On 23 September 2025, the Department of Health and Social Care and NHS England announced the implementation of Jess’s Rule: Three strikes and we rethink.
Jess’s Rule is in memory of Jessica Brady who passed away due to cancer in December 2020 at the age of 27. In the five months leading up to her death Jess had over 20 consultations with her GP practice, and her cancer had not been diagnosed.
Under Jess’s Rule, GP teams are encouraged to take a “three strikes and rethink approach”. This means taking further action after three appointments with a patient whose condition isn’t improving, to prevent avoidable deaths.
This could entail arranging face-to-face consultations with a patient previously only spoken to on the phone, ordering extra tests or asking for a second opinion from a colleague. GPs should also consider referring patients to a specialist.
Dr Hein Le Roux, Deputy Medical Director at NHS Gloucestershire, said:
“No doctor ever wants to miss signs and symptoms of serious illness such as cancer or sepsis, and across Gloucestershire, GP surgeries already follow this three-strike approach.
Nonetheless, we welcome this ruling which highlights the crucial importance of this practice and will support GP teams to manage patients with unclear symptoms.
Our priority is to listen carefully to every patient’s concerns and symptoms and ensure that they receive the thorough and compassionate care they deserve.”
Please visit the Jess’s Rule website for more information and resources: https://www.england.nhs.uk/long-read/jesss-rule-three-strikes-and-we-rethink/
Jess’s Rule was envisioned by Andrea and Simon Brady, parents of Jess. It is supported by the Royal College of General Practitioners.