The GP practice did not assess Mr L's mole adequately in 2010 and did not refer him to hospital with suspected cancer. His daughter, Mrs N, was distressed because she believed that her father was not adequately assessed or referred when he should have been. The inadequate handling of her complaint by the practice and the Trust caused her further unhappiness.
What happened
In 2003 the practice assessed and removed a mole from Mr L's back and sent it to the Trust for biopsy. Although the Trust said that there was no evidence of cancer, after Mr L's death in 2011, it retested his mole and found cancer had been present. It apologised to Mrs N but explained that her father's chances of survival had not been affected by the error.
Mr L had visited the practice in 2010 because his mole had come back. The assessment was brief, and the practice did not refer Mr L to hospital for further investigations.
During a routine hospital appointment a month later, doctors discovered that Mr L had cancer. He subsequently died in spring 2011. After Mrs N's complaint, the practice wrote to her to explain that there was no suspicion of cancer during its assessment, and that it had followed the relevant guidelines.
What we found
The Trust's comments about Mr L's chances of survival were appropriate. However, it did not respond to subsequent correspondence from Mrs N, which caused her distress.
The practice failed to adequately assess Mr L in 2003 or 2010. There was not enough evidence to conclude that the practice should have referred Mr L to hospital in 2003. However, there was evidence that it should have referred him in 2010, but it did not.
Some of the practice's responses to Mrs N's complaint were evidence-based, but others were not and were ambiguous. The failure to adequately assess Mr L, or refer him to hospital when it should have done, caused Mrs N distress that was compounded by the practice's, and the Trust's, inadequate complaint handling.
Putting it right
The practice and the Trust acknowledged and apologised for the failings and the injustice these led to.
The practice paid Mrs N £250 compensation. It produced an action plan that set out how it will prevent these problems happening again.
The Trust explained how it will communicate better with complainants in future.
A GP practice
University Hospitals of Morecambe Bay NHS Foundation Trust
Cumbria
Came to an unsound decision
Apology
Compensation for non-financial loss
Recommendation to learn lessons or draw up an action plan
Taking steps to put things right