Jess’s Rule: Three strikes and we rethink

Jess’s Rule is a primary care initiative to encourage GPs teams 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 (DHSC) and NHS England and is supported by the Royal College of General Practitioners (RCGP).

What is Jess’s Rule?

Jess’s Rule asks GP teams to ‘reflect, review and rethink’ if a patient presents three times with the same or escalating symptoms.

• Reflect: Think back on what the patient has said and consider what has changed or been missed. Offer ongoing episodic continuity of care for future direct patient care. If previous consultations have been remote, see the patient face-to-face and conduct a physical examination.
• Review: Where underlying uncertainty exists, consider seeking a view from a peer and review any red flags that may suggest another diagnosis, regardless of the patient’s age or demographic.
• Rethink: If appropriate, refer onwards for further tests or for specialist input.

 Implementing Jess’s Rule will support GP teams to manage patients with unclear symptoms, helping to improve quality of care and potentially saving lives by avoiding late or missed diagnoses of potentially serious conditions such as cancer or sepsis.

This is important as diagnosing cancer and other serious conditions earlier increases a person’s chance of survival and recovery.

For further information visit: NHS England » Jess’s Rule: Three strikes and we rethink

Published on 8 October 2025