnosed with cancer after her mother arranged for a private consultation. Jessica died in hospital just three weeks later.

Andrea Brady reflected on her daughter’s determination to instigate meaningful change, leading to the formation of Jess’s Rule. She noted the encouraging response from healthcare practitioners, many of whom have committed to further training and outreach to patients regarding the initiative.

The Department of Health and Social Care has also dispatched a letter to GP surgeries from both Mr. Streeting and Dr. Claire Fuller, NHS England’s national medical director, stressing the importance of adhering to Jess’s Rule. Dr. Fuller highlighted that challenging a diagnosis could prevent missed or delayed identification of serious illnesses.

Professor Victoria Tzortziou Brown, chairwoman of the Royal College of GPs, acknowledged that Jessica’s story serves as a crucial reminder that rare conditions may be overlooked. She stated, “Jess’s Rule formalises ‘best practice’ in general practice, underscoring the significance of reflecting on diagnoses when treatment plans fail.”

Research conducted by the Nuffield Trust and the Health Foundation reveals alarming trends, indicating that half of individuals aged 16 to 24 required three or more consultations with a GP before receiving a cancer diagnosis, compared to one-in-five across the general population.

By encouraging GPs to take a fresh look at cases with repeated symptoms, Jess’s Rule aims to foster a culture of vigilance and thoroughness in patient care. As this initiative rolls out, it holds the promise of improving early diagnosis and ultimately saving lives.