GP failed to refer husband for further investigations for prostate cancer and delayed in diagnosing wife's heart problems

What happened

The GP received Mr B's test results soon after the first consultation. These indicated that Mr B was at increased risk of prostate cancer.

According to guidelines issued by the National Institute for Health and Care Excellence (NICE), he should then have referred Mr B to a specialist but the GP did not refer him at that stage. Mr B returned to his GP in early summer 2008, when further tests were carried out. The GP referred him to a specialist and he was diagnosed with an aggressive form of prostate cancer, for which he underwent radiotherapy.

Mrs B visited her GP in early 2008 complaining of breathlessness. He prescribed an inhaler.

Mrs B returned to her GP in the spring of the following year and her GP referred her for an ECG (a test that records the electrical activity of the heart). Shortly afterwards she was diagnosed with heart failure (the heart not pumping the blood around the body as well as it used to) and atrial fibrillation (a condition that causes an irregular and often abnormally fast heart rhythm).

What we found

We decided to investigate in spite of the significant time that had passed. The delay in diagnosis resulting from the GP's failure to refer Mr B immediately had led to an increased risk of Mr B's cancer recurring or spreading to other parts of the body.

The GP did not record details of his examination of Mrs B's chest or heart in spring 2008; he did not record her heart rate or his assessment or diagnosis of her condition.

In early 2009, the GP referred Mrs B for an ECG but did not record his finding of an irregular pulse, Mrs B's heart rate or any assessment for heart failure. We could not say whether appropriate examinations took place because there were no proper records. We concluded that there was no evidence of an adequate history or examination when Mrs B presented with breathlessness in spring 2008. There was no record of her heart rate or any assessment for heart failure when she returned to the GP the following year, although there was a full history in the referral letter that indicated the GP had been recording Mrs B's pulse.

The GP said that he examined and assessed Mrs B correctly, but we were unable to come to a view on this in the absence of appropriate records. We found that the delay in diagnosis gave Mrs B an increased stroke risk. We also found that Mrs B's symptoms of breathlessness could have been alleviated if the GP had prescribed the correct medication earlier.

We did not think that the delay in diagnosing her condition had had a long–term impact on Mrs B's prognosis, however.

Putting it right

We recommended that the GP should discuss the outcome of the investigation at his next appraisal. The GP paid Mr B £500 in recognition of the distress caused as a result of the failure to refer him in good time.