New ‘Three Appointments’ Rule Aims to Improve Patient Diagnosis

A new initiative named Jess’s Rule will be implemented across all general practitioner (GP) surgeries in England starting this week. This rule, designed to enhance patient safety, instructs doctors to reconsider a diagnosis if a patient has attended three appointments without a definitive conclusion. The move comes in response to the tragic case of Jessica Brady, who sought medical help around 20 times for her symptoms before her untimely death in 2020.

The rule’s introduction is intended to prevent avoidable fatalities and to ensure that serious conditions, such as cancer, are not overlooked. The Department of Health and Social Care (DHSC) emphasizes the importance of encouraging healthcare professionals to take a fresh perspective when patients return with persistent or worsening symptoms.

Background and Implementation of Jess’s Rule

Jessica Brady, a 27-year-old engineer at Airbus, experienced a range of troubling symptoms, including abdominal pain and significant weight loss, prior to her diagnosis of advanced cancer. During the pandemic, she was primarily offered virtual appointments, leading to delays in her treatment. Tragically, her cancer was only identified after her mother, Andrea Brady, arranged for a private consultation. Jess passed away three weeks later.

The new rule was officially rolled out in September 2023 and involves displaying informative posters in all 6,170 GP practices throughout England. These posters, created in collaboration with NHS England and the Brady family, aim to reinforce the need for thorough evaluations of patients who have not received a diagnosis after multiple visits.

Health Secretary Wes Streeting stated, “Every patient deserves to be heard, and every serious illness deserves to be caught early. Jess’s Rule makes that possible by reminding clinicians to take a fresh look when symptoms persist.” He noted that this initiative serves as a tribute to Jessica Brady and the persistent efforts of her family to foster change within the healthcare system.

Impact and Support from the Medical Community

The launch of Jess’s Rule has received positive feedback from healthcare professionals. Andrea Brady expressed her pride in her daughter’s legacy and highlighted the encouraging response from primary care practitioners adopting the “three strikes and rethink” approach. Many GPs have committed to further training and have actively supported the initiative by communicating with patients about its importance.

Dr. Claire Fuller, the national medical director of NHS England, emphasized the potential life-saving impact of this rule. “Encouraging GP teams to challenge a diagnosis when it matters most could save lives by avoiding missed or late diagnoses,” she remarked.

Professor Victoria Tzortziou Brown, chairwoman of the Royal College of GPs, noted that Jess’s story serves as a critical reminder that sometimes a rare diagnosis could indeed be the correct one. She added that Jess’s Rule formalizes best practices in general practice, underscoring the necessity of reevaluating diagnoses when treatment does not yield expected results.

Research conducted by the Nuffield Trust and the Health Foundation revealed that half of individuals aged 16 to 24 required three or more interactions with a GP before receiving a cancer diagnosis, a stark contrast to one in five across the overall population. This alarming statistic underscores the urgency of improving diagnostic practices within primary care settings.

Jess’s Rule is designed to enhance early detection and treatment of serious conditions, ultimately aiming to save lives and improve patient outcomes. The initiative embodies a meaningful response to the needs of patients and their families, providing a framework for better healthcare practices moving forward.