To think the new “Jess’s rule” should be blindly obvious & it’s an embarrassment that we have to remind GPs this?

[Waitingforthesunnydays]

This new NHS initiative, “Jess’s rule” is supposed to remind GPs to “rethink” things if a patient has had 3 appointments and they haven’t been able to diagnose them with anything. AIBU to think this should be blindingly bloody obvious?! And it’s actually embarrassing that we’re putting up posters to “remind” GPs to get a second opinion or refer on for tests if someone’s had 3 appointments with severe symptoms and hasn’t got a diagnosis. The initiative is a result of the death of Jessica Brady, who was 27 & died of cancer that was missed by GPs in December 2020. She had 20 appointments with SIX different GPs at the same surgery. She was suffering from unexplained weight loss, vomiting, and night sweats which were steadily & significantly worsening. Yet she was told she had long covid (even I know these are not the symptoms of long covid) and was “too young” for cancer. She eventually paid for a private doctor who diagnosed the cancer but by that time it was too late, it had spread and she died 3 weeks later. Am I missing something by thinking these GPs are 100% personally at fault for missing this? Wouldn’t anyone in their right mind think to refer her for further tests if she’d had 20 appointments with six different GPs and her symptoms were severe and getting worse?! Apparently none of the individual GPs have been blamed or investigated at all. It’s being seen as a wider issue with the NHS in general - I really disagree that it is. I can’t imagine going to my gp 20 times and never being referred for further tests. AIBU to think this gp practice is the one at fault here and some disciplinary action needs to be going on?

I do want to add for this thread that I have had so many encounters with brilliant caring GPs who have taken their time and made a huge difference to me or my children.

But I do also think that there is a bit of an assumption that female patients may be presenting with anxiety or similar and this can stop doctors seeing what is really going on. I would really love that to be a system where when someone finally gets a diagnosis they can request that the doctors who didn't spot it are just alerted to the fact so that they can learn from it. I didn't feel angry with the doctors who missed my diagnosis but I would have loved them to have all found out and reflected on their practice.

When there is a thread like this obviously everyone piles on with their own or a friends story of misdiagnosis and I am sure they are all true. What is never taken into account however is the other side of the story. All the sore throats and rashes that were viral and didn’t need antibiotics. All the abdominal pain that was constipation or IBS and not cancer. The GPs job is a hard one to pick out the serious from the far more common non serious presentations they see. Sometimes even good GPs will get it wrong and there should always be safety net advice given to come back if it’s worse.

As a psychiatrist I not infrequently see people who have been mugged off for thousands of pounds on a string of private consultations for every body system going whereas in fact they actually did have somatised depression or health anxiety which when correctly diagnosed was able to be treated or at least improved. However on Mumsnet these conditions do not exist and are made up by evil Drs who are hell bent on failing to diagnose a rare endocrine cause. More investigations and consultations are not always a good thing in such cases.

As someone who had cancer in 2025 it shocked me how much you can be dismissed by the GP. I knew something wasn’t right and I really, really had to make a nuisance of myself to be referred. At one point I was told the relentless breast pain that actually woke me at night meant ‘I needed a bra re-measure’.

I agree that a referral/antibiotics is absolutely the easiest thing a GP can do.

Personally I don't think blanket rules are beneficial. I work in hospital care and see reems of inappropriate referrals from primary care everyday (not usually Gps). No investigations, patients referred in on 2ww pathway without any need or any proper history. Patient is happy because they got seen quickly, but absolutely didn't need that slot and patient 2 who actually did have cancer has now been delayed.

I also think people conflate multiple normal investigations with being fobbed off. And some people will manipulate the system if they know there's a 3 strikes rule so clinical judgement has to be used

The case of Jessica Brady is horrific, and should never have happened. But she did see multiple practitioners I.e a second opinion was sought and she did have a diagnosis (long covid) it was just wrong. That history should always have a been a red flag for cancer/referral and its always been an unspoken rule that cases like that should be referred

I don't see how the rule will prevent cases like Jessica Brady, I think it will just put more strain on the NHS.

