Majority of NHS cancer care complaints caused by GP delays

Patients in a clinic waiting room
The most common reason was a delay in referring men to a specialist doctor despite them having symptoms - SolStock/E+

The majority of official complaints about cancer care are caused by GP delays, an analysis of reports by the Medical Defence Union (MDU) has revealed.

About four in five of the complaints and claims for compensation made by cancer patients were against GPs, according to the MDU, which provides indemnity for clinicians.

A study of 106 cases involving prostate and testicular cancer patients in a two-year period and published in 2018 revealed that 92 per cent had taken action against their GP.

The most common reason was a delay in referring men to a specialist doctor despite them having symptoms.

This was attributed to misdiagnosis, a lack of a “family doctor” to provide continuity of care, and missed follow-up appointments.

For example, some men with high protein-specific antigen (PSA) test scores were not given follow-up examinations, while one man – who did ultimately have prostate cancer – was denied a PSA test despite having a family history of the disease.

More than half of the complaints led to claims for clinical negligence.

A separate study revealed a similar trend among women being treated for breast cancer, with 77 of 84 claims directed at GPs and all of them citing missed or delayed diagnoses.

In 58 cases, the women were under 50 and so were not eligible for NHS screening.

A landmark report published by Cancer Research UK last week found that Britain is still lagging behind European counterparts despite a “war on cancer” announced 18 months ago.

Prof Sir Mike Richards, the former national cancer director at the Department of Health, said that late diagnosis was to blame and the NHS would miss its target to diagnose three-quarters of cancers at stage one or two, when it is easier to treat, by 2028.

The report called for a dedicated plan to improve cancer survival that could save 20,000 lives a year by 2040, pointing out that Denmark, which had languished at the bottom of league tables alongside England almost 30 years ago, had since “raced ahead, with consistent funding and long-term cancer strategies”.

Further studies by the MDU revealed that in cases of melanoma, an aggressive skin cancer, 66 of 79 patients who had made claims were seen at a general practice, including three people examined by nurses.

Delays in diagnosis ranged from three weeks to three years among people aged between 15 and 85, the study said, adding that “a delayed diagnosis may lead to a poorer prognosis” because of the cancer spreading.

There were 165 complaints made by patients or their relatives diagnosed with pancreatic cancer in five years.

The study did not break down the number directed at GPs but said there was “confused clinical decision-making”, with doctors ordering blood tests instead of the recommended CT scans, blaming pre-existing conditions and failing to weight patients.

It said that delays were caused by “poor continuity of care and communication with several GPs being involved in the patient’s care in the run up to diagnosis”.

There were also 209 claims relating to ovarian cancer in nine years, “mostly” relating to GPs.

An NHS spokesman said: “While some of the data used is more than a decade old, the latest data actually shows that GPs are referring more people for urgent cancer checks than ever before – in September this year, NHS staff saw over 257,000 people following an urgent referral by their GP, compared to 195,000 in September 2019.

“As ever, we would encourage anyone worried about symptoms which may be cancer to contact their GP practice so that they can get checked.”

‘UK has worst cancer survival in G7’

A new study published in the BMJ Quality & Safety journal has described deaths, serious harm and wrong or missed diagnoses resulting from virtual GP consultations. That data was collected from 2020-23, when virtual consultations were at their peak, triggered by total triage to cope with the Covid pandemic. Face-to-face consultations were reduced to a minimum. Because virtual consultation is so convenient for GPs, this practice is slow to reverse.

However, evidence of patient harm from missed or delayed diagnosis has existed for a decade or more before 2020, when there were few remote consultations and when general practice was not so frantic. The evidence, presented here, draws attention to the questionable competence of some GPs and their inability to recognise red flag symptoms.

This evidence has been hiding in plain sight and can be accessed from the MDU website and its journal. The MDU provides indemnity for doctors. My interest relates to delay in diagnosis of cancer but the MDU site also describes delay in diagnosis of non-malignant conditions.

The UK has the worst cancer survival in the G7 group of countries and also among Western European countries, despite our excellence in research and development of cancer treatments. This week, Cancer Research UK suggested that at least 20,000 cancer deaths annually are avoidable.

Concern has been raised that this poor cancer survival may be because of insufficient diagnostic facilities or the short delays in starting treatment from the time of diagnosis. I would suggest that these are minor causes.

It is an indisputable fact that the best way to reduce deaths from cancer is early diagnosis. Even the best radiotherapy and chemotherapy cannot regain the survival advantage lost from late diagnosis, more advanced disease and the inevitable deterioration in prognosis. Screening is important and the best example is the huge improvement in survival from cancer of the cervix.

The following MDU data on delay in diagnosis is incomplete but nevertheless alarming. In repeated correspondence, the MDU has refused to provide me with any additional data including information on compensation paid, but this is where some of the skeletons lie for further investigation by agencies more important and powerful than I am. The MDU is not subject to freedom of information requests.

In an analysis of 84 complaints and claims for compensation following the late diagnosis of breast cancer in a four-year period, 77 (92 per cent) related to GPs. Most patients were between 30 and 50 years of age when the diagnosis may not have been considered. The two-week urgent pathway was available.

A doctor speaks to patients in a waiting room
'The evidence draws attention to the questionable competence of some GPs,' writes J Meirion Thomas - Ghislain & Marie David de Lossy/Getty

Following the diagnosis of prostate or testicular cancer, 106 complaints/claims were made to the MDU in a two-year period and 92 per cent were against GPs.

There were 79 complaints/claims in a two-year period following the diagnosis of malignant melanoma (an aggressive skin cancer). Of these, 66 (84 per cent) related to patients seen in general practice. The equivalent figure quoted by the Medical Protection Society, another indemnity provider, was 94 per cent.

Following the diagnosis of the rare bone cancer, myeloma, 61 cases were referred to the MDU in a three-year period, with 76 per cent against GPs.

There were 165 complaints/claims made by patients or their relatives diagnosed with pancreatic cancer in five years, and 209 relating to ovarian cancer in nine years, “mostly” relating to GPs.

The MDU articles describe some GPs being referred to the General Medical Council for further investigation. Repeatedly, they stress the importance of continuity of care and seeing the same GP for repeat visits as methods of reducing diagnostic errors. This is particularly important when cancer symptoms are vague and non-specific as, for example, in ovarian or pancreatic cancer.

This advice is contrary to the current ideology of group general practice where patients are regarded as the responsibility of the practice and not of a named GP. That risk is compounded by part-time working and the liberal use of locums.

Admittedly, GPs work at the cutting edge of medicine. They are generalists and are exposed to the whole spectrum of medical diseases. Nevertheless, to improve, they will need longer hospital training and a greater commitment to continuity of care.

It is hard to avoid the conclusion that at least to some extent, GPs are responsible for the poor cancer survival in the UK.

J Meirion Thomas is a recently retired cancer surgeon