Three strikes and we rethink: what Jess’s Rule means for GPs

GPs in England are being urged to reconsider their approach when faced with patients whose symptoms persist or worsen after multiple consultations, following the tragic case of Jessica Brady, who died of cancer at just 27 after 20 GP visits without a diagnosis. Her legacy, known as “Jess’s Rule,” was formally adopted as national policy on 23^rd September 2025, thanks to tireless campaigning by her parents and collaboration with the chair of the Royal College of General Practitioners and NHS England.

What Jess’s Rule means for GPs in England

While many general practitioners already deliver exceptional care, Jess’s Rule introduces a new standardised protocol aimed at improving outcomes for patients with persistent or unexplained symptoms.

Under the “Three Strikes and Rethink” approach, GPs are now encouraged to take a more cautious stance when a patient presents with the same or worsening symptoms across three separate appointments. This involves a structured process of reflection, review, and reconsideration:

Reflect: GPs are urged to revisit the patient’s concerns, assess any changes or overlooked details, and ensure continuity of care.

Review: A thorough re-evaluation of the patient’s condition and medical records is expected, with consideration given to alternative diagnoses.

Rethink: Where appropriate, GPs should escalate care—referring patients for further testing or specialist input to avoid missed or delayed diagnoses.

This policy aims to reduce diagnostic delays and ensure that patients like Jessica Bradley receive timely and accurate care.

Benefits and support for GPs under Jess’s Rule

The introduction of Jess’s Rule brings a range of benefits for general practitioners across England, aiming to strengthen clinical decision-making and improve patient outcomes.

• Empowering clinical judgement: The new guidelines are designed to support GPs in trusting their instincts, offering a clear framework for when to seek further input or escalate care.
• Tackling health inequalities: By standardising responses to persistent or unclear symptoms, the initiative ensures that all patients—regardless of age, background, or circumstance—receive consistent, high-quality care.
• Promoting early diagnosis: Encouraging earlier identification of serious conditions not only improves patient outcomes but also helps reduce the risk of delayed diagnoses and potential malpractice claims.

Implementation and Resources

To support the rollout, the Royal College of General Practitioners has partnered with the Jessica Brady CEDAR Trust to develop an eLearning module focused on improving early cancer diagnosis in young adults. Additional campaign materials, including posters and learning tools, are available to help GPs integrate Jess’s Rule into everyday practice.

Why Jess’s Rule matters for your medical malpractice insurance

The introduction of Jess’s Rule could have far-reaching implications for how medical malpractice claims are assessed by indemnity and discretionary indemnity providers. With a national standard now in place, insurers may begin to scrutinise whether GPs adhered to the “Three Strikes and Rethink” protocol when evaluating patient care.

Failure to follow Jess’s Rule, particularly in cases where a patient suffers harm after repeated consultations without a diagnosis, could be viewed as a deviation from expected clinical standards. This raises the possibility that insurers might use non-compliance as grounds to challenge or decline claims, especially if the rule is seen as a benchmark for reasonable care.

Ultimately, Jess’s Rule not only aims to improve patient outcomes but also introduces a new layer of accountability that could reshape how risk is measured and defended within the medical malpractice insurance landscape.

With Jess’s Rule now a national standard, it is important for healthcare professionals to understand how it may influence clinical expectations and the handling of medical malpractice claims. Reviewing your current practices and staying informed about how insurers interpret compliance with the rule could help ensure both patient safety and professional protection.