Summary
Mrs C complained that the practice failed to take appropriate action when her late father (Mr A) presented to them reporting symptoms of back pain. Mr A was 81 years old at the time and Mrs C considered that the GPs failed to recognise potential underlying symptoms and arrange appropriate investigations. Mr C was initially given pain medication and told to return if his symptoms did not improve. When his symptoms had not improved by the following month, a referral was made to urology for further investigation. Shortly after this, Mrs C removed Mr A from the practice and took him to live with her. He was subsequently diagnosed with terminal cancer.
We took independent GP advice, which noted that the GP elected to refer Mr A to urology due to his history of raised prostate-specific antigen (PSA). This is a protein produced by cells of the prostate gland, levels of which can indicate prostate cancer or other problems with the prostate. Mr A had been diagnosed two years previously with benign prostatic hyperplasia (BPH) - an enlarged prostate gland - and he was prescribed medication for this. Mr A’s PSA had last been checked around this time and we were advised that this should have been followed up by the practice with an urgent urology referral, rectal examination, and repeat blood tests.
The next clinical prompt for checking Mr A’s PSA was when he presented with back pain but this was not done. We were advised that new onset back pain in a man of Mr A’s age should have been a red flag sign and should have prompted further investigations and/or specialist referral. The practice acknowledged that further investigations should have been carried out, including a check of Mr A’s PSA. We were also advised that Mr A’s PSA should have been re-checked at the time of referring him to urology and, again, the practice acknowledged that this should have happened. It was also noted that the referral was sent on a routine basis, when we were advised it should have been given an urgent priority.
We found nothing to link the identified failings to Mr A’s death. His death certificate recorded gastric cancer and no prostate cancer diagnosis was evident. However, we were advised that the actions taken by the GPs were unreasonable irrespective of the cause of death. We found it particularly concerning that their knowledge of Mr A’s history of raised PSA, and lack of follow-up in this regard, did not appear to have prompted a higher degree of suspicion when he presented with new onset back pain. In the circumstances, we upheld the complaint. While we were satisfied that the practice had ultimately demonstrated adequate reflection, we considered that there were earlier opportunities for them to have recognised the noted failings. In particular, they carried out a significant event analysis which did not identify any shortcomings in the care provided.
Redress and Recommendations
The Ombudsman recommends that the practice:
- apologise to Mrs C for the failings this investigation has identified; and
- ensure that the Practice team involved in carrying out significant event analyses have familiarised themselves with the relevant NHS Education for Scotland guidance and report back to the Ombudsman when this has been done.