University Hospitals Dorset NHS Foundation Trust

4. Mr Y complains the Trust’s UTC GP did not thoroughly investigate his mother’s back pain on 17 June 2024.

5. He says his mother sadly died on 16 August from carcinoma of unknown primary (when cancer has spread around the body, but the original tumour has not been found). He explains had the GP requested imaging (for example X-ray, or another kind of imaging) on 17 June, his mother may have received her cancer diagnosis sooner and been a candidate for chemotherapy.

6. Mr Y tells us he is heartbroken to lose his mother and is shocked, angry and very disappointed that doctors dismissed his mother and told her she did not require imaging. He says earlier treatment could have improved the quality of his mother’s life in her last few months and chemotherapy could also have increased the time she had left.

7. Mr Y wants the Trust to acknowledge its mistakes and apologise for them. He also wants the Trust to improve its service.

8. Mrs A experienced back pain after lifting a heavy bag of compost on 31 May 2024.

9. Mr Y tells us he was concerned about his mother’s symptoms, and, due to inaction from her GP he recommended she attend the local UTC. Mrs A attended the Trust’s UTC on 17 June.

10. He says the UTC’s GP diagnosed a musculoskeletal injury and prescribed diazepam (a drug used to treat a number of symptoms including muscle spasms). A musculoskeletal injury is damage to the muscular or skeletal systems of the body, which includes muscles, bones, tendons, ligaments and soft tissues.

11. Mr Y explains his mother continued to struggle with pain in the days following her visit to the Trust’s UTC. He tells us his mother visited her GP again and they recommended she attend hospital.

12. After attending hospital Mrs A received a computed tomography (CT) scan which showed widespread bony metastases (cancer from another part of the body which has spread extensively to multiple bones). A CT scan uses X-rays and computers to create detailed images of the body.

13. Mr Y tells us his mother sadly died on 16 August from complications relating to her cancer.

18. Mr Y tells us the UTC GP missed his mother’s red flag symptoms (potentially serious symptoms) and should have investigated further by arranging an X-ray or CT scan.

19. The Trust says it took a history of Mrs A’s symptoms and fully examined her. It says the UTC GP’s assessment and management was appropriate given the timeframe of Mrs A’s symptoms, the intermittent nature of her pain and the absence of red flag symptoms. It did not see an X-ray or CT scan was indicated at the time.

20. GMC Guidance sets out how doctors can provide good care. Section six and seven say doctors should adequately assess a patient, taking account of their history, symptoms and physical examination and promptly provide any advice, investigation or treatment where necessary.

21. It is important to set out here that a UTC GP works in the acute setting (short term treatment for serious or sudden health conditions). This means they will focus upon what is new and what immediate action is required. A patient’s own GP will usually handle chronic, longer-term investigation and treatment.

22. Mrs A reported middle back pain since 31 May. We can see the UTC GP took a detailed history and carried out a thorough examination of Mrs A on 17 June.

23. The UTC GP also supplied appropriate safety netting advice by discussing red flag symptoms and to come back to the Trust’s emergency department (ED) if they occur. Safety netting advice ensures the patient knows what to do if their condition fails to improve.

24. Our GP adviser says based on the symptoms Mrs A presented with on 17 June it is quite reasonable for the UTC GP to have diagnosed a musculoskeletal injury and prescribe diazepam.

25. We recognise both Mr Y and the Trust have differing opinions on whether Mrs A was exhibiting red flags on 17 June.

26. The Trust appears to have referred to National Institute for Health and Care Excellence (NICE) guidance on lower back pain while Mr Y appears to have referred to NICE guidance on sciatica.

27. Our GP adviser notes Mrs A’s back pain was not typical of sciatica. Sciatica pain normally starts in the lower back and radiates down the legs. Mrs A reported middle back pain, and there was no mention of leg pain.

28. In any event, the red flags for cancer in both NICE sciatica guidance and NICE lower back pain guidance are broadly similar.

29. Our GP adviser agrees Mrs A’s age and progression of her pain are listed by NICE as red flags for cancer, but this does not necessarily mean further investigation was necessary.

30. Those red flags must be considered alongside Mrs A’s history and her presentation at the time. Her middle back pain followed a clear history of injury, and, in the absence of more obvious red flags, we think the UTC GP’s actions are in line with GMC guidance.

31. Our GP adviser points out that we cannot know how much of Mrs A’s back pain could be attributed to her lifting injury or to the cancer she would sadly later be diagnosed with.

32. We think this further supports that the UTC GP acted correctly in line with applicable guidance when they reviewed Mrs A in the acute setting.

33. We also acknowledge Mr Y’s concerns about his mother’s symptom diary, and her blood results which showed raised alkaline phosphatase (ALP) markers. Raised ALP markers can indicate the presence of bone cancer.

34. Mr Y tells us his mother’s GP, who was also involved in her care at this time, took three blood tests in April and June which all showed raised ALP markers.

35. We understand the UTC GP did not have access to these blood results and there is no evidence Mrs A made them aware of these key pieces of medical evidence on 17 June.

36. Our GP adviser says had Mrs A given the UTC GP this information, it may have changed their approach and pointed toward the need for further investigation.

37. Based on the evidence we have seen, we are not persuaded the UTC GP did anything wrong. We have therefore decided to take no further action in Mr Y’s complaint.

38. We understand Mr Y has been through a great deal and can only imagine the distress and pain he has experienced since his mother fell ill and sadly died. We hope our statement can provide him with some reassurance that the Trust’s UTC handled his mother’s care correctly in line with applicable guidance.

1. We have carefully considered Mr Y’s complaint about the Trust. We recognise how upset he is about the care his mother, Mrs A, received at the Trust’s urgent treatment centre (UTC) on 17 June 2024.

2. We know our primary investigation cannot change what happened or take away his pain. We sincerely hope our decision statement addresses his concerns and provides some reassurance around the care his mother received.

3. We have seen no indication something went wrong with the care Mrs A received and have decided to take no further action in Mr Y’s complaint. We have set out our reasoning in this decision statement.