A practice in the Medway area

3. Mr N complains about aspects of care the Practice provided between August 2024 and March 2025. He specifically complains:

• a GP did not recognise symptoms of skin cancer and did not refer him to secondary care within a timely manner • a GP did not refer him urgently via the NHS two-week pathway despite red flag symptoms including night sweats, nerve issues and persistent seeping from the ear and advice his family sought from a consultant dermatologist.

4. Mr N says the events led to a delay of nearly a year in him getting a diagnosis. He was seen by secondary care in June 2025 and was subsequently diagnosed with skin cancer in his ear canal in July 2025. He says he would not have had to undergo two biopsies had he been referred to secondary care urgently.

5. Mr N says the events caused him prolonged distress and avoidable suffering. He says he would not leave his house due to persistent ear fluid that leaked and other concerns including abnormal smells.

6. He says the events placed a lot of strain on the family at what was an already difficult time with the family looking after his wife who was at the end of her life. He says the events have had a lasting effect on his ability to manage his health and engage confidently with medical care due to a loss of trust in medical professionals, impacting his confidence in seeking clinical advice and the management of his current conditions.

7. Mr N is seeking an apology, service improvements and a financial remedy as an outcome to the complaint.

8. ​​Ms N (Mr N’s daughter) emailed the Practice with concerns about a smelly discharge from her father’s right ear on 6 and 19 August 2024.

9. A GP saw Mr N on 24 September. The GP sent a referral to the hospital ear, nose and throat department (ENT).

10. Ms N sent further concerns about her father’s ear to the Practice on 21 October. A GP saw Mr N on 27 November.

11. Ms N sent ongoing concerns about her father’s ear to the Practice on 23 February 2025. A locum GP saw Mr N on 28 March and sent a second referral to ENT.

12. Mr N saw an ENT surgeon on 10 June. A biopsy was taken and he was diagnosed with squamous cell carcinoma.​ This is a form of skin cancer that arises from the abnormal growth of cells in the skin's outer layer.

15. Mr N says a GP did not recognise symptoms of skin cancer, despite communication and concerns from the family about this and did not refer him to secondary care within a timely manner. Ms N says she told the Practice about red flag symptoms including night sweats, nerve issues and persistent seeping from the ear and advice the family sought from a consultant dermatologist that Mr N should be referred under the NHS two-week pathway.

16. The Practice says Mr N did not present with any red flag symptoms during the consultations he had with GPs at the Practice.

17. NICE guidance on referrals for suspected cancer says;

‘Squamous cell carcinoma - consider a suspected cancer pathway referral for people with a skin lesion that raises the suspicion of squamous cell carcinoma.’

18. On 6 August 2024 Ms N sent the Practice pictures of a pigmented lesion on Mr N’s outer ear. On 7 August the Practice GP diagnosed a benign solar lentigo. This is a harmless, flat, pigmented spot commonly known as an ‘age spot’. The Practice GP noted no features of malignancy but requested a face-to-face appointment with Mr N to examine the lesion.

19. The Practice GP saw Mr N on 24 September 2024. The records note he had a smelly discharge coming from his right ear. On examination a small growth was visible in the ear canal, and the Practice GP made a routine referral to ENT.

20. GMC Good Medical Practice says:

‘In providing clinical care you must:

• adequately assess a patient’s condition(s), taking account of their history, including symptoms […] • carry out a physical examination where necessary • promptly provide (or arrange) suitable advice, investigation or treatment where necessary […] • refer a patient to another suitably qualified practitioner when this serves their need.

21. The Practice GP appropriately assessed Mr N in line with GMC guidance. Our adviser said Mr N’s lesion had no features of malignancy. The Practice GP did not suspect cancer. A routine ENT referral was therefore appropriate. The Practice acted in line with NICE and GMC guidance.

22. Mr N next saw the Practice GP on 28 March 2025. The records document ongoing symptoms of bloody discharge from his ear.

23. On examination there was discharge obscuring the ear canal and a swab was taken to rule out infection. The swab was negative for an infection. The Practice GP made another routine ENT referral.

24. There is no guidance on what pathway a clinician can follow in this situation. Our adviser said there is a range of practice GPs follow. Some will note previous ENT referrals and send an expedited request. Some GPs make an urgent or a two-week wait (2ww) referral where there is ongoing bloody discharge with no infection present. But this is not a requirement of the NICE guidance.

25. Mr N was seen by ENT on 10 June 2025 (following the referral the Practice GP made in September 2024). A diagnosis of squamous cell carcinoma originating in the ear canal was confirmed. The cancer was excised and tests confirmed it had not spread.

26. Our adviser said squamous cell carcinoma is a rare diagnosis and could not be suspected by the Practice GP based on Mr N’s presentation. They noted the ENT surgeon also did not suspect this prior to the biopsy. Our adviser noted that even if the Practice GP had made a faster referral to ENT, Mr N’s treatment would have been the same.

27. We recognise the frustration Mr N and his family experienced in the clinical care and treatment he received for his ear symptoms. We have seen no indication the Practice managed Mr N’s treatment inappropriately. We are grateful to Mr N and his family for bringing their concerns to our attention.

1. We have carefully considered Mr N’s complaint about the Practice. We understand the events that caused Mr N to complain are important to him. We recognise how upsetting it was to feel like he did not receive the correct care. We are sorry to hear about the distress the events caused him and his family at an already difficult and upsetting time. We offer our condolences for the family’s loss.

2. We acknowledge Mr N’s concerns that his GP Practice did not treat him appropriately given the symptoms he had with his ear. We have seen no indication the clinical care he received was incorrect.