Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

4. Mr N complains the Trust refused his request for a more tolerable examination. He asked for a computerised tomography (CT) or magnetic resonance imaging (MRI) scan instead of a nasoendoscopy.

5. Mr N said because of this decision, it dismissed his needs and prolonged his pain and discomfort.

6. Mr N wants the Trust to refer him for a CT or MRI scan because he could not tolerate the flexible naso endoscopy. He remains without a diagnosis, which is causing him worry and uncertainty for what it could be.

7. Mr N would also like financial remedy.

8. Since 2020 Mr N has had ongoing throat problems, including a lump sensation, pain, discomfort and weight loss.

9. In November 2024, Mr N’s GP referred him to the ear, nose, and throat (ENT) department at the Trust, for further investigations. The Trust detected no lump at this time.

10. In early February 2025, his GP referred him again to the ENT department, on a two-week pathway, He told his GP he had lost a couple of stone in weight over last few months and the lumpy feeling was getting worse. His GP requested a face-to-face review with Mr N, but he was unable to attend due to mobility and financial constraints.

14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications something has gone wrong.

15. In early February 2025, Mr N’s GP wrote to the Trust ENT department saying the Trust had assessed him in November 2024 with no abnormal findings, but his symptoms had worsened and he had a persistent “lump in the throat” sensation. They noted he had no swallowing or breathing difficulties but had lost around two stone in weight over recent months.

16. Mr N’s GP said they were unable to request a CT scan or an MRI scan in primary care and asked if the Trust ENT department could arrange the scan, or fast track his appointment. A CT scan is a very detailed X-ray that can see cross-sectional images inside the body. An MRI scan is a high-definition picture of the body's soft tissues.

17. In late February, the Trust saw Mr N in the ENT department. A consultant head and neck surgeon examined him. They found he had a lump sensation with symptoms that come and go. They noted Mr N reported, recently, his symptoms had not been as bad as before.

18. He did not have a sore throat, throat clearing, or cough, and only occasionally experiences mild discomfort after talking. His voice was not hoarse, and there was no difficulty swallowing, heartburn, or weight loss. His reflux score was within normal limits, with no evidence to suggest reflux.

19. The Trust noted his medical history included autism and a phobic disorder. It also recorded he did not smoke or drink alcohol. On examination, it noted he appeared healthy, with a normal voice and airway. An examination of his mouth and throat was also normal.

20. It concluded there were no red flag symptoms and assessed his condition as mild globus pharyngeus. This means a mild, harmless feeling of a lump or tightness in the throat, even though no actual lump or blockage has been found on examination.

21. It noted it would normally carry out a full examination which included a flexible nasoendoscopy, but Mr N declined this. A flexible nasoendoscopy is a thin, soft tube with camera a which looks inside your throat or airways through your nose or mouth.

22. As a result, the Trust did not arrange a follow-up. It discharged him with this information documented in a letter back to his GP.

23. Our adviser explained many throat symptoms are often associated with underlying anxiety, particularly the sensation of a lump in the throat. They said the ENT department would be expected to to identify any “red flag” symptoms that may suggest a more serious underlying condition.

24. BJGP guidance states the link between anxiety and globus sensation must be considered.

25. The same guidance highlights that in most cases of globus, a GP can appropriately manage it in primary care, and over-investigation may increase patient anxiety and potentially worsen symptoms. It also notes unnecessary referral, and investigation can add to concern in patients, despite the condition being typically harmless.

26. BJGP guidance also says diagnosing globus is based on history of key features and absence of red flags.

Key features include: • Sensation of a lump in the throat, often worse when swallowing saliva, and may be relieved by swallowing food.

• Fluctuating symptoms, exacerbated by stress, anxiety, or prolonged talking.

• Absence of true dysphagia or painful swallowing.

• Association with reflux symptoms (heartburn, regurgitation, and throat clearing).

27. According to BJGP guidance red flag symptoms includes persistent or progressive difficulty swallowing (dysphagia), painful swallowing (odynophagia), persistent hoarseness or voice change, difficulty breathing, coughing up blood, unexplained weight loss, neck lumps or swollen lymph nodes, one-sided throat or ear pain, and significant smoking or alcohol history.

28. At this stage, the Trust did not identify any red flag symptoms. It’s working diagnosis was he had mild globus.

29. Our adviser said mild globus is primarily a clinical diagnosis made from the patient’s history and examination findings, particularly where no red flags are present.

30. We appreciate Mr N found his symptoms concerning and the ongoing sensation in his throat caused him distress. As recognised in the BJGP guidance, although globus is typically a harmless condition, it can be worrying for patients and often leads to specialist referrals to provide reassurance.

31. In mid March, Mr N’s GP saw him again. He reported pain and a lump sensation in his throat, along with spreading chest pain. His GP felt further investigation was needed and no longer considered his symptoms to be related to acid reflux.

32. A few days later, his GP wrote to the Trust ENT department again asking it to arrange a CT scan or an MRI scan as Mr N could not tolerate the endoscopy, due to a strong gag reflex. They said he was still very concerned about his ongoing throat symptoms.

