A delayed diagnosis

The 65-year old patient, who had died due to colonic carcinoma, had seen the GP with a three-month history of rectal bleeding and his daughter considered that there had been a delay in referral and diagnosis which had resulted in the patient's premature death.
The patient's daughter initially complained in writing to the practice, which responded by providing an account of the patient's consultations and explaining that they considered that the GP concerned had managed the patient appropriately. The practice met with the daughter to discuss her concerns.

At the conclusion of that meeting she remained dissatisfied as she considered that her father should have been referred urgently for investigation, that the practice had not acknowledged this to be the case nor apologised for not having done so.
The daughter asked the Ombudsman to review her complaint. The practice then asked for the MDU's assistance.
The MDU advised that, in line with the NHS complaints procedure, practices were expected to analyse any complaint received in order to determine what lessons, if any, could be learnt from it and to identify what changes, if any, should be made as a result of the case.

The MDU warned that it was likely that the practice would be criticised by the Ombudsman for not having done this and advised the practice to consider analysing the complaint through their significant event audit procedures.
As part of this analysis the MDU recommended that the practice referred to the NICE referral guidelines for suspected cancer and considered seeking an independent opinion on the care provided in this case, which should be anonymised. They were advised to offer to provide the complainant with the results of their analysis, to acknowledge any mistakes and to apologise as appropriate.
The practice's investigation identified that the care provided had not been in line with NICE guidance, which was that the patient should have been referred urgently to a team specialising in the management of lower gastrointestinal cancer. This view was supported by an independent colorectal surgeon. The practice wrote both to the Ombudsman and the complainant, detailing the investigation and its findings.
The Ombudsman, having sought independent clinical advice, found the complaint to be partially upheld. She did not uphold the aspect of the complaint that the delay in diagnosis had led to the patient's death but she did consider that the practice had failed to refer the patient appropriately under the two-week rule in accordance with guidance.

She also found that the practice had failed to acknowledge mistakes and to apologise for these in their initial response. The Ombudsman recommended that the practice apologise to the complainant for the mistakes and for the suffering and distress that had occurred. The practice apologised to the daughter for the failings in her father's care and the handling of the case and the complaint was resolved.
This case is anonymous but based on those from the MDU's files.

This page was correct at publication on 24/11/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.