A practice in the Devon area

3. Mrs R complains that GP’s at the Practice missed several opportunities from early 2022 to spot the signs of cancer in her father. Mr C was diagnosed with secondary cancer in January 2023 and sadly died in March 2023.

4. Mrs R says if the Practice had acted sooner, her father could have been saved and may not have suffered like he did, which was distressing for her and her family to see.

5. Mrs R would like the Practice to accept it missed opportunities to spot the signs of cancer and to apologise for this. She would also like a financial payment that covers the cost of moving her mother to be nearer the rest of the family.

6. Mr C had a history of renal cysts (fluid collection in the kidney). A CT scan (an X-ray using cross sectional images inside the body) from May 2017 showed the cysts had not changed in size.

7. Mr C also had a history of chronic obstructive pulmonary disease (COPD) which is a condition characterised by ongoing respiratory symptoms like a cough or breathlessness. Mr C also had a history of lymphoma (cancer of the lymphatic system) that had been successfully treated.

8. In February 2020, another GP practice who is not part of this complaint, referred Mr C for an ultrasound scan (a test that uses high frequency sound waves to capture images inside the body) for suspected sarcoma (a type of cancer that can happen in bones and soft tissue).

9. In March 2020, Mr C had a mass removed from behind his left knee.

10. Mr C had chest X-rays in November and December 2021 which came back as clear.

11. In December 2021, Mrs R says Mr C had complained of a persistent cough. She thinks the Practice should have repeated a chest X-ray in 2022 when her father complained of shortness of breath.

12. Around the same time, Mr C had blood tests that showed high haemoglobin and higher white blood cell levels. Although this was followed up, the notes showed no further action was taken because of a vitamin deficiency. Mrs R thinks this was a missed opportunity to do scans or tests.

13. On 22 April 2022, Mr C went to the Practice as his hernia had increased in size and was painful (the hernia was diagnosed in October 2021). The GP notes say he was referred for surgery, but Mrs R says nothing came of this. Mrs R says this was another missed opportunity.

14. On 18 May, the Practice did an asthma and COPD assessment over the phone. Five days later it referred Mr R to pulmonary rehabilitation (an exercise and education programme for people with lung disease and breathlessness), but nothing else was done. Mrs R thinks he should have had tests or scans.

15. In early August, Mr C went to Practice with a small lump on his back. The GP notes say they would see if they could list Mr C for surgery. Mrs R thinks the GP should have listed her father for an urgent scan because of his history of non-Hodgkin lymphoma (a type of cancer).

16. On 15 September, a different GP at the Practice examined the lump on Mr C’s back and noted it was 5cm in size. Mrs R thinks the GP should have made an urgent referral due to the size.

17. The GP thought it might be an infected abscess so attempted to lance it (to make a small cut to drain the pus or pressure) but it was not successful. Mrs R thinks this may have made it worse and squamous cell carcinoma (SCC is a type of skin cancer) can mimic an abscess. SCC is what Mr C was eventually diagnosed with.

18. The GP diagnosed Mr C with an infected abscess. Mr C had been down for surgery to have it removed but the GP advised the abscess could not be removed until the infection had settled. The GP gave Mr C antibiotics.

19. On 11 October, Mr C went to the Practice with shoulder pain. The GP said it was a frozen shoulder. Mrs R thinks this was a symptom of lung cancer that the GP missed.

20. At the same appointment, a GP that had not seen the lump before noted that it had not changed from the last visit. Mrs R says the family have pictures that it had increased and looked like an SSC.

21. The GP notes show they requested bloods and gave antibiotics. We have seen the notes say that the cyst looked much the same as it did before the antibiotics, meaning the antibiotics were not having any effect. We also note the results of the blood tests are not listed in the medical records. Mrs R wonders whether they were done.

22. In November, after trying the antibiotics, feeling unwell and seeing no change Mr C went back to see another GP. He showed the GP pictures of the cyst and they agreed it looked infected and referred Mr C on a two-week referral for suspected skin cancer. Mrs R thinks the GP should have requested a CT scan at this appointment.

23. On 21 December, Mr C had the cyst removed.

24. Notes show that on 28 December, Mr C had shortness of breath for the last month, a cough and hoarse voice. The Practice requested an urgent chest X-ray for suspected head and neck cancer.

25. On 10 January 2023, Mr C was diagnosed with SCC as a secondary cancer. The Practice requested a CT scan. Mrs R says the Practice did not order any other tests to find out where the primary cancer was coming from until 17 January. Mr C had the CT scan at the end of January.

26. In early February, Mr C was diagnosed with lung cancer that had spread. Very sadly, a short while later, Mr C died.

28. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We have discussed this with Mrs R to understand her circumstances and the outcomes she wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

29. Because Mrs R believes that Mr C suffered and may have died due to delays in his cancer being diagnosed, she could make a legal claim.

30. We discussed what Mrs R was looking for as an outcome. She told us her mother lives in the South of the country and she lives in the Midlands. She wants a payment that will cover the cost of moving her mother up to live nearer to her. She also wants the Practice to accept its failings.

31. Mrs R could explore a legal route to discuss her options of making a clinical negligence claim. If successful, this could potentially achieve the financial payment Mrs R wants.

32. The other outcome Mrs R would like is for the Practice to accept it missed opportunities to spot the signs of her father’s cancer sooner and to apologise for that.

33. While a court would not necessarily look at this as part of a clinical negligence claim, if the court finds failings, this may indirectly lead to this outcome.

34. When discussing the complaint with Mrs R, she told us that her family wanted to approach a solicitor, but in the end, they decided to come to us first. We cannot see any barriers to Mrs R exploring legal action at this time.

35. We think Mrs R should explore her option by discussing her complaint with a solicitor.

36. Should for any reason Mrs R wants to come back to us after exploring her legal options, we are happy to re-open her case subject to our time limit considerations.

1. We have carefully considered Mrs R’s complaint about a GP practice in the Devon area (the Practice). We have decided Mrs R could take legal action on the matters she has brought to us.

2. We are sorry to learn about the circumstances of Mrs R’s complaint. We appreciate how strongly Mrs R feels about the issues she has raised and that she thinks the Practice missed opportunities to spot signs of cancer for her father, Mr C, sooner. Having spoken to Mrs R about this, we think she should explore the option of taking legal advice.