A practice in the Solihull area

3. Miss A complains the Practice failed to identify her breast cancer or refer her for relevant tests at an appointment on 5 January 2023. She says during the appointment, the GP documented she had ‘itching’ and there was no lump in her breast. She disagrees and says she could feel a lump.

4. As a result, Miss A says she has suffered distress and has lost trust in the medical staff. She also has unanswered questions about her care.

5. Miss A is seeking a financial remedy, an apology and service improvements.

7. To decide if we should conduct a detailed investigation, we first consider if there are reasons not to. These include if an investigation might not be practical or come to a satisfactory conclusion. We have considered this case and think we should not investigate it. On balance, there is not sufficient evidence available to reach a robust view of the care provided.

8. Miss A visited the Practice on 5 January 2023. She gave us her account of what happened during her GP appointment. She told us she could feel a lump in her breast, and she told the GP this.

9. The records from the appointment show the GP examined her breasts. The GP recorded Miss A had ‘itching’ and ‘dryness’ on her right upper breast, but there was no lump present. There is also no record of Miss A telling the GP about the lump during the appointment. The GP prescribed her with a hydrocortisone cream (a topical steroid that can be used to treat a variety of inflammatory skin conditions) for the itching. They also gave her safety netting advice and told her to come back for another appointment if her symptoms changed or did not improve.

10. Miss A returned to the Practice on 13 April as she still had concerns about her breast. The records indicate the GP examined her breast and found a lump. The GP referred Miss A to the breast clinic for further investigations. Miss A was diagnosed with stage two breast cancer on 13 June.

11. Miss A says her GP should have referred her for further investigations at the appointment on 5 January. She feels her cancer diagnosis and lump was missed at this appointment. We are very sorry to hear this has led her to losing trust in medical staff. We recognise this was an incredibly difficult and distressing time for her.

12. In its response letter of 26 October, the Practice confirmed the GP could not feel a lump during their examination on 5 January. This is in keeping with what they recorded in the clinical records. Sadly, there are no other medical records, or any other sources of evidence available, to help us determine on balance, whether a lump was present at this time. We are left with two different accounts from Miss A and the GP about what her symptoms were.

13. It is important to explain our role is to make independent final decisions about NHS complaints in England. We make decisions by weighing up and considering all the available evidence. We then consider the likelihood that something has gone wrong with the service provided. As we are impartial, we must make robust decisions based on facts and evidence. Unfortunately, Miss A believes her medical records are not factual and we are not able to prove or disprove this. Regrettably, without further evidence we are not able to reach a view on whether something likely went wrong at this appointment. For this reason, we consider a formal investigation would not be practical for this complaint.

14. We recognise this may cause Miss A further frustration. We are sorry we have not been able to investigate her complaint further or provide her with closure for her concerns. We would like to thank her for her time and effort in bringing this complaint to our attention.

1. We have carefully considered Miss A’s complaint about a practice in the Solihull area (the Practice). We were very sorry to hear Miss A feels the Practice missed an opportunity to refer her for breast cancer investigations in January 2023. We recognise this has caused her significant worry and distress. We would like to wish her the best for her future care and treatment.

2. On balance, we sadly cannot reach a view on the care Miss A received. This is because, Miss A and her GP have a different recollection of what symptoms she presented with during the appointment. We do not have sufficient evidence available to us to determine what most likely happened or what was discussed during the appointment. For this reason, we have decided not to consider this complaint further.