Poor management of a patient with a breast lump

What happened

Dr M noted a mobile lump the size of a 20 pence piece on Mrs P's right breast in spring 2013. Mrs P subsequently met Dr M again to discuss another, unrelated, matter. Dr M did not re-examine the lump on Mrs P's breast at this appointment and Mrs P did not raise it as an issue of ongoing concern. In early summer, Mrs P returned to the Practice and was seen by a different doctor, who made a referral to the breast clinic. Some weeks later, the breast clinic diagnosed breast cancer. Mrs P had a mastectomy and began chemotherapy treatment in late summer 2013.

What we found

The management plan in the GP records, to review in one month after the first consultation, was appropriate and in line with National Institute for Health and Care Excellence (NICE) guidance. However, on the balance of probabilities, we considered that Dr M did not communicate this management plan clearly to Mrs P.

Despite documenting, after the first consultation, that the plan was to review the lump in a month's time, Dr M did not go back over the consultation notes or carry out a review.

There were failings in communication and the care provided. However, we felt it was highly likely that Mrs P would have had the treatment she received after the referral in summer, even if she had received appropriate care and been referred sooner.

We partly upheld the complaint.

Putting it right

The Practice reviewed the findings of our investigation report and confirmed to Mrs P and us the actions it planned to take to prevent similar failures of care in the future. We advised the Practice to consider our clinical adviser's view that it may be appropriate to arrange to see all patients with a breast lump in four weeks' time, even if the GP strongly suspects that the lump is benign.