Jess’s Rule, a system which calls for family doctors to think again if a patient has had three appointments for their symptoms with no diagnosis, will be advertised in all GP practices across England from this week.
The rule is named after 27-year-old Jessica Brady, who contacted her surgery 20 times before she passed away in 2020.
It was rolled out in September to prevent avoidable deaths and help medics avoid missing serious illnesses such as cancer.
Jess’s Rule urges GPs to think again when it comes to patients who have had three appointments with no diagnosis, or if symptoms have worsened.
They are encouraged to consider a second opinion, see patients face-to-face for physical examinations, or order more tests.
Ms Brady’s mother Andrea Brady, said the charity set up in her daughter’s name has been “heartened” by the response from primary care to the “three strikes and rethink” approach.
Posters advertising Jess’s Rule have been distributed to all 6,170 GP practices in England.
Their display will boost patient safety by urging family doctors to challenge initial assumptions, according to the Department of Health and Social Care.
Health Secretary Wes Streeting said: “Every patient deserves to be heard, and every serious illness deserves to be caught early. Jess’s Rule makes that possible – reminding clinicians to take a fresh look when symptoms persist, and empowering patients to speak up about their care.
“This is a fitting tribute to Jessica Brady and the tireless campaigning of her parents. Their determination to turn tragedy into lasting change will help protect patients and save lives for years to come.”
The posters were co-designed by DHSC, NHS England and Jess’s parents Andrea and Simon Brady.
GP surgeries will also receive a letter from Mr Streeting and NHS England’s national medical director Dr Claire Fuller to stress the importance of Jess’s Rule.
Ms Brady, an engineer for Airbus, contacted her GP surgery around 20 times over six months in the lead up to her death in 2020, reporting symptoms such as abdominal pain, coughing, vomiting and weight loss.
Due to restrictions during the pandemic she was offered virtual appointments and prescribed medications including antibiotics and steroids. She was also told she may be suffering from long Covid.
Ms Brady was finally diagnosed with cancer that had spread throughout her body – but only after her mother paid for her to see a doctor privately. She died in hospital three weeks later.
Andrea Brady said: “Throughout her illness, Jess showed a quiet determination that her experience should lead to meaningful change, inspiring the launch of Jess’s Rule in September last year. I am so incredibly proud of my caring and courageous daughter.
“The Jessica Brady CEDAR Trust, the charity established in Jess’s name, has been heartened by the response from primary care practitioners adopting ‘the Three Strikes and We Rethink’ approach.
“Many have committed to developing further training, while others have written to patients to endorse the initiative and show their support. This level of engagement has been profoundly encouraging.
“Jess’s Rule posters have now been distributed to all GP practices in England and are expected to be displayed in consultation rooms. By supporting clinicians to take a fresh eyes approach when a patient returns for a third time with the same or worsening symptoms, Jess’s Rule aims to ensure serious illnesses, including cancer, are identified and treated earlier – a goal I remain hopeful will be achieved.”
Dr Fuller said: “Encouraging GP teams to challenge a diagnosis when it matters most could save lives by avoiding missed or late diagnoses, and I’d like to thank Andrea and Simon Brady and the Jessica Brady CEDAR Trust for funding and providing their important insights to develop the posters.”
Professor Victoria Tzortziou Brown, chairwoman of the Royal College of GPs, said that Ms Brady’s story “is an important reminder that sometimes a rare diagnosis could be the right diagnosis”.
She added: “Jess’s Rule formalises ‘best practice’ in general practice and underlines the importance of taking time to reflect and review a diagnosis, if a treatment plan doesn’t seem to be working.
“This might mean having a more in-depth conversation with the patient to see what other factors could be impacting their health, asking a colleague for a second opinion, or if appropriate, making a referral to secondary care.
“Timely diagnosis can mean better outcomes for patients – but many serious 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.
“The college has worked with Jess Brady’s family and the Jessica Brady CEDAR Trust to develop learning resources for GPs on diagnosing cancer in younger people.”
Research by Nuffield Trust and the Health Foundation found that half of 16 to 24-year-olds required three or more interactions with a GP surgery before being diagnosed with cancer, compared with one-in-five across the population.
