On 23 September, this Government announced the introduction of Jess’s rule—“three strikes and we rethink”—in England. Under this new rule, we are asking GPs and other clinical staff working in primary care to reflect, review and rethink when a patient comes in for the third time with the same symptom or concern.
Re-evaluation may be particularly important if the condition remains unexpectedly unresolved, the symptoms are worsening, or there is still no confirmed diagnosis. Listening carefully to the patient’s symptoms and concerns, and recognising that they are an expert in their own body, remains crucial.
This call for change follows the tragic death of Jess Brady in December 2020. Jess was just 27 when she died of stage 4 adenocarcinoma. In the five months leading up to her death, she had 20 appointments with her GP practice. Tragically, her cancer remained undiagnosed until she was admitted to hospital, by which time it was too late. Her story, and the tireless efforts of her parents Andrea and Simon Brady, prompted an important and necessary reflection on how we can better support clinical teams in identifying serious conditions earlier, especially in younger adults, whose symptoms may not always align with typical diagnostic expectations. Her story should never be forgotten.
This initiative is jointly led by the Department of Health and Social Care and NHS England, and is supported by the Royal College of General Practitioners, reflecting a united commitment to improving early diagnosis and patient safety across the healthcare system.
At its heart, Jess’s rule provides clear, structured guidance that sharpens and reinforces the intuition which so often saves lives. It is there to back those instincts with a prompt for timely, proactive action when something does not feel right. By reviewing patient records and questioning initial assumptions, we hope to ensure that fewer serious conditions are missed, especially among young adults who may not fit typical diagnostic patterns.
We know that the practice of “three strikes and rethink” is commonplace. Every day, clinicians across the country are doing an extraordinary job, making complex decisions under immense pressure, often with limited time and information. Jess’s rule is designed to support them in this challenging work, offering a prompt for reflection and reinforcing the instincts they already rely on every day.
I want to pay tribute to Jess’s parents, Andrea and Simon. They have shown extraordinary courage and determination in the face of unimaginable loss. They have worked tirelessly to raise awareness of Jess’s story, and to ensure that what happened to Jess drives lasting change in how we think, how we listen, and how we act in primary care.
I would like to recognise the work of Dr Claire Fuller, Dr Kiren Collison and the entire team at NHS England. Jess’s story is included in the “Primary Care Patient Safety Strategy”, published in 2024, which highlight the importance of re-evaluation when a diagnosis remains unclear. Dr Fuller’s leadership has been instrumental in developing and embedding Jess’s rule.
Finally, I would like to acknowledge the support of the Royal College of General Practitioners in taking this work forward. Under the leadership of Professor Kamila Hawthorne, the RCGP has partnered with Jess’s family’s charity, the CEDAR Trust, to develop an online resource to support GPs in earlier cancer detection. This resource is available to all healthcare professionals registered on the RCGP’s learning platform.
Jess’s rule is more than a clinical process, It is a vital step toward ensuring that patient concerns are taken seriously, that patterns are reviewed carefully, and that every opportunity is used to identify serious conditions as early as possible. We owe that to Jess. And we owe it to every patient who places their trust in our health system when they seek help.
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