Royal Devon University Healthcare NHS Foundation Trust

5. Ms D complains about the Trust and the care and treatment it provided on 15 July 2025. Specially, Ms D says that after attending a mammogram appointment in early July 2025, she found a new breast lump and the Trust refused to re-examine her.

6. Ms D says this has affected her mental health, physical wellbeing and relationships. She says she felt frightened, powerless and dismissed after she was not offered what she believes was urgent care for a potentially serious condition.

7. Ms D says this experience caused her ongoing emotional distress and reduced her trust in healthcare services. She says she continues to experience anxiety, sleep problems, low mood and increased health-related stress.

8. Ms D also says this has affected her physical health. Ms D told us she has requested to be seen and has been referred to another clinic that is willing to investigate her concerns. However, she says this clinic is further away and difficult for her to travel to because she has chronic fatigue.

9. As an outcome to the complaint, Ms D wants an apology, service improvements and financial remedy.

10. Ms D has suffered with breast cysts for over 30 years. A breast cyst is a fluid-filled lump in the breast. Breast cysts are benign, meaning non-cancerous. We understand they have been managed through check-ups, examinations, scans and aspirations during this time. An aspiration is a minimally invasive procedure used to drain fluid from a cyst. Ms D says when a new lump appears she has a check-up without any issues.

11. In early July 2025, Ms D had a mammogram, ultrasound scan and aspiration on her cyst. A mammogram is a type of X-ray used by the NHS to screen for breast cancer. An ultrasound scan is a non-invasive imaging test which allows clinicians to look at images of soft tissues and organs inside the body. Following this appointment, Ms D found a new breast lump and called her GP Practice. Her GP Practice says it was unnecessary to re-examine her, and the new breast lump was most likely to be the cyst that has refilled. Ms D was worried and insisted her GP Practice re-examine her.

12. The GP Practice emailed the Trust where Ms D was seen three weeks prior for her tests and procedure. The Trust called Ms D and had advised the same information as the GP Practice. It said given that a sinister cause had been excluded three weeks prior, further imaging and examination would not be appropriate. The Trust added that the cyst would likely settle, but if in the case the cyst significantly worsened or persisted after six months, it would review if necessary.

16. Ms D says the Trust refused to offer a further examination or imaging after she reported a new breast lump to her GP in July 2025. She says this left her feeling frightened and dismissed and caused distress and inconvenience.

17. We acknowledge Ms D’s concerns and understand why she was worried when she believed she had found a new lump.

18. In the Trust’s response to the complaint, it explains Ms D had been seen three weeks prior and during this appointment she had fluid drained from the breast cysts which were present. It had not identified any concerns during this appointment. For this reason, it felt further imaging and examination would not be appropriate. Instead, it advised it would re-review Ms D in six months’ time if the cyst did not settle or worsened.

19. The records show Ms D attended the Trust on 25 June 2025 under the two-week wait pathway. This is the urgent referral pathway used where symptoms may need assessment for possible cancer.

20. The records show the Trust carried out a full triple assessment. This included: • a physical examination by a clinician • a mammogram, which is an X-ray of the breast • an ultrasound scan, which uses sound waves to examine breast tissue • aspiration of a breast cyst, which involved draining fluid from the cyst using a needle guided by imaging

21. NICE guidance on suspected cancer supports specialist assessment and investigation of breast symptoms where clinically appropriate. We consider the Trust acted in line with this guidance by arranging comprehensive investigations when Ms D first attended.

22. Our adviser explained that the investigations carried out on 25 June were comprehensive and the results were otherwise normal apart from the presence of breast cysts. There was no evidence of anything suspicious or concerning that required further urgent investigation at that time.

23. The records show that when Ms D contacted her GP on 15 July to report a new lump, the GP contacted the Trust for advice. We can see the consultant oncoplastic breast surgeon personally telephoned Ms D, discussed her concerns and reviewed her recent investigations.

24. The consultant recorded that Ms D had undergone a full breast assessment only three weeks earlier and that the findings had been otherwise normal. The consultant considered it was most likely the breast cyst had refilled.

25. Our adviser explained that breast cysts can refill after aspiration and this can cause a lump to return without indicating cancer or another concerning abnormality.

26. The records show the consultant advised that repeating imagine or arranging another urgent clinic appointment at that stage would not be clinically appropriate.

27. Our adviser explained there are no specific national guidelines requiring repeat imaging or reassessment where a patient reports symptoms shortly after a normal comprehensive breast assessment.

28. Therefore, this decision was a matter of clinical judgement. Clinical judgment means a clinician uses their professional knowledge, experience and the available clinical evidence to decide what care or treatment is medically appropriate.

29. GMC guidance says doctors must base investigations, treatment and referrals on assessment of the patient’s condition and their clinical judgement about the likely effectiveness of the available options.

30. We consider the consultant appropriately reviewed Ms D’s recent investigations, discussed her concerns directly and applied clinical judgement in line with GMC guidance.

31. Overall, we consider there are indications the Trust’s decision not to repeat imaging or offer another urgent clinic appointment was in line with the GMC’s good medical practice given it had carried out a thorough examination of the cysts three weeks prior. We have seen no evidence in the records, or in the independent clinical advice, that national guidance required the Trust to arrange another urgent assessment in these circumstances.

32. The records also show that when Ms D remained unhappy with the Trust’s decision, her GP arranged referral to another provider for a second opinion, and the Trust supported this approach. GMC guidance says doctors should respect patients’ right to seek a second opinion where appropriate. We therefore consider the Trust acted appropriately in supporting onward referral.

33. In conclusion, having reviewed all the available evidence, we have seen no indications the Trust failed to assess Ms D’s concerns appropriately. For the reasons outlined in this statement, we will not be investigating this complaint further.

34. We acknowledge Ms D was distressed by the Trust’s decision and understand this experience caused her worry and frustration. Distress caused by disagreement with a clinical decision does not in itself indicate maladministration or service failure. We hope our decision provides Ms D with some reassurance about the care she received.

1. We are sorry to learn of Ms D’s distress following her experience with Royal Devon University Healthcare NHS Foundation Trust (the Trust). We acknowledge the difficult circumstances around this complaint, and the impact this had on Ms D.

2. We have carefully considered Ms D’s complaint about the Trust. Having done so, we have decided we will not investigate this complaint further. This is because we have not seen any signs anything went seriously wrong with regards to the Trust’s decision to not provide Ms D with another urgent assessment.

3. We understand this was and continues to be an upsetting time for Ms D. Our decision is not made without recognition of the upsetting experiences she had with the Trust and its outcome.

4. We have explained the reasons for our decision below and we hope this provides Ms D with some reassurance about the care she received.