Gateshead Health NHS Foundation Trust

2. Mr A complains about the GP care provided to his father, Mr B, by the GP Practice (the Practice) from 29 January to 17 April 2024. Specifically:

• the Practice failed to identify the potential signs of cancer in Mr B promptly despite several consultations • the Practice offered inadequate support after Mr B was diagnosed with pancreatic cancer in March 2024 up until his hospital admission on 17 April 2024.

3. Mr A says the Practice’s carelessness; lack of knowledge and support delayed his father’s cancer diagnosis and any treatment that he could have had. Mr A says his father lost precious time with his family due to his pain not being adequately managed by the Practice and delays in his referral to hospital.

4. As an outcome, Mr A wants further explanation about his father’s GP care and apologies from the Practice for its failings. He also wants changes in procedure regarding cancer referral and support, as well as a financial remedy.

5. Please note that we have not included all the background to the complaint in this report as all parties already know this information. We have included the information outlined in this section to put the complaint into context.

6. Mr B was in his 60s. He was registered blind. Mr B originally reported abdominal pain (which had been present for 6 weeks) to his GP on 29 January 2024. Blood, stool, and FIT tests all came back normal. Over the next few weeks, Mr B’s pain symptoms persisted. He had further consultations at the Practice and was given Lansoