3. Mrs B complains the Practice did not provide her with a timely referral to hospital in August 2022 after a pharmacist told her she had a possible cancerous growth on her face.
4. Mrs B told us this resulted in a delay to her diagnosis and treatment.
5. She is looking for an explanation and service improvements.
6. Mrs B was a patient at several different GP practices before she registered at the Practice on 8 August 2022.
7. It is unclear when Mrs B went to the pharmacy as she does not recall the exact date and the Practice does not have a record of this.
8. On 9 August, Mrs B attended Royal Liverpool University Hospital’s (the Hospital) Accident and Emergency (A&E) which resulted in her being seen in the Hospital’s ophthalmology clinic.
9. On 17 August, the ophthalmology clinic wrote to the Practice explaining Mrs B had a visual acuity test and she should see her GP for an urgent referral to an ‘ocular plastics’ team. A visual acuity test tests vision, to see how well someone can see a letter or symbol from a certain distance. Ocular plastics deals with surgical procedures on the eye and surrounding structures, including the eye lids and parts of the face.
10. On 23 August, Mrs B had a review at the Practice about a separate medical issue. At the same appointment, a GP measured and took photos of the lesion on her face. A lesion is tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumour.
11. The Practice sent the details of Mrs B’s lesion to a consultant dermatologist on the same day. Later that day the consultant dermatologist made a probable diagnosis of basal cell carcinoma. Basal cell carcinoma is a type of skin cancer that most often develops of areas of skin exposed to the sun, such as the face.
12. On 26 August, the Practice referred Mrs B to the Hospital’s plastic surgery department.
16. Mrs B attended A&E and then had an assessment in the ophthalmology department on 9 August.
17. The ophthalmology clinic wrote to the Practice on 17 August. It said it had advised Mrs B to see her GP about an urgent referral to an ocular plastics department. The letter also said, ‘could be malignant’. Malignant is a term used to describe cancer. The letter does not say what the referral was for, or what it considered might be malignant.
18. The Practice received this letter on 19 August and contacted the ophthalmology department for further clarification on the same day. It asked who the member of staff the letter referred to was, what the problem that needed a referral was, and what the clinic had told Mrs B.
19. GMC’s Good Medical Practice says doctors should refer a patient to another practitioner when this serves the patient’s needs.
20. We consider the Practice asking for clarification was in line with this guidance as it was trying to get more information in order to establish how it could meet Mrs B’ needs. It also contacted Mrs B to arrange a face to face appointment. Our adviser agreed and said the Practice would not have been able to act on the request for a referral without further information.
21. During the telephone call, Mrs B told the Practice she had already sorted out an eye hospital appointment for 22 August.
22. On 23 August, Mrs B attended the Practice for a review of an unrelated health matter. At the same appointment, the GP assessed Mrs B’s facial lesion and took measurements and a photograph.
23. On the same day, the GP sent a referral to the Hospital’s dermatology department saying they thought the lesion was likely to be a basal cell carcinoma.
24. The Hospital responded the same day agreeing with the GP’s probable diagnosis. It suggested a referral to either the plastic surgery department or the ocular department due to the proximity of the lesion to Mrs B’ eye.
25. On 26 August, the Practice referred Mrs B to the Hospital’s plastic surgery department, three days after it had seen her.
26. NICE Guidance says GPs should ‘consider a routine referral for people if they have a skin lesion that raises the suspicion of a basal cell carcinoma’.
27. NICE Guidance also says that a suspected cancer pathway (for an appointment within two weeks) should only be considered for people with a skin lesion that could be a basal cell carcinoma, if there is particular concern that a delay may have a significant impact, due to the size or placement of the lesion.
28. There is nothing in Mrs B’ medical records to show that the dermatology department was concerned by the significance of the lesion. Our adviser said that for this reason, Mrs B did not need to be referred urgently via the suspected cancer pathway.
29. Based on NICE Guidance, the Practice acted appropriately when making Mrs B’s referral. We have not seen any indications of failings as there is no evidence of a delay.
30. We recognise how difficult it can be to make a complaint. We thank Mrs B for bringing her concerns to us. We hope we have explained our decision clearly.
1. We have carefully considered Mrs B’s complaint about a GP Practice in the Liverpool area (the Practice). We were sorry to hear about her cancer diagnosis. We do not underestimate the distress this has caused.
2. From the evidence we have seen, we have seen no indication the Practice did anything wrong. We will explain our decision below.