GPs will have to seek a second opinion if they are unable to diagnose a patient after three appointments under new NHS guidance.

The ‘three strikes and rethink’ approach comes into effect across England today with the aim of speeding up diagnoses and cutting avoidable deaths.

It follows concerns that too many patients are having their symptoms repeatedly dismissed or overlooked until their disease is too advanced to treat.

The policy will be known as Jess’s Rule, in tribute to Jessica Brady who contacted her GP surgery around 20 times in the six months before her death from cancer aged 27.

The Airbus engineer, from Stevenage, reported symptoms such abdominal pain, coughing, vomiting and weight loss but was offered virtual appointments and given numerous medications including antibiotics and steroids.

She was also told she was suffering from long Covid and that she was too young for her symptoms to be anything serious.

Ms Brady was finally diagnosed with adenocarcinoma, which had spread throughout her body – but only after her mother paid for her to see a doctor privately.

She was placed on oxygen and died in hospital three weeks later, in 2020.

The new initiative tells GPs to think again if, after three appointments, they have been unable to offer a substantiated diagnosis, or the patient’s symptoms have escalated.

While many GP practices already use similar approaches in complex cases, Jess's Rule will make this standard practice across the country.

It has been designed in collaboration with the Chair of Royal College of General Practitioners (RCGP) and NHS England.

The rule could involve arranging face-to-face consultations if previous appointments were remote, conducting thorough physical examinations, or ordering additional diagnostic tests.

It also encourages GPs to review patient records comprehensively, seek second opinions from colleagues, and consider specialist referrals when appropriate.

Andrea Brady, Jess’s mum, said: ‘Jess lived for just three short weeks following her terminal cancer diagnosis.

‘Despite her shock and devastation, she showed unfailing courage, positivity, dignity, and love.

'Jess was determined that people should understand how desperately she had tried to advocate for herself and seek a resolution for her declining health.

‘In the bleak weeks following the loss of Jess, I realised it was my duty to continue what she had started.

‘It has taken nearly five years to bring about Jess’s Rule. I would like to dedicate this initiative to all the young people who have been diagnosed too late.

‘It has only been made possible because of the people who have listened — politicians, medics, and the nearly half a million who supported the campaign.’

Research shows that younger patients and those from ethnic minority backgrounds often face delays in diagnosis of serious conditions, as their symptoms may not match typical presentation patterns seen in older or white patients.

A report from the Nuffield Trust and the Health Foundation found that half of 16 to 24-year-olds required three or more interactions with a healthcare professional from a GP practice before being diagnosed with cancer, compared to one in five across the whole population.

Paul Callaghan, policy manager at patient watchdog Healthwatch England, said Jess’s Rule will come as a ‘relief’ to patients living with the ‘anxiety of worrying symptoms’ but unable to get a diagnosis.

He added: ‘Jess’s Rule will also improve patient safety by ensuring more rapid diagnosis of cancer and other illnesses, and provide clarity to those experiencing sickness or ill health.

‘Feedback from the public consistently highlights their frustration with long waits for diagnosis and treatment.

‘It is vital that the rule is implemented quickly and consistently, and people can make informed decisions about their care.

‘It’s also imperative that specialist teams have the resources to deal with potential increases in demand, resulting from increased referrals.’

Writing for the Daily Mail, health secretary Wes Streeting welcomes Jess's Rule 

By Wes Streeting, Secretary of State for Health and Social Care

Jessica Brady should be alive today.

At just 27, this bright young woman died of cancer after her GP surgery failed to diagnose her condition despite more than twenty appointments over five months.

The truth is that her death could have been prevented. The system that should have saved her life, instead let her down in the most catastrophic way possible. I will do all I can to stop this ever from happening again.

When I met Jess’s parents Andrea and Simon last year to hear their story, I was struck by their courage in the face of grief.

Daily Mail readers will know that they’ve been campaigning tirelessly for change, to make sure no other parents go through what they endured when they lost their daughter.

Today, I'm proud to announce the launch of Jess's Rule across the NHS in England – named in Jessica's memory.

This new patient safety initiative will encourage GPs to take a "three strikes and rethink" approach when patients return repeatedly with worsening or undiagnosed symptoms.

The harsh reality is that Jessica's story isn't unique.

Every person deserves the same standard of care, regardless of their age or background, but research shows that too many young people, and those from ethnic minority backgrounds, face delays getting proper diagnoses because their symptoms don't match typical patterns doctors expect to see in older, white patients.

Jess's Rule aims to change this, supporting early diagnosis of illness and saving lives in the process.

When a patient has attended three appointments without diagnosis or with escalating symptoms, their GP must take fresh eyes to the case and reflect, review and rethink.

This could include arranging a face-to-face consultation instead of a phone call, ensuring continuity of care, seeking a colleague's second opinion, or ordering additional tests.

Every cancer diagnosed at Stage One rather than Stage Four sparks a butterfly effect, saving not just individual lives, but NHS resources that will help other patients survive cancer too.

Our Plan for Change is already making an impact, with 160,000 more people having cancer diagnosed or ruled out within 28 days from August 2024 to July 2025 compared to the 12 months from July 2023 to June 2024.

And we're already fixing the front door of the NHS with over 2,000 extra GPs recruited this year and record funding of over £1 billion for practices in 2025-26. Patient satisfaction with GP services is finally rising.

But money alone isn't enough.

We need reform too, and that means listening to patients and their families – brave people like Andrea and Simon.

They have suffered the unthinkable, but in Jess’s name, we are working with them to learn from such tragedies, improve patient safety, and turn our NHS around.

Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: ‘No GP will ever want to miss signs of serious illness, such as cancer.

‘Ensuring a timely diagnosis often means better outcomes for patients - but many conditions, including many cancers, are challenging to identify in primary care because the symptoms are often similar to other, less serious and more common conditions.

'Alternative diagnoses are often more likely, particularly when considering risk factors such as age.

‘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.

‘We hope that by formalising this with Jess's Rule, it will remind GPs to keep this at the forefront of their minds.’

Health secretary Wes Streeting said: ‘Jessica Brady's death was a preventable and unnecessary tragedy.

‘I want to thank her courageous family, who have campaigned tirelessly through unimaginable grief to ensure Jessica’s legacy helps to save the lives of others.

‘Patient safety must be the bedrock of the NHS, and Jess’ Rule will make sure every patient receives the thorough, compassionate, and safe care that they deserve, while supporting our hard-working GPs to catch potentially deadly illnesses.

‘I don’t want any family to endure the pain Jessica’s family have been through.

‘This government will learn from such tragedies and is taking decisive action to improve patient safety.’

Dr Claire Fuller, national medical director at NHS England, said: ;I am very humbled by the efforts of Andrea and Simon Brady, who have campaigned for this important initiative which will undoubtedly save lives by avoiding missed or delayed diagnoses and ensuring patients receive the right treatment at the right time.

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