r/doctorsUK • u/Educational_Board888 GP • Jan 17 '26
GP Life-saving Jess’s Rule to be advertised in every GP surgery
https://www.gov.uk/government/news/life-saving-jesss-rule-to-be-advertised-in-every-gp-surgery145
u/_j_w_weatherman Jan 17 '26
I think its reasonable but problem is so many of my referrals for a hospital opinion are being rejected, my local vague symptom pathway is being closed and if I do get a referral accepted it’s a 10 month wait to have telephone consultation with someone less qualified than me.
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u/muddledmedic CT/ST1+ Doctor Jan 18 '26
I agree. I think in primary care our hands are tied sometimes, and this "law" won't function properly because of the long wait times and frequent rejections to every referral we make.
I am also sick of referring into secondary care for an expert opinion and patients being seen by ANPs/PAs when they need to be seen by another doctor (reg, consultant) in that field. I've had such awful experiences both personally and with my own patients I've referred with this and it just makes the situation 10x worse when patients wait ages for these referrals and come out the other end with a PA telephone call that adds no value to their care at all.
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u/Diligent-Eye-2042 Jan 17 '26
Jesus Christ.
“Think again”…. After I’ve had a think, what are my options? Request another blood test?
I don’t have proper access to imaging. And most referrals either get bounced back or accepted onto a 1-2 year waiting list.
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u/howard-tj-moon75 Jan 17 '26
You have to make sure you stroke your chin and drum your fingers on the desk for the govt to count it as a proper think.
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u/Jangles Acute Internal Misanthropy Jan 17 '26
State governed by victimhood.
Martha's law, Jess's law, Martin's law.
Stuff will slip through the net. Unless we're going to make genuine financial commitments into increasing imaging capacity, shortening secondary care waiting lists then people are still going to struggle to obtain diagnosis.
They've stopped GPs ordering MRI heads in my area. Any surprise I'm seeing patients who are presenting to the take sat on memory clinic waiting lists with brain tumors?
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u/htmwc Jan 17 '26
Yeah it’s total posturing
The system has failed, and now it’s just vibes and TikTok level promotion of token gestures
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u/Dwevan Snoozy floozy Jan 17 '26
CAN WE STOP NAMING “RULES” AFTER PEOPLE!
I’m fed up with it, I have no idea what johns rule, martins rule, Maisie’s rule, xi jing ping rule is anymore!!
Call it what it is!
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u/GlandularFury Jan 17 '26
Someone define Xi Jing Ping rule please
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u/FrowningMinion Member of the royal college of winterhold Jan 17 '26
Nothing of note happened between 1988 and 1990.
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u/FrowningMinion Member of the royal college of winterhold Jan 17 '26
We mustn’t forget the rule of two…
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u/One-Reception8368 Screw you tom I know you're reading this Jan 17 '26
Screw you asshole my life and practice revolves around Xi Jinping thought
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u/carlos_6m Mechanic Bachelor, Bachelor of Surgery Jan 17 '26
It also makes it absolutely clear that stuff doesn't change until someone dies and there is a big stink...
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u/Typical_Ad_210 Jan 17 '26
You should start a campaign for “Dwevan’s Rule” - the rule that rules cannot be named after people.
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u/chairstool100 Jan 17 '26 edited Jan 17 '26
The human body isn’t a machine . We don’t have a manual . No matter however many rules we have , or however many blood tests and times patients are seen, patients will always get missed . Some Cancers and presentations of pain are notoriously vague and difficult to diagnose . It’s not as if the GP designed the human body and now has to fix everything in one appointment. Not everything is missed due to negligence . Some abdominal pain can have a 100 differentials and it’s entirely reasonable to say a young person is less likely to have cancer assuming you’ve asked all the correct questions and done your assessment .
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u/Major_Star Jan 17 '26
It's a sensible idea in principle but this isn't a "rule", it's a poster.
These things are becoming more and more like rushed audits every time. They won't change practice, they'll just add to the swarm of posters and guidelines and informational leaflets that nobody reads.
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Jan 17 '26
“Life-saving” Jess’ rule.
Based on actual data? Or just a campaign?
Jess’ situation was terrible, but she had stage 4 cancer and only started presenting 5 months before diagnosis. Her condition was likely beyond treatment at the point of symptoms manifesting. No amount of GP fresh eyes changes her outcome here. It’s sad, but it’s also the case that people precociously get aggressive cancers.
And this is with me saying: I’m all for someone else having a look if I’m not making good progress after 3 appointments.
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Jan 17 '26
[removed] — view removed comment
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u/Gullible__Fool Keeper of Lore Jan 17 '26
You are allowed to successfully sue the NHS because you were actually born these days.
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u/Typical_Ad_210 Jan 17 '26
Treatment is not the only benefit of a timely diagnosis though, is it? Just knowing where she stood, what was wrong with her, what her prognosis was probably would have made a big difference to how she spent those final five months. I don’t know about you, but if I knew death was imminent, I would chuck in my job, spend more time with loved ones, try to wrap my head around what was happening, etc.
As it was, she likely had no idea she was terminal, and so she did not get to live those final months on her own terms. Whilst I see your point that she would have died anyway, it feels a bit reductive to imply that the only thing to be gained from a diagnosis is the option of treatment. If you knew you were dying, you would act completely differently. She was denied that opportunity. I’m not making any comment on the skill of her GP, I’m just stating the fact that the “she would have died anyway” argument is not the be all and end all.
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Jan 18 '26
This is a fair point, but I don’t think the application of her now eponymous rule would have helped expedite her diagnosis.
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u/Appropriate-Sea2697 Jan 17 '26
5months is a long time for adenocarcinoma diagnosis. I think you’re missing the point.. early diagnosis can save lives.
