Jess’s Rule: Three strikes and we rethink (NHS England, 23 September 2025)

Summary

Jess’s Rule is a primary care initiative to encourage GPs teams to rethink a diagnosis if a patient presents three times with the same symptoms or concerns, particularly if symptoms unexpectedly persist, escalate, or remain unexplained. It is led by the Department of Health and Social Care and NHS England and is supported by the Royal College of General Practitioners.

Content

Jessica Brady passed away due to cancer in December 2020 at the age of 27. In the 5 months leading up to her death, Jess had 20 consultations with her GP practice, and her cancer had not been diagnosed. Jess was then admitted to hospital with stage 4 adenocarcinoma and passed shortly afterwards. Since then, Jess’s family have campaigned for primary care staff to elevate a patient’s case for review after their third appointment with their practice about a condition or symptom.

Jess’s Rule asks GP teams to ‘reflect, review and rethink’ if a patient presents three times with the same or escalating symptoms. Below is a poster for displaying in GP consultation rooms in relation to this, which you can also find attached as a PDF at the bottom of this page.