Jess’s Rule is a patient safety initiative developed in memory of Jessica Brady.>
It was created by her family in collaboration with NHS England and the Department of Health and Social Care to promote earlier diagnostic review when symptoms persist or worsen.
Jess’s Rule was introduced following the death of Jessica Brady, a young woman who repeatedly sought medical advice with ongoing symptoms that were not improving.
Over a number of consultations, her symptoms were assessed and treated, but when they persisted and escalated, the original working diagnosis was not fundamentally reconsidered early enough. Jess was later found to have a rare and serious underlying condition. Sadly, the delay in diagnosis affected her outcome.
Following her death in 2020, Jess’s parents worked with NHS England and the Department of Health and Social Care to promote a simple but important principle: when symptoms do not improve as expected, clinicians should consciously pause, review the diagnosis, and consider whether something different could be going on.
Jess’s Rule was developed to reduce the risk of delayed or missed diagnoses and to encourage a culture where patients feel listened to and taken seriously when they say their symptoms are continuing or worsening.
What is Jess’s Rule?
Jess’s Rule encourages healthcare professionals to pause and re-think a diagnosis if:
- A patient presents three times with the same or related symptoms, and
- Those symptoms are unexpectedly persisting or getting worse, and
- The current treatment plan does not appear to be working.
It is designed to reduce the risk of missed or delayed diagnoses by supporting reflective clinical practice and ensuring patients feel heard when they are concerned that something is not improving.
What this means for our patients
At Thamesmead Medical Associates, we are committed to listening carefully to our patients and reviewing diagnoses when symptoms do not follow the expected course.
Jess’s Rule supports:
- Careful reassessment of ongoing or worsening symptoms
- Clear documentation and safety-netting advice
- Open conversations between patients and clinicians
- A culture where patients feel confident to say, “I’m still not better”
If you feel that your symptoms are continuing despite treatment, or are worsening, please let us know. It is always appropriate to return for further review if you are concerned.
What Jess’s Rule is not
Jess’s Rule is not an automatic referral rule and does not mean that three visits will always result in specialist investigation. Every patient is assessed individually based on clinical judgement, examination findings, and appropriate guidelines.
It is a prompt to ensure that diagnoses are actively reconsidered when the clinical picture is not evolving as expected.
Our commitment
By adopting Jess’s Rule, we are reinforcing our commitment to:
- Patient safety
- Thoughtful and reflective clinical decision-making
- Continuous learning and improvement
- Listening to our community
Further information
NHS England – Jess’s Rule campaign page:
https://www.england.nhs.uk/long-read/jesss-rule-three-strikes-and-we-rethink/
Jessica Brady CEDAR Trust:
https://jessicabradycedartrust.org.uk