"Jess's Rule" Introduced to English GPs to Prevent Diagnostic Delays
General practitioners (GPs) across England are adopting a new "three strikes and rethink" approach, dubbed "Jess's Rule," aimed at improving patient safety and preventing diagnostic delays. This initiative follows the tragic death of Jessica Brady, who passed away from stage four cancer after repeated misdiagnoses.
The Story Behind Jess's Rule
Jessica Brady, a 27-year-old engineer at Airbus, experienced abdominal pain, coughing, vomiting, and weight loss for six months before her death in December 2020. Despite contacting her GP practice more than 20 times, she was repeatedly misdiagnosed with long Covid. Coronavirus restrictions limited her to non-face-to-face appointments.
It was only after a private consultation that Brady, from Stevenage in Hertfordshire, was diagnosed with adenocarcinoma. Sadly, she died three weeks later. The experience highlighted the critical need for a more thorough approach to diagnosing persistent symptoms, especially in younger patients.
Andrea Brady, Jess's mother, started a petition advocating for measures like funding for specialist referrals and increased face-to-face consultations. The petition garnered nearly 500,000 signatures, becoming the largest healthcare petition on Change.org since the pandemic.
How Jess's Rule Works
Jess’s Rule mandates that GPs must reconsider a patient’s case if their symptoms escalate or if a credible diagnosis cannot be established after three appointments. This includes considering face-to-face consultations, ordering additional tests, and seeking second opinions or specialist referrals.
The rule, developed by NHS England and the Royal College of General Practitioners (RCGP), aims to ensure that patients receive thorough and compassionate care, while also supporting GPs in identifying potentially deadly illnesses earlier. It is designed to be a strong reminder to GPs to take action and prevent avoidable deaths.
"Jessica Brady’s death was a preventable and unnecessary tragedy," said Wes Streeting, the health secretary. "Patient safety must be the bedrock of the NHS and Jess’s rule will make sure every patient receives the thorough, compassionate and safe care that they deserve, while supporting our hardworking GPs to catch potentially deadly illnesses."
Addressing Diagnostic Disparities
Jess’s Rule also seeks to address concerns that younger patients and those from minority ethnic backgrounds often experience delays in the diagnosis of serious conditions. Research suggests that younger individuals may require more interactions with healthcare professionals before receiving a cancer diagnosis.
The RCGP has collaborated with Jessica Brady's family to create educational resources for GPs on the early diagnosis of cancer in young adults. The goal is to improve awareness and ensure that younger patients are not dismissed simply because of their age. They emphasize the importance of reviewing diagnoses when treatment plans are ineffective or a patient’s condition deteriorates.
“If a patient repeatedly presents with the same or similar symptoms, but the treatment plan does not seem to be making them better - or their condition is deteriorating – it is best practice to review the diagnosis and consider alternative approaches,” said Prof Kamila Hawthorne, the chair of the Royal College of GPs.
Impact and Future Implications
The introduction of Jess's Rule is expected to promote a more proactive and thorough approach to patient care, potentially leading to earlier diagnoses and improved outcomes for individuals with serious illnesses like cancer. The Department of Health hopes this rule will become standard practice across the country.
Andrea Brady expressed her hope that Jess's Rule will prevent similar tragedies and ensure that other young people receive timely and effective care, emphasizing the importance of patients advocating for themselves when their health is declining.
