Investigation Report 201304325

  • Report no:
    201304325
  • Date:
    November 2014
  • Body:
    A Medical Practice in the Grampian NHS Board area
  • Sector:
    Health

Overview
The complainant (Mr C) raised concerns about the care and treatment his wife (Mrs C) received from the GPs at the medical Practice (the Practice) from January to October 2013.  Mrs C subsequently attended Aberdeen Royal Infirmary, where she was diagnosed with bowel cancer.  Since the events within this complaint, Mrs C's condition deteriorated further, and she sadly died during the course of our investigation.

Specific complaint and conclusion
The complaint which has been investigated is that there was an unreasonable delay by the Practice in 2013 in diagnosing Mrs C's cancer (upheld).

Redress and recommendations
The Ombudsman recommends that the Practice:

  • apologise to Mr C for their failure to appropriately refer Mrs C for diagnosis of her cancer during the period from January to October 2013, and for the distress this caused her and her family;
  • provide evidence that the actions set out in their Significant Event Analysis have been met, giving consideration to the NHS Education for Scotland Enhanced Significant Event Analysis approach;
  • identify the training needs for the practice team relating to the issues raised in this complaint, and reflects these in appraisals and assessments; and
  • explain what changes the Practice will introduce to ensure that, in future, their procedures for Significant Event Analyses are in line with national guidelines, and that they receive the prompt attention of the whole Practice.

The Practice have accepted the recommendations and will act on them accordingly.

Updated: December 11, 2018