It’s a lot worse if you are a female and have ever been diagnosed with a mental health problem too. I had anxiety and was totally overlooked for a sudden onset 10/10 headache several times. (Not just GP in A&E too)!! Ended up in A&E 5 times over 2 days and in a state of total delirium eventually being admitted to hospital… after a few days the consultant finally saw me and said that they would do an MRI and if nothing wrong it might be that there was a psychiatric cause!

days later they did the mri and I had a rare brain condition which had caused several strokes!!

months later after rehab etc, I got my medical notes and saw that in A&E they had redacted some stuff - which was that on my history they had “hypochondriasis”!!!

Also, the consultant had written in my notes before my MRI that I was to be referred to the Psychiatrist for assessment for post natal psychosis (I was 6 months post post partum at the time). It was horrific but I think I was medically gaslit and once anxiety had been put on my notes they didn’t look further! I was in agony, vomiting etc and the worse pain of my life!!

Disgusting and so sad.

my mum was fobbed off with ‘depression’ for over two years even though many of her symptoms didn’t match depression. Only after complete insistence from me and my sister and literally kicking up a stink demanding an MRI was it found she actually had a massive brain tumour. Diagnosed on the Monday removed on the Friday. It was the size of a tennis ball. She had a really hard recovery but now is like a different person.

did we even have any sort of apology from the GP practice. No. Nothing.

It took five months and countless appointments for them to accept I had a broken back, five broken bones and a sixth damaged, plus drop foot, I had been telling them exactly what was wrong since the beginning.

I’ve come to accept that they ask obvious questions when you walk in; they need to hear you say it. But to not know your history with all the data on a computer in front of them is unforgivable

What a tragic case
it needs a full and proper investigation as to the mindset of a group of gps following a groupthink mentality that there was nothing wrong

why did the fresh pair of eyes private doctor pick it up ?

it could be a mixture of covid , time , laziness or arrogance but it needs a proper investigation

What’s even more disgusting throughout my mums ordeal I found research has shown if you are man you are more like to correctly diagnosed with brain tumours and heart attack as women are fobbed off as hormones. Fucking patriarchy at its best.

I had the same thought. Basically if a GP has seen the same patient 3 times without action, they're assuming the patient is a time waster. They need telling they shouldn't do that?

Wow. I have to say I think our GP surgery isn't like this. It's so awful that this has happened, such a tragic case. I do have a diagnosis of health anxiety, but they don't fob me off as 'oh it's just anxiety', and I have always been referred for tests etc when needed.

I had an appointment with a GP, not my usual one but the surgeries re linked.

My symptoms were vomiting and weight loss. I was given a FIT test there and then. I was also booked in for blood tests at my own surgery on the Monday (Saturday appointment).

The FIT test was positive so I was sent for a colonoscopy and sent to the 'vague' clinic. I was then set for a CT, MRI, endoscopy, chest X-ray, a follow up colonoscopy (they had removed some polyps) and ultrasound.

They still don't know what is wrong with me but this is what poor Jess should have had. RIP Jessica Brady.

I'm not well at the moment.

I've got several symptoms that have been ongoing for a couple of years now but recently I've developed problems with swollen legs and feet. I feel unsteady on my feet now, I'm struggling with work and generally walking around. I've been fobbed off several times and told it's just a normal part of aging.

I'm 48!

My friend went to the doctor repeatedly with shoulder pain and was prescribed painkillers without any examination. It was only when he saw a private osteopath, who told him to go back to GP and insist on a scan because he didn't think it was musculoskeletal, that his cancer was found. Dead now 😪

My DD recently turned 28, so similar age to Jess. After a couple of years of knee pain being dismissed as damage from overtraining, (she also had stress fractures) she was finally referred for MRI but got one privately instead as there would be along wait.
She has a cancerous tumour in her femur. Diagnosed two weeks ago. It's huge. Just about to have a PET-CT scan to check for spread/ metastasis. She'll have surgery in about 3-4 weeks - the surgery is huge and shocking. We're so shattered.