33. A month later, the Trust saw Mr N in the ENT department. It offered him a nasoendoscopy. Mr N declined the procedure again. The Trust discharged him from its care. It said it did not need to see him again in the ENT department.

34. Mr N told us he declined the endoscopy due to his anxiety and a strong gag reflex, which made the procedure intolerable when he attempted it. He believes the ENT consultants were negligent in not arranging a CT scan or an MRI scan of his throat, despite his request and recommendations from his GP, in his referral letters.

35. Mr N said the refusal for either scan has resulted in further worry, distress, and uncertainty, prolonging his pain and discomfort. He also said a family member was previously injured when a camera was put down their throat. This added to his concern. He said he would have felt more safe and less anxious if he had a CT scan. He believes these factors are valid reasons for the Trust to offer him a more tolerable examination.

36. The Trust said after the physical examination the first and most important investigation for his symptoms is a flexible nasoendoscopy. It said a CT scan would not be of value in this situation, as it would not provide the same information as a nasoendoscopy.

37. It reassured Mr N it was not refusing his request for CT scan. It explained it cannot request a CT scan without first examining his throat using a flexible camera. It said there must be a clear clinical reason to refer a patient for a CT scan.

38. Our adviser said they considered the physical examination performed by the Trust appropriate. This included the inspection of his throat for any visible abnormalities and examination of the neck. Our adviser said the Trust noted he looked healthy. His voice and airway were satisfactory and his mouth and throat were normal. He was not a smoker and therefore he had no red flag symptoms. The working diagnosis mild globus was therefore clinically reasonable.

39. GIRFT guidelines say patients with globus pharyngeus do not require endoscopy, CT scanning or barium swallow investigations, unless red flag symptoms are present.

40. Our adviser stated GIRFT guidance does not support routine CT or MRI imaging for patients with classic globus symptoms in the absence of red flags. Most patients do not require further investigations. Our adviser considered the Trust acted appropriately in not arranging a CT or MRI scan.

41. The GIRFT guidance also states routine follow-up appointments are not required and a review to discuss ongoing symptoms is unnecessary in the absence of concerning features.

42. The Trust did not refuse his request for a CT scan, In line with GIRFT guidelines, it was unable to make a referral as Mr N had no red flag symptoms, that indicated a clinical need for further investigation.

43. Our adviser said, as there were no red flag symptoms, it was appropriate for the Trust not to refer for further tests. They said in these cases, patients are usually managed with reassurance and treatment in primary care, and extra tests are not normally needed or recommended in guidance.

44. This approach supports the GIRFT guidelines which says an effective use of NHS resources is by avoiding unnecessary investigations and follow-up appointments, helping services remain accessible and sustainable in the face of increasing referral volumes while ensuring patients receive care that is clinically appropriate.

45. Although a nasoendoscopy may have provided additional reassurance to Mr N, that there was nothing of clinical concern, he declined the procedure. In line with GIRFT guidance, there was no clinical reason to arrange further imaging or referrals at that time.

46. Our adviser said if Mr N’s symptoms had got worse, changed over time, or new concerning symptoms had appeared, clinicians would be expected to reconsider further tests such as scans. However, as his symptoms stayed the same, and the Trust found no new concerns, there was no clinical reason under guidance to carry out a CT or MRI scan.

47. We can see the Trust initially reviewed Mr N's concerns in May and then again in June. Following a full review and investigation, it reached the same conclusion.

48. The Trust saw Mr N again in the ENT department in August. Mr N again declined the nasoendoscopy. The Trust wrote to his GP explaining it declined to refer him for a CT scan or an MRI scan because it was not an appropriate test for his symptoms.

49. We recognise why Mr N wanted an alternative examination and investigation of his symptoms. The Trust assessed him on several occasions, and the outcome did not change. It did not identify any concerning or red flag symptoms that would suggest a more serious underlying condition.

50. Based on evidence we have seen, we are satisfied the Trust acted in line with BJGP and GIRFT guidance in its decision not to refer Mr N for a CT or MRI scan. We have seen no indications of failings in their decision making and will not be taking this further.

We hope this provides Mr N with some reassurance about the Trust's findings and the nature of his symptoms.

1. We have carefully considered Mr N’s complaint regarding the Trust’s decision not to refer him for a CT or MRI scan. After reviewing all evidence, we found the Trust acted in line with guidance and found no indication the Trust got anything wrong with its decision to refuse his request for a computerised tomography (CT) or magnetic resonance imaging (MRI) scan instead of a nasoendoscopy.

2. We want to thank Mr N for bringing this complaint to us. We recognise all the challenges he has faced relating to the Trusts decision. We are sorry to hear about the frustration, prolonged discomfort and worry the decision has caused him. We recognise how difficult it’s been for him and have taken his concerns seriously.

3. We hope our explanation reassures Mr N about the Trust’s actions. We recognise the importance of his complaint and the time he has invested in pursuing it.