Jess's Rule

Jess’s Rule – Three Strikes and we Rethink - was launched in England on the 23rd September 2025 by Department of Health and NHS England. It is endorsed by the Royal College of General Practitioners. But what does it mean for you and what should you know?

An Explanation

Jess’s Rule is a new primary care initiative created in memory of Jessica, who died at age 27 after her cancer went undiagnosed despite multiple GP consultations. It aims to prevent similar tragedies by encouraging clinicians to reassess unresolved or escalating symptoms, particularly in younger patients.

The core principle of "Three Strikes and We Rethink" is for General Practice Doctors.

If a patient presents three times with the same symptom or concern and their condition remains unresolved, clinicians must “Reflect, Review, and Rethink.”

The Three-Step Approach

1. Reflect – Reconsider what has been discussed and what might have been missed. If consultations have been remote, offer a face-to-face review and physical examination. Offer continuity of care with follow-up.
2. Review – Discuss the case with peers if uncertain, and look again for red flags, regardless of the patient’s age.
3. Rethink – Escalate the case if appropriate, arranging further investigations or referral to a specialist.

The key messages for GPs 

• “Three Strikes and We Rethink.” After three presentations without resolution, re-evaluation is essential.
• Do not dismiss cancer risk in younger adults. Early-onset cancers are increasing, with around 35,000 under-50s diagnosed annually in the UK.
• Recognise the limits of remote consultations. Physical exams and continuity of care are crucial for detecting subtle changes.
• Use non-specific symptom pathways to refer patients whose symptoms do not fit site-specific cancer criteria.

Purpose

Jess’s Rule aims to strengthen diagnostic vigilance, improve continuity of care, and promote earlier cancer detection—especially in younger adults who may not fit typical risk profiles. Red flag symptoms are red flag regardless of demographic or statistical likelihood. 

Rule or Law?

Thank you to everyone who continues to show such heartfelt support for Jess’s Rule. We understand why many of you are still hoping it will one day become law — and we deeply appreciate your passion and commitment.

While we’re no longer campaigning for it to be made legislation, we want to reassure you that the changes already made to official NHS guidance are a significant and meaningful step forward. In fact, guidance like this — when widely known, understood, and followed — can be just as effective as law in practice.

That’s why our focus now is on raising awareness:

• Among GPs, so they know what’s changed and how to act on it; and,
• Among the public, so people know what they’re entitled to expect — and feel confident in asking for it.

As many of you have rightly pointed out, even laws can be ignored if no one knows they exist. The same is true for guidance — which is why awareness is everything. Jess’s Rule is already changing the way people are treated in primary care. Together, by continuing to share, talk, and raise awareness, we can make sure it protects as many lives as possible.

Posters

As a charity, we have funded the printing and distribution of Jess’s Rule posters to all GP surgeries in England. These should be displayed in doctors’ consulting rooms from January 2026. The Health Secretary, Wes Streeting, and NHS England’s National Medical Director, Dr Claire Fuller, have sent a letter to 6,170 surgeries underlining why the posters matter and asking that they be displayed in consultation rooms or staff areas.

The Future

In the future, the Jessica Brady CEDAR Trust is committed to working alongside the Department of Health to ensure Jess’s Rule is properly actioned. Our intention is to create a presentation and guide for clinicians about the initiative for Jess’s Rule.

Jess’s Rule has generated significant interest both nationally and internationally. We have received messages of support from eminent clinicians in Denmark and as far afield as the United States. Many of you have contacted us to ask how Jess’s Rule might be implemented in Scotland, Wales and Ireland. We are extremely grateful for this support and recognise how much this new guidance means to so many people. As health policy is devolved, those who wish to see Jess’s Rule adopted in Scotland, Wales or Ireland can help by writing to MPs and devolved representatives to ask that Jess’s Rule be considered within their health services.

What You Can Do

Ask your GP if they are aware of Jess’s Rule, and encourage them to display the poster if it is not visible in consultation rooms.

Remember: cancer is rare, and your GP is a highly trained medical professional. It is their job to assess, diagnose, and treat you. They are the medical expert in the room.

However, you are the expert in your own body. You know what feels normal for you. If you are experiencing symptoms that are not improving, are worsening, or if your previous diagnosis (for example, stress, migraine, or irritable bowel syndrome) was unsubstantiated and does not seem to explain your ongoing health issues, be clear and explicit about your declining health.

Keep track of your symptoms: Write down when they started, how they’ve changed, and how they affect you.

Be clear if you’re not getting better: If symptoms continue or worsen after several visits, say so directly.

Your doctor’s goal is to treat you effectively and support your recovery. Open, honest communication helps them to do that.