A practice in the Hammersmith and Fulham area

3. Mr U complains that the Practice did not refer him to secondary care for his bowel symptoms soon enough after October 2024. He says it incorrectly diagnosed him with a hernia in his groin.

4. Mr U says this delayed his diagnosis and treatment for colon cancer. He thinks earlier diagnosis might have given him more and better treatment options, and he may have responded better. Earlier treatment might have meant the cancer did not spread or progress to stage 4. He also says he may have avoided serious complications, including pulmonary embolism.

5. He says months of ongoing symptoms before his GP referred him caused him physical and emotional suffering.

6. Mr U wants the practice to give him £12,000 to acknowledge the impact of its failings.

7. In February 2024, Mr U had an emergency appendectomy (surgery to remove the appendix).

8. Between October 2024 and January 2025, he told his GP he was experiencing concerning abdominal symptoms.

9. In November 2024, the GP investigated the possibility that a hernia was causing his symptoms. Mr U had blood tests and the GP requested an abdominal ultrasound.

10. In late November, Mr U went to the emergency department (ED) at a local hospital because of abdominal pain. The ED diagnosed him with diverticulitis (inflammation or infection in the colon) and gave him antibiotics.

11. In early December, Mr U reported to the Practice that he had ongoing abdominal pain and was struggling with bowel movements which he thought was related to taking antibiotics. It booked a telephone appointment for two days later. This did not happen. It is not wholly clear why, but the GP says this was possibly because he had a face-to-face appointment the next day for a different issue.

12. In early January 2025, Mr U reported a change in bowel habit for three months, and ongoing groin pain. The GP booked a telephone appointment for later that month, by which time they hoped Mr U would have had the ultrasound requested in November and the results would be available.

13. At the appointment, the GP noted Mr U’s three-month history of right lower abdomen pain. The records show Mr U declined an examination to wait until the ultrasound scan results were available. The GP arranged a follow-up.

14. At the end of January, the GP arranged faecal immunochemical testing (FIT) and faecal calprotectin tests. When these investigations both came back as abnormal, the GP referred Mr U under the two-week wait lower GI (gastrointestinal) pathway at the beginning of February.

15. Mr U had a confirmed diagnosis of advanced colorectal cancer in May 2025.

19. Before we decide if we should do 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 that something has gone wrong.

20. Mr U says the Practice knew there were precancerous signs in his bowel because the hospital that did his appendectomy picked up on them in February 2024. He was registered at a different GP surgery at the time of the appendectomy. The Practice sent the records it had access to from his appendectomy. It sent four letters to us.

21. Our adviser said the letters do not mention precancerous signs. One letter details that Mr U had a CT scan (a computed tomography scan, which is a 3D X-ray) of his lungs, abdomen and pelvis whilst in hospital, after his appendectomy. The scan report notes possible ileitis (inflammation in the bowel) and a collection of fluid near the surgical site. Our adviser said these are not precancerous signs, but common findings after an appendectomy.

22. Our adviser also said the surgeons would have been responsible for following up on any precancerous signs, whilst he was receiving care at the hospital, not for the GP.

23. When Mr U first reported his bowel symptoms to his GP in the early November face-to-face appointment, the GP noted he had tenderness over the inguinal canal (an area of the lower abdomen, near the groin), but no other abdominal tenderness or abnormal signs.

24. Our adviser said this is a common area for hernias to develop and this is why the GP recommended Mr U had an ultrasound. The records do not suggest the GP noticed a lump in the affected area, so requesting an ultrasound as an initial investigation was in line with NICE CKS for suspected inguinal hernia.

25. The records also show the GP considered whether Mr U’s symptoms warranted any other tests at this stage. Our adviser says this was in line with NICE guidance for suspected cancers of the lower bowel (NG12).

26. The GP ordered blood tests to check his blood count and iron levels, which came back as normal in November 2024.

27. The records show that other than the inguinal tenderness, there were no other abnormal signs that indicated the need to offer stool tests. The records do not show any report of lumps in the abdomen, any weight loss, bleeding or significant change in bowel habit at this point.

28. Although Mr U contacted the Practice in late November and early December about his symptoms, we do not think there is an indication something went wrong here. In November, he was already in the ED when he contacted the Practice. We would not expect the GP to have arranged an appointment for him when he was already receiving treatment at the hospital. The hospital would have notified the Practice if it needed to follow up with anything.

29. The telephone appointment the GP arranged in early December did not happen, likely because Mr U went to a face-to-face appointment the day after he contacted the Practice. Whilst that appointment was for a different issue, it was an opportunity for Mr U and the GP to discuss his abdominal concerns. We do not think the GP should have done anything differently in here because there is no record of a discussion about Mr U’s bowel symptoms.

30. The records show that when Mr U reported a change in bowel habit that had lasted over three months in January 2025, the GP arranged FIT and faecal calprotectin testing. Our adviser said that these tests were the right thing to do because Mr U reported a change in bowel habit. The NICE guidance (NG12) identifies this as a trigger for the tests. When they came back as abnormal, our adviser says the GP rightly referred Mr U under the two-week wait lower GI pathway, in line with the NICE guidance (NG12).

31. We understand it was around three months from the first time Mr U reported his symptoms to the Practice until it referred him to secondary care. We appreciate it was a distressing time for him. We have not seen any indication of a failing in how the Practice responded to his symptoms in this time. It arranged investigations in line with the relevant guidance and in response to the symptoms he reported at each stage. There was no indication to arrange FIT testing before January 2025, when Mr U reported a change in bowel habit. When those tests returned as abnormal, the GP promptly referred him under the two-week wait pathway.

32. We can appreciate this was a very worrying time for Mr U, and we can tell how difficult it was for him to later learn he had advanced cancer. I hope our decision reassures him that he did not miss out on earlier diagnosis and treatment because the Practice did anything wrong.

1. We have carefully considered Mr U’s complaint about the Practice. We have seen no indication the practice did something wrong in how it managed Mr U’s bowel concerns.

2. We understand Mr U was diagnosed with a terminal illness and we can understand why he has questioned what the Practice did. We do not intend our decision to minimise or diminish the impact of his diagnosis and the distress his experience has caused him. We hope our decision is clear about why we do not think the Practice made any mistakes in his care.