Decision Report 201704277

Summary

Mr C complained on behalf of his late wife (Mrs A) that the practice failed to provide a reasonable standard of care and treatment. Mrs A attended the practice with pain in her right chest wall which was thought to be related to an injury. The practice noticed a small lump over her clavicle (collar bone) and requested an x-ray, which showed no significant abnormality. Mrs A attended the practice again with worsening shoulder pain and was referred to orthopaedics (the branch of medicine involving the musculoskeletal system). Mrs A was later diagnosed with bone and liver cancer. Mr C complained that the practice failed to note Mrs A's history of breast cancer on the x-ray request form and that they had not chased up the orthopaedic referral.

We took independent advice from a general practitioner. We found that there was no indication for the practice to consider cancer as a possible diagnosis. The practice had been investigating Mrs A's shoulder pain and lump as an injury and we considered that the practice's diagnosis was reasonable. We did not uphold Mr C's complaint. However, we identified failings in the way the practice handled his complaint and made recommendations in light of this.

Recommendations

In relation to complaints handling, we recommended:

• The practice should ensure that they have adopted the model complaints handling procedure and all staff should be aware of this. The model complaints handling procedure and guidance can be found here: http://www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.