Mandatory A&G unintentionally weaponises Jess’s Rule

Editor Sofia Lind laments GPs’ fundamental right to refer patients and muses over the unintentional consequences for the three-strikes-and-refer rule

The recently-introduced Jess’s Rule encourages GPs to ‘think again’ if after three appointments about the same symptoms they have been unable to offer a ‘substantial diagnosis’, or if a patient’s symptoms have escalated.

The new NHS policy was announced with a lot of fanfare, but not a lot of reaction in GP land. Probably because it is something most GPs would already do routinely, and also because it has no teeth: it is just a rule, non-contractual in nature.

But the rule – in memory of 27-year-old Jessica Brady, who sadly died with adenocarcinoma in 2020, having been ill for six months – is about to become crucial to enable GPs to protect the safety of their patients going forward.

Because this week, NHS England clarified that the new contractual A&G requirement will effectively mean stripping GPs of their automatic right to refer patients to a specialist for further investigation.

Although NHSE primary care director Dr Amanda Doyle told GPs in a webinar that ‘there will be nothing that removes the right of GPs to refer’, and insisted GPs would be given a say in setting up the new pathways, she added that GP practices will be asked to send referrals without specifying whether they are for an appointment or A&G, and trusts will ‘sift them at their end’. 

To all the GPs I’ve spoken to, this is synonymous with losing their automatic (fundamental and sacred) right to refer. And this is described as a massive psychological blow – before we even get to the unfair workload distribution – which could come to be a tipping point for some.

In a BMA webinar this week, GPC England’s chair Dr Katie Bramall said the new A&G requirement risks leading to a ‘doom loop’ where GPs lose the right to refer and patients do not receive the care they need. The committee is awaiting further guidance, but its leaders strongly suggested that it could launch a legal challenge to the new contractual requirement.

But, as some have suggested, there is a get-out-of-jail card, and it is Jess’s Rule. How many times have you ‘seen’ this patient?

In the NHSE webinar, Dr Doyle also confirmed that the rule will have a crucial role in the new system. She said trusts will need to ‘recognise where Jess’s Rule comes into play’, and will be provided with guidance on this.

As such, Jess’s Rule looks set to become the workaround for GPs to retain control of the referral of patients. It is an unintentional weapon against workload dump, amid further erosion of GP autonomy in clinical decision-making.

Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn 

Read all of our coverage of the 2026/27 contract here.

Discover our programme of free, CPD-accredited events – delivered face-to-face and online – designed to bring you practical clinical updates and expert-led sessions. Book your free place today and join us in person or virtually.