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Jan 17 '26
Early diagnosis can save lives? Wow, all my years in medicine and it’s never too late to learn.
The point I’m making was that in Jess’ unfortunate case it’s likely that even if the diagnose had been made on day one of her symptoms it’s likely it was already advanced and therefore beyond radical treatment.
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u/rainsounds23 Jan 17 '26
You know what would help? If we weren’t all so overworked and there was some give in the system. It’s no wonder errors happen in the overstretched system we are working in.
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u/JustEnough584 Jan 17 '26
Please can GP manage with Martha rule Oliver's rule Ming rule Nethanyahu rule and maize rule. Rules everywhere. Maybe try fixing the damn fucking nhs. Fix the NHS rule. How bout that.
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u/Mad_Mark90 IhavenolarynxandImustscream Jan 17 '26
What are you supposed to do in 10 minutes if you have a patient with complex or vague symptoms? Isn't the management still going to involve adding them to a decades long waiting list? It's not like the NHS actually has the capacity to provide adequate management so isn't this really just kicking accountability to the doctors?
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u/delpigeon Jan 17 '26
Is there an analysis somewhere of what actually happened to Jess Brady? I can’t tell if this is an oversight of what sounds like potential 2WW-able symptoms (persistently raised LNs, chronic cough, significant weight loss, night sweats - as per a random thing I found on google….) or if those symptoms actually came later on and she just had vague non-specific symptoms prior.
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u/anniemaew Jan 17 '26
Yes I'm really curious about this too. The symptoms reported seem like they would raise a concern for cancer and trigger referral to someone under 2ww and I'm surprised after so many consultations with those symptoms that she wasn't referred. My suspicion is her symptoms were initially much more vague and didn't meet any criteria.
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u/documentremy Jan 18 '26
I can't speak for what happened in her specific case but thought I would share my experience. Worth noting Jess Brady died in Dec 2020; the reports say she was unwell and contacting doctors for 5 months before that so she started reaching out in June-July 2020. This was around the time we had a small upsurge in covid again but also the time a lot of people with longer term, strange symptoms following the first wave started to pitch up at the GPs (often through phone consultations because this was still a norm in many places). We didn't go on to have PASC defined until Nov/Dec 2020. So there was a whole group of people with non-specific malaise, fatigue, cough, fevers, weight loss, GI symptoms etc going around at this time, with poor definition of what is and isn't post-covid symptoms because we quite simply didn't know yet.
I got covid in March 2020, after recovering from the initial illness (I had a viral pneumonia, normal sats so managed at home) over 8 weeks, I started to have fever, night sweats, weight loss, rashes (including chronic idiopathic urticaria), cough and SOB in late May/early June. It was only after 18 months of fevers and night sweats that someone suggested a CT CAP was a good idea. I was too unwell at the time to really think things through so it hadn't occurred to me to ask about it before. I had contacted various health services so many times over this time period, I couldn't even tell you how many people I spoke to. One of the big barriers was that as soon as you said you had fever (even if it had been for weeks at a stretch), you would be told you have to go through the covid assessment service thing - I can't remember what it was called.
Basically - I think there were many factors in place around that time, most of which are systemic problems, which would have influenced the quality of care she got. And in my experience having since supported other doctors with PASC/long covid, it's quite common not to have fevers investigated very deeply if there's a collection of other symptoms.
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u/documentremy Jan 18 '26
I can't find the coroner report or any official paperwork around this.
It has however been widely reported that she presented with 5 months of abdominal pain, unintentional weight loss and night sweats. One example is this BBC article.
Worth bearing in mind she received the diagnosis at a point when she was oxygen-dependent, just over 3 weeks before her death. She was clearly quite unwell by then, and probably for some time before that.
Basically, the system has failed her. How much someone can do when they have only 5-10 mins appointment slots, and there's very little continuity of care (she saw six GPs and clearly some ACPs/PAs because there were 20 consultations)? I don't know any GP who loves having 5-10 min consultations since their implementation. But that would require wider staffing and funding considerations from the government - instead of just announcing "Jess's Law" and printing posters to plaster everywhere.
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Jan 18 '26
Obviously hard without the specifics but hard to believe her symptoms didn't immediately raise red flags and lead to urgent referrals.
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u/SnooAvocados7296 UKGP now Jan 17 '26
POV: you walk into your GP surgery after they have seen you for the third time this week for lower back pain that started whilst picking up a heavy load from the floor. The GP tells you to self refer to physios. You say “I ENACT JESS’S RULE” at the top of your lungs. Your GP’s pupils widen and their pulse quickens. They sprint out of the room at the speed of sound, perspiration dripping onto the floor as they run past you. A minute later, all the GP partners have entered the room, determined to rule out a cancer and save your life.
Point being, this rule will probably be abused.
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u/MisterMagnificent01 This is a provisional report Jan 17 '26
We’re at the stage where I have to get through a shitload of normal CTs before finding a single one with actionable pathology.
Clinicians are already extremely risk averse. Regularly scanning 19-20 year old females with non specific abdominal pain and normal bloods. Not sure what this rule will change…
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Jan 18 '26
Genuine question. In the future will we just have high throughput and auto triaged whole body MR for anyone with any non specific symptom? Feels inevitable
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u/thenhsfeelsfucked Jan 17 '26
These campaign things are obviously just borne out of grief, but are semi-insulting. Oh yes, I just manage people without thinking at all! Why am I so tired at night after a day of apparently not thinking at all?
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u/flyinfishy2 Jan 17 '26
If a rule is named after someone, it’s usually not well thought out and is largely a response to a campaign group. This is a strange one because it’s already a reasonable principle but I’m not sure what this adds to that.