NHS spearheads Jess's Rule so GPs don't ignore serious symptoms

According to the NHS, the idea is to encourage GPs to rethink a diagnosis if a patient presents three times with the same symptoms or concerns, particularly if symptoms unexpectedly persist, escalate, or remain unexplained. It is led by the Department of Health and Social Care and NHS England and is supported by the Royal College of General Practitioners (RCGP).

Jessica Brady was just 27 years old when she died from adenocarcinoma (cancer of the glands that line the body's organs) in 2020. She had contacted her GP more than 20 times in the months before her death, but was told that she was 'too young' to have cancer, despite her ongoing symptoms.

Fieldfisher's medical negligence team is regularly contacted by people with serious medical conditions as a result of misdiagnosis or late diagnosis by a GP, meaning a vital referral to a specialist is also delayed or non-existent. Where there is clear indication that symptoms should have been spotted earlier by a competent practitioner, these people often have grounds for a negligence claim against their GP.  At the very least, this can provide much needed funds for specialist follow up care and financial help when someone can't work or, in some cases, their condition is fatal.

Clients pursuing misdiagnosis claims say similar things:

''I kept telling the GP the same thing, but I was told there was nothing to worry about''.

''I was made to feel that I was wasting their time''

''The GP told me to go to hospital if anything got worse''.

GPs must tread a difficult balance between over-referring patients to over-stretched hospitals with doing the right thing by their patient. Some GPs may be very quick to refer to be on the 'safe side'' but this can lead to unnecessary escalation, increased waiting times, and wasting NHS resources. And some GPs see an important part of their job being to take the strain away from hospitals and, as far as possible, treat patients themselves.

The hope is that Jess's Rule will mean fewer cases of missed diagnoses, particularly among the young. We often hear the phrase in serious incident reports following serious negligence that medical practitioners are blindsided by an initial diagnosis that prevents them from considering other options.

Criticism of individual GPs is often criticism of the system in which they operate and clearly the support for Jess' Rule by the RCGP indicates that anything practical that can ease the burden of GPs and ensure patients are referred when they need to be is welcome

There are certain challenges facing GPs that should be considered in the light of Jess's Rule':

1. Patients will often see different GPs during their visits and so most of the time the GP will be seeing any symptoms for the first time – that can mean an over reliance on the notes of the previous visits, and also an over reliance on the GP reviewing the history, compounded when appointments are short and waiting lists are long.
2. Patients increasingly see their GP via telephone and video consultations which rely on the patient understanding their symptoms and being able to articulate them. And even where the patient does describe something accurately, the GP can't perform a physical examination that would uncover other signs and symptoms.
3. We hear from clients that they don't want to 'bother' their busy doctor, particularly when they've already been a couple of times and been told not to worry.

Contact us

For further information about GP negligence claims, please call Will Jones on 0330 460 6822 or email will.jones@fieldfisher.com.

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