Jess’s Rule: An Important Step Forward in Patient Safety

GP surgeries across England will begin displaying posters promoting a new NHS patient safety initiative known as Jess’s Rule. The rule encourages doctors to “think again” when they have been unable to reach a clear diagnosis after seeing a patient three times, or when symptoms persist or escalate.

Jess’s Rule represents a meaningful shift in how diagnostic uncertainty is approached in primary care. It recognises that persistent symptoms should not be dismissed and that revisiting clinical assumptions can be critical to patient safety.

The Story Behind Jess’s Rule

Jess’s Rule is named after Jessica Brady, who died in 2020 aged 27 from advanced stage four adenocarcinoma. Before her diagnosis, Jess contacted her GP on more than 20 occasions. Her symptoms were repeatedly attributed to long Covid, and she was told she was “too young for cancer”.

Despite multiple consultations with different doctors, no referral to a specialist was made. It was only after her family arranged a private appointment that Jess was referred to secondary care, where she received a terminal diagnosis. She died just three weeks later, days before Christmas.

Jess’s experience highlights the devastating consequences that can arise when symptoms are repeatedly explained away rather than re-examined.

What Jess’s Rule Asks Clinicians to Do

Under the new initiative, GPs are encouraged to take a “fresh eyes” approach if they have been unable to provide a substantiated diagnosis after three appointments. This includes:

• Revisiting patient records

• Challenging initial assumptions

• Remaining alert to warning signs and symptom escalation

The aim is not to undermine clinical judgement, but to support reflection when uncertainty persists and to reduce the risk of missed or late diagnoses.

Why This Matters for People With Persistent or Complex Symptoms

For many patients, particularly those living with persistent, complex, or medically unexplained symptoms, repeated consultations can feel like a cycle with no clear route forward. Being labelled a “frequent attender” can carry stigma, and symptoms that do not fit neatly into diagnostic frameworks may be downplayed or normalised.

Jess’s Rule sends a clear message: repeated attendance is not a failure of the patient, but often a signal that something has not yet been understood.

A Welcome Cultural Shift

Jess’s Rule promotes a culture of curiosity and humility in medicine, acknowledging that not all diagnoses are immediately obvious. It also empowers patients to speak up when their symptoms continue, while maintaining trust in clinicians.

As Wes Streeting has stated, every patient deserves to be heard and every serious illness deserves to be caught early. Jess’s Rule reinforces this principle within everyday primary care.

Looking Beyond the Rule

While Jess’s Rule is an important step, it cannot address all the systemic challenges that affect people with complex symptoms. Time-limited appointments, fragmented care, and difficulties accessing secondary services remain significant barriers.

For patients whose symptoms are ill-defined or span multiple specialties, the question is not only whether clinicians think again, but whether there is a clear pathway for what happens next.

Our Chair’s Perspective

We fully support the adoption of Jess’s Rule. It addresses some of our concerns about how doctors respond to frequent attenders and encourages clinicians to look further when someone presents with persistent symptoms. Seeking a second opinion when there is diagnostic doubt should be seen as a positive attribute, not a failing.

However, it is also important to acknowledge that doctors work in a challenging environment. Pressures within the healthcare system, including limited appointment times, can be a significant disadvantage for people living with complex and/or rare conditions. Referrals to secondary care for those with complex or ill-defined symptoms can also be difficult to arrange and may be rejected.

We hope that Jess’s Rule will be a genuinely positive step in the right direction. However, there is still much to be done to ensure that people with complex symptoms and no obvious diagnosis are appropriately listened to, supported, and signposted to the most suitable resources.

— Adrian Tookman, Chair