Jess’s Rule: New Guidance for GPs in England

AMMF welcomes the new NHS initiative called Jess’s Rule that urges GPs in England to “think again” if they see a patient three times with the same symptoms or concerns, particularly if symptoms persist, get worse, or remain unexplained.

Jess’s Rule, introduced in September 2025, is named in memory of Jessica Brady who died of 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 died 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.

What is Jess’s Rule?

Jess’s Rule is not a law, but a strong reminder for General Practitioners (GPs) to ‘reflect, review and rethink’ if a patient attends three appointments with the same or worsening symptoms.

• Reflect: Think back on what the patient has said and consider what has changed or been missed. If previous consultations have been remote, see the patient face-to-face and conduct a physical examination.
• Review: Where underlying uncertainty exists, consider seeking a view from a peer and review any red flags that may suggest another diagnosis, regardless of the patient’s age or demographic.
• Rethink: If appropriate, refer onwards for further tests or for specialist input.

Implementing Jess’s Rule will support GP teams to manage patients with unclear symptoms, helping to improve quality of care and potentially saving lives by avoiding late or missed diagnoses of serious conditions such as cancer or sepsis.

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

AMMF welcomes Jess’s Rule

Paul Howard, Head of Policy & Research at AMMF, said:

“Jess’s story and the new guidance in her name will hopefully serve as an important reminder for GPs across England to carefully listen to the concerns of patients who may have persistent, non-specific symptoms, and consider the possibility that they could be signs of cancer.

“Cholangiocarcinoma (bile duct cancer) is often missed and managed too late, which can be due to patients presenting with only vague symptoms in its early stages. Unlike the other main type of primary liver cancer, hepatocellular carcinoma (HCC), cholangiocarcinoma commonly develops in people without chronic liver disease. Cholangiocarcinoma is also more common in younger people, with more than one-in-five patients being diagnosed whilst under 65 years old. This means that many cholangiocarcinoma patients may not present as what some GPs consider ‘typical’ for liver cancer.

“In addition to implementing Jess’s Rule the government and NHS must ensure GPs and A&E staff receive appropriate training to Rethink Liver Cancer and recognise possible signs of cholangiocarcinoma to support access to care at the earliest opportunity.”

Further Reading

Find out more about Jess’s Rule on the NHS England website.