We don't yet know the extent of metastasis, but her cancer has been growing for at least 2 years. Earlier detection (and less fobbing off) would have given her a much better prognosis and treatment options.

I had an appointment with a GP, not my usual one but the surgeries re linked.

My symptoms were vomiting and weight loss. I was given a FIT test there and then. I was also booked in for blood tests at my own surgery on the Monday (Saturday appointment).

The FIT test was positive so I was sent for a colonoscopy and sent to the 'vague' clinic. I was then set for a CT, MRI, endoscopy, chest X-ray, a follow up colonoscopy (they had removed some polyps) and ultrasound.

They still don't know what is wrong with me but this is what poor Jess should have had. RIP Jessica Brady.

It is interesting that a lot of the examples in PPs are from 15-20 years ago. Maybe things have changed?

My recent experience is that what I think are quite mild things get referred on for detailed investigation. I had some vaginal bleeding that resulted in a vaginal examination during the gp appointment, then an ultrasound scan and then a cervical biopsy and examination by a specialist. Ive also had some intestinal pain which meant being referred for blood tests, a stool sample, and an ultrasound which has led onto further investigation on one of my kidneys from the initial gp appointment. In both cases the gp has phoned me to let me know how things are progressing. I’m a 50 something menopausal woman so expected to be fobbed off.

As a pp said, the vast majority of rashes and pains are simple things that would result in enormous increased costs and delays for everyone if they were all referred to specialists straight away.

I have a Gp friend who has many patients that keep coming back even though they have had all the tests and investigations, should she just keep referring them?

I would not use the term ‘time waster’ but surely you are aware that many people consult GPs frequently and they actually don’t have anything seriously wrong with them at all? Every GP practice has those patients. Some people also call 111 and 999 ambulances frequently to the extent that hospitals have to put in ‘frequent attendee’ plans for them. Consulting frequently really isn’t a marker for serious illness it’s usually quite the opposite. Newly starting to consult frequently I would say is a different matter and should be looked into but we can’t categorically state that everyone who consults a Dr more than 3 times with the same symptoms definitely has a serious undiagnosed condition.

This is why I would never go to a GP with something like anxiety or depression. I'm convinced that once that was in my medical notes any symptoms I had of anything serious would be fobbed off as mental health related.

Unfortunately nowadays many many people present many many times and are investigated many many times for the same thing. I really don't think the public (or the government) really appreciate the volume of patients GPs have contact with. For ONE week I would like every GP to refer urgently every patient that has presented 3 times. If you think its bad now, secondary care services would be done in a day.
Dont let government rhetoric and gaslighting scapegoat the front line staff.

Oh lovely, another GP bashing thread.

For those who are interested in learning something (not just ranting about how overpaid and shit GPs are)……whilst I can’t comment on the details of this case as I don’t know them, and it’s possible the GPs were negligent, it’s worth people knowing that us GPs don’t have unfettered instant access to secondary care.

2 week wait referrals are strictly governed by specific criteria, such as age of the patient, what their haemoglobin level is, if they have positive cancer markers, if the have a positive FIT etc. We can’t just refer people because we’ve run out of ideas and have got a bad feeling. Of course we can refer via the normal (not 2ww) pathway, but the waiting time can be a year.

I’ve currently got a patient with some dodgy bleeding on HRT. She doesn’t fit the urgent pathway. I’ve referred her on the “correct” pathway, and the waiting time is about 9 months. I wrote to gynaecology expressing my concern at her symptoms, and was advised to give her higher doses of hormone to suppress the bleeding while she waited for her appointment.

In the past I’ve lied on 2ww forms, in order to get a patient seen when I had a gut feeling that something was wrong, but you can’t do that regularly. And you can only really stretch the truth, not tell outright lies.

Referrals to secondary care are triaged by non clinicians much of the time, and if the specific criteria aren’t met, then our referrals are rejected.

I work in ED the amount of people diagnosed with cancer is shocking.
Also you hear about GPs saying people are too young for cancer , this needs to be addressed immediately. Of course no one is too young.

GPs can’t refer breast pain on the 2 week wait pathway. There has to be a lump or skin changes.