As stated by NHS England, Jess’s Rule is a ‘new NHS primary care initiative to encourage GP 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 comes following the story of Jessica Brady, who sadly died from cancer in December 2020 at the age of 27. In the five months leading up to her passing, Jess had 20 consultations with her GP practice. Jess was ultimately admitted to hospital before her cancer was diagnosed, and she passed shortly afterwards. Since then, Jess’s family have campaigned for primary care staff to relect upon, review and potentially rethink a patient’s case after their third appointment with their practice with symptoms that are persistent or have escalated.
Jess’s Rule is not a clinical referral pathway (although there are other pathways in place for GPs to refer patients to who are presenting with non-specific symptoms). Rather, it is designed to:
- offer a prompt for primary care teams when a patient’s symptoms persist or escalate, and to perhaps even reconsider any initial diagnosis they may been given.
- encourage GP teams to reflect on what the patient has said in each prior consultation and note any changes, and to invite them for a face-to-face appointment and physical examination if they have been seen remotely beforehand.
- ask teams to review any red flags that might suggest another diagnosis, and possibly seeking a second professional opinion if there is still underlying uncertainty around a patient’s condition.
- lastly, it asks teams to rethink a diagnosis, and if appropriate, refer the patient onwards to further tests or for specialist input.
“We welcome Jess’s Rule and the “three times and we rethink” approach” says Ropinder Gill, Chief Executive at Lymphoma Action. “This new NHS initiative could have far reaching consequences for people experiencing potential symptoms of lymphoma. We know that from our 2024 patient survey that nearly a quarter of people waited six months or longer to receive their lymphoma diagnosis after first seeking medical attention. Further research conducted as part of the Blood Cancer Alliance showed that 1 in 3 people diagnosed with blood cancer had to see their GP 3 or more times before being referred."
"The symptoms of lymphoma can be vague, and can be mistaken for other conditions" she adds. "That is why it is so important to contact your GP practice if you are concerned about any symptoms you may be experiencing, and to go back again if they are not improving or are getting worse. This continues to be a key focus of our policy work, as we support developments that aim to improve outcomes in treatment and care.”