Royal Primary Care

3. Ms O complains about the care Mr B had from Royal Primary Care between February and March 2023. Ms O complains Royal Primary Care: • incorrectly categorised Mr B’s symptoms as non-urgent resulting in a four-week wait to see a GP • did not properly examine Mr B and wrongly diagnosed him with a blocked gland • did not recognise Mr B needed an urgent referral for suspected cancer investigations, causing a delay diagnosis and beginning treatment.

4. Mr B received a cancer diagnosis on 24 May 2023 after seeing a different GP. His physical and mental health are poor. He is unable to work and needs more treatment despite having radiotherapy and chemotherapy already.

5. Ms O also complains about Royal Primary Care’s communication. She contacted the business support team for help with making a critical illness insurance claim. She says they did not return her calls and only completed the forms after she attended in person. This delayed Mr B’s claim.

6. Ms O would like Royal Primary Care to accept its mistakes, make service improvements and pay Mr B £10,000 or more.

7. On 13 February 2023 Mr B contacted Royal Primary Care to make an appointment. He had been experiencing a persistent cough since December and had a lump in his neck. Royal Primary Care offered him a non-urgent appointment on 9 March.

8. On 9 March Mr B had a GP appointment. The GP diagnosed him with a blocked gland and stated it would likely get bigger before it shrank.

9. Mr B ’s condition worsened between March and May.

10. On 9 May Mr B had an appointment with an advanced nurse practitioner (ANP). The ANP urgently referred him to hospital for consideration of potential cancer.

11. On 24 May Mr B received a cancer diagnosis.

12. Ms O contacted Royal Primary Care by phone three times in June for support in making a critical illness insurance claim. She visited in person on 22 June after getting no response. This resulted in a GP completing the critical illness claim form on 27 June.

15. The law says we must first consider if there is a legal route available to achieve the outcome wanted.

16. The law says we cannot investigate if the complaint can be dealt with by any court of law.

17. The law also says we must be satisfied that it is reasonable to expect the complainant to take to legal action. We first looked at whether the complaint could be dealt with by taking legal action.

18. We have spoken with Ms O by phone and email. It is clear that she and Mr B feel negligence has happened. They tell us Royal Primary Care’s actions delayed Mr B receiving a cancer diagnosis which delayed his treatment. During the period of delay his cancer progressed and his condition deteriorated.

19. Ms O tells us Mr B ’s condition prevents him from working. This has had a significant financial impact. The main outcome they are looking for is payment for the significant financial loss Mr B has faced and will face.

20. Ms O and Mr B could make a clinical negligence claim. They want a payment of £10,000 or more. We explored this with Ms O and she told us Mr B is unable to work, he has fatigue, depression and can only eat minimal solid food. They do not know at this stage when Mr B will be able to return to work as doctors have now found more lumps on his vocal cords which need surgery. From our conversations we understand this impact will have a lasting and negative effect.

21. Part of our guidance on financial remedy is our severity of injustice scale. This allows us to make open, fair and consistent financial recommendations by deciding how seriously someone has been affected by what happened and what level of payment would put this right. We also look at similar cases and the amount we recommended.

22. We shared this scale with Ms O. The scale shows six levels of severity ranging from minor inconvenience and frustration (level one) to extreme injustice including permanent disability and loss of life (level six). She felt the impact on Mr B falls into at least level six of the scale and they want £10,000 plus because of this.

23. We recognise the amount she is looking for is much more than we would recommend and above the highest level on our scale (£10,000). We explained that a much higher payment may be achieved by a legal route and through the determination of a court. Ms O confirmed she did not want to be limited to the amounts in our scale as the impact to Mr B is ongoing. We agreed we are very unlikely to award the same financial amount as a court.

24. Based on this, we think there is a legal route available to try to achieve what they are looking for.

25. We then went on to explore if it is reasonable for Ms O to take a legal route. We explained we had a conversation with Royal Primary Care on 11 April 2024 and it advised it did in fact uphold the complaint, admit a failing and its legal team was considering offering a payment to recognise this.

26. Ms O confirmed she had received a letter from Royal Primary Care with the details for NHS Resolutions, but she was unsure what was happening with her complaint. It was clear from our discussion that Ms O did not understand that pursuing a claim with NHS Resolutions is a form of legal action.

27. NHS Resolutions is an arms-length body of the Department of Health and Social Care, with the purpose of resolving NHS claims through their indemnity schemes.

28. Royal Primary Care reached out to us again on 22 April. It explained its legal team had not formally passed the case to NHS Resolutions as Mr B had not yet made a claim to them.

29. During our call with Ms O, we explained how we look at making financial recommendations if we find failings. We also explained that the amounts we may award if we find failings, may not be as high as a legal claim, because the courts can consider things we cannot like future costs.

30. Ms O explained she was considering taking legal action before coming to us. She explained she decided against it while she waited for our response. While Mr B is too unwell to take legal action himself, it is clear Ms O is willing and able to act on his behalf. We have not seen any barriers to Ms O taking legal action.

31. It is clear from our contact with Royal Primary Care that it considers a legal route is available via NHS Resolution. It has told us its legal team is waiting for Mr B ’s confirmation that he wishes to make a legal claim.

32. The NHS Resolution website provides different options for making a negligence claim. It says this can be done by a solicitor or by the complainant or their representative. A template for making a claim is available online.

33. Mr B has Ms O to support him with making a claim. There is also the option of getting a solicitor which Ms O has shown a willingness to do. We do not think that legal action would be any more difficult than our process. We think it is reasonable for Ms O and Mr B to explore a legal route.

34. We recognise Mr B would like Royal Primary Care to confirm it failed him and to make service improvements. These may be achieved as a by-product of making a claim with NHS Resolution.

35. We recognise the impact the events had on Mr B and Ms O. Ms O can return to us with any outcomes not achieved by legal action after this is complete. We strongly advise Ms O to take legal action quickly because if she needed to come back to us, we would need to consider our time limit.

1. We have carefully considered Ms O’s complaint about Royal Primary Care on behalf of her partner, Mr B. We are very sorry to hear about the circumstances that led Ms O to come to us. We understand this complaint is very important to them.

2. We think Mr B could take legal action on his complaint and it is reasonable for him to do this. Based on this we have decided not to consider his complaint further. We explain our decision in detail in this statement.