Jess's Rule: A New Standard for GPs?

On 23 September 2025 the Department of Health and Social Care together with NHS England announced a “three strikes and rethink approach” for General Practitioners

Introduction

Named after Jessica Brady, a 27-year-old who tragically died of cancer in 2020 following over 20 GP appointments without a diagnosis, the rule mandates a “three strikes and rethink” approach.

In essence, if a patient presents three times with the same or worsening symptoms without a substantiated diagnosis, GPs are now expected to pause, reassess, and consider alternative diagnoses or escalate care.

The aim of the rule is to help avoid tragic, preventable deaths by allowing GPs to catch potentially deadly illnesses sooner.

Implementation

Many GP teams already apply a version of “three strikes and rethink” in their routine practice. It is said that Jess’s Rule formalises this approach to provide a consistent structure to support reflection and timely action.

As such, NHS England have confirmed that no additional training or materials are required for its implementation.

Response

The Royal College of General Practitioners have already affirmed Jess’s Rule and have commented:-

"If a patient repeatedly presents with the same or similar symptoms, but the treatment plan does not seem to be making them better - or their condition is deteriorating - it is best practice to review the diagnosis and consider alternative approaches. We hope that by formalising this with Jess's Rule, it will remind GPs to keep this at the forefront of their minds.”

Legal impact

In circumstances where the aim of Jess’ rule is to formalise existing practice the impact upon clinical negligence claims is likely to be minimal.

Moreover, as explained in O'Brien v Guy's & St Thomas' NHS Trust [2022] EWHC 2735 (KB), national clinical guidelines are not a substitute for clinical judgment in an individual case and that departure from these guidelines is not evidence of negligence (albeit there is a need for explanation).

What will ultimately matter is whether the GP’s conduct fell within a Bolam compliant practice in the usual way. The rule does however highlight the importance of good record keeping and practitioners should consider documenting when there has been a “rethink”.