New rule for GPs after 27-year-old's cancer missed

General Practitioners (GPs) in England are being urged to "think again" if they see a sick patient three times without reaching a diagnosis, or if the patient's symptoms are worsening. This new NHS initiative, known as "Jessie's Rule," is named after Jessica Brady, a 27-year-old who died of advanced stage 4 cancer after her symptoms were dismissed as Long Covid. She had been told she was "too young for cancer."

Health Secretary Wes Streeting described her death as "a preventable and unnecessary tragedy" and said the new rule would help GPs "catch potentially lethal diseases," thereby increasing patient protection.

A Preventable Death

Jessica Brady, an engineer from Stevenage who worked on satellites, began feeling unwell in the summer of 2020. Over the next five months, she repeatedly contacted her GP surgery as her symptoms became "increasingly debilitating," according to her mother, Andrea.

Jess suffered from unexplained weight loss, night sweats, chronic exhaustion, a persistent cough, and significantly enlarged lymph nodes. However, due to her age, "it was clearly [thought] that there wasn't anything wrong." Despite having contact with six different doctors and three face-to-face consultations with a GP, no referral was made. "Her body was failing her," Andrea said.

"It was difficult for Jess to advocate for herself. She was saying, 'What's the point? Nothing will happen.'"

When the family finally arranged a private consultation, it was too late. Jess was referred to a consultant but died just three weeks later, days before Christmas 2020. She had been diagnosed in November with terminal cancer of the glands that line the organs.

The Campaign for Change

Jessie's Rule is not a statute but a strong recommendation for GPs to adopt a "three strikes and rethink approach." The rule is designed to prevent avoidable deaths by requiring action when a patient attends three appointments with the same symptoms without improvement.

This action could include scheduling a face-to-face consultation for a patient previously only seen on the phone, ordering further tests, or seeking a second opinion from a colleague. GPs also have the option of referring the patient to a consultant.

According to the Royal College of General Practitioners (RCGP), which helped write the recommendations, no doctor ever wants to miss the signs of a serious illness like cancer. Prof. Kamila Hawthorne, chair of the RCGP, explained: "Many disorders, including many cancers, are difficult to recognize in primary care because the signs are often similar to other, less common, and more common conditions."

She added that if a patient's symptoms persist and treatment does not appear to be improving them or, worse, their condition is worsening, it is in their best interest to "investigate the diagnosis and explore alternative approaches."

Studies show that younger patients and people from ethnic groups are often delayed in receiving a diagnosis for a serious illness because their symptoms may not present in the same way as those of white or older patients. Additionally, younger people, like Jess, can be dismissed simply for being "too young" to have a serious illness.

The RCGP has collaborated with Jess Brady's family to create an educational resource for GPs on the early diagnosis of cancer in young adults. The Department of Health stated that while many GP practices already follow this approach, Jessie's Rule would make it a "standard procedure throughout the nation."

A Lasting Legacy

Health and Social Care Secretary Wes Streeting praised Jess's family for their tireless campaign through "unimaginable pain" to ensure her legacy helps save the lives of others.

"Patient health must be the bedrock of the NHS," he said, stating that Jessie's Rule will "ensure that every patient receives the comprehensive, compassionate, and safe care they need."

Paul Callaghan of Healthwatch England, which represents health and social care service users, said the new guidance should be "enforced quickly and consistently." He added that it is "also crucial that specialist teams are able to deal with future demand rises resulting from increased referrals."