GP practices asked to display posters promoting ‘three strikes and rethink’ approach

The Government has asked all GP practices to display posters promoting a ‘three strikes and rethink’ approach.

As part of Jess’s Rule, GPs across England are being asked to ‘think again’ if after three appointments – about the same symptoms or concerns – they have been unable to offer a ‘substantial diagnosis’ or if a patient’s symptoms have escalated.

The Department of Health and Social Care said that displaying Jess’s Rule posters in consultation rooms ‘will boost patient safety’ by ‘prompting doctors’ to revisit patient records, challenge initial assumptions and ‘remain alert to warning signs that might otherwise be missed’. 

The initiative, designed in collaboration with the RCGP and NHS England, was launched in September and now every surgery will receive a poster to put up – although DHSC clarified that this is not mandatory.

As revealed by Pulse, last year NHS England had spoken out in support of the rule.

The rule is named after Jessica Brady, who was 27 when she died from metastatic adenocarcinoma in 2020, having been ill for six months.

She suffered from symptoms – including a nasal drip and persistent cough – but had been unable to have physical consultations because this was in 2020, and doctors had said she was likely suffering from Long Covid.

In the five months leading up to her death, Jessica had more than twenty appointments with her GP practice but eventually had to seek private healthcare. She was later diagnosed with stage four adenocarcinoma and was admitted into hospital where she died three weeks later. Her parents have since been petitioning for Jess’s rule to be implemented.

‘The rollout to all 6,170 GP surgeries in England showcases the government’s commitment to protecting patients, saving lives and preventing unnecessary tragedies,’ the Department of Health and Social Care said.

Health secretary Wes Streeting said: ‘I want to thank GPs across the country for embracing Jess’s Rule since we announced it in the Autumn. 

‘The response from primary care has been genuinely encouraging, and I know many of you are already putting the “fresh eyes” approach into practice.

‘I know GPs care deeply about getting diagnoses right. Jess’s Rule is about making space to revisit, reflect and catch what might otherwise be missed. 

‘By advertising Jess’s Rule in your consultation rooms and staff areas, you’ll be helping to embed this approach and honour Jessica Brady’s legacy. Together we can ensure patients’ voices are heard and, ultimately, save lives.’

NHS England medical director Dr Claire Fuller said: ‘These posters will help reinforce the important principle of Jess’s Rule “three strikes, and we rethink” which will be displayed in consultation rooms where clinicians make key decisions relating to a patient’s diagnosis and treatment plan day-to-day.’

DHSC previously clarified that the initiative is a ‘rule’ and not ‘law’, so it will not be followed by legislation.

The RCGP has developed an eLearning resource with the Jessica Brady CEDAR Trust which was published at the beginning of the year, although it will now be updated to reflect Jess’s Rule is now national policy.

RCGP chair Professor Victoria Tzortziou Brown said: ‘No GP ever wants to miss signs of serious illness, such as cancer. Jess’s Rule formalises “best practice” in general practice and underlines the importance of taking time to reflect and review a diagnosis, if a treatment plan doesn’t seem to be working. 

‘This might mean having a more in-depth conversation with the patient to see what other factors could be impacting their health, asking a colleague for a second opinion, or if appropriate, making a referral to secondary care. 

‘Timely diagnosis can mean better outcomes for patients – but many serious 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.’

The RCGP has developed an eLearning resource with the Jessica Brady CEDAR Trust which was published at the beginning of the year, although it will now be updated to reflect Jess’s Rule is now national policy.