GPs advised on avoiding missed cancer diagnoses

  • Over 250 GPs contact the MDU each year for advice on complaints or negligence claims involving cancer diagnosis.
  • Breast, prostate, bowel and lung cancers feature frequently in MDU cases.

NICE published its updated referral guideline for suspected cancer earlier this year. The guideline was published as concerns were being raised in the media about the time it takes to diagnose the major forms of cancer (breast, bowel, prostate and lung cancer).

An international study published in BMJ Open suggested the UK's cancer survival rates were worse than other countries' because GPs were less likely to immediately refer possible cancer patients for tests. The study suggested that GPs' access to cancer diagnostics like CT and MRI scans could explain the disparity across countries.

The guidance from NICE provides management guidance on suspected cancers by site as well as a list of potential symptoms and how they should be investigated or managed. There is also guidance on safety netting for patients whose symptoms do not meet the threshold for investigation or referral.

Complaints and claims

GPs regularly notify the MDU of complaints and claims arising from alleged delays in diagnosing cancers, or from late referral for suspected cancers.

We reviewed complaints and claims related to the common causes of cancer within the population, namely breast, prostate, lung and bowel cancer. Between January 2010 and March 2015 the MDU opened 1,453 files - averaging over 250 cases a year - where a complaint or a claim arose from an alleged delayed diagnosis or wrong diagnosis of these types of cancer.

The breakdown of cases were:

  • lung cancer - 467 cases
  • colon/bowel cancer - 453 cases
  • breast cancer - 368 cases
  • prostate cancer - 165 cases

Compensation payments

Only a small minority of GP claims are settled, with the majority successfully defended. But in cases where a compensation payment was made between January 2005 and December 2014, just over 15% resulted from a delayed referral or a missed or wrong diagnosis of cancer.

Some of the compensation payments have been significant, with several exceeding one million pounds and the highest being over two million pounds.

Mitigating risk

It's an unfortunate reality of GPs' work that diagnoses will sometimes be missed or delayed. However, there are steps you can take to mitigate risks for patients and help explain your actions if required. We offer the following advice.

  • Familiarise yourself with the updated recognition and referral guidelines from NICE (NG12).
  • When referring patients, make sure they know how soon to expect an appointment, and who they should contact if they don't receive notification by then.
  • Clearly document any discussions with the patient and their carers about the nature and purpose of the referral and the safety netting advice provided.
  • For patients who aren't referred, consider either scheduling a further review or telling the patient precisely when to seek further advice. Again, document this clearly in the notes.
  • Make sure that appropriate systems are in place within the practice for following up results and ensuring referrals are sent. Remember that the clinician who has requested an investigation is responsible for reviewing and acting on the result of the investigation. If this is not possible then responsibility should be explicitly passed to another clinician.
  • If there is a delay, ensure patients or their relatives receive an apology and explanation.
  • Consider whether you should review a case as part of your adverse incident reporting system, to see if care can be improved to the benefit of all patients.

This page was correct at publication on 22/09/2015. 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.