Background
In December 2020, Jessica Brady sadly passed away at the age of 27 from cancer. Jess had 20 consultations with her GP in the 5 months leading up to her death, during which she reported concerning symptoms; however, her GP failed to diagnose her condition.
It wasn’t until Jess sought private healthcare that she was diagnosed with stage 4 adenocarcinoma. She passed shortly after.
Since then Jess’s family has campaigned for a new patient safety initiative that requires GPs to reconsider diagnoses and escalate a patient’s case for review by another clinician after a third appointment without a definitive diagnosis.
What is it?
‘Jess’s Rule’ has now been implemented in GP practices, building on existing customary approaches. NHS England and the Royal College of General Practitioners have created a structural framework designed to support clinicians when faced with diagnostic challenges. Central to this framework are the principles of ‘reflect, review, and rethink’:
- Reflect: Encourages the GP to revisit what has been said by the patient and consider any changes or potential misses. For example, where previous consultations were conducted remotely, then a face-to-face appointment may now be appropriate.
- Review: Encourages seeking a view from a peer. This will be to go over any red flags and obtaining a second opinion to explore alternative diagnoses.
- Rethink: If needed, this is the stage at which a referral for specialist input or further tests may be necessary.
Current status
Jess’s rule has now become standard practice within GP practices. It ensures that patients with persistent unresolved symptoms receive a comprehensive review and, where appropriate, further investigations or specialist referrals.
The death of Jess has been described by Health Secretary Wes Streeting as a “preventable and unnecessary tragedy”. He has offered reassurance that the government is committed to learning from such cases to improve patient safety.
Expected impact
Standardising the rule provides valuable support to GPs managing patients with unclear or persistent symptoms. Patients will also be heavily involved as they are considered the experts regarding what feels right for their own bodies. The rule encourages collaborative decision-making, not only between clinicians but also between the clinician and the patient.
The quality of care provided by GPs will undoubtedly be improved and has the potential to save lives by avoiding late or missed diagnoses.
From a legal perspective, the rule may also reduce clinical negligence claims by ensuring symptoms are thoroughly considered and encouraging more diagnostic tests/referrals are completed.
Conclusion
At DWF, we welcome Jess’s Rule as a significant milestone in providing clarity for GPs, who often operate under significant pressure when navigating complex diagnostic decisions. By introducing a clear pathway, the decision provides valuable support for clinicians facing diagnostic uncertainty, marking a pivotal moment in patient care. The rule has the potential to prevent countless missed diagnoses, restoring trust in the healthcare system.
Please see our other related health articles:
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Special thanks to Aimée McGoldrick and Sharny Richards for their input in producing this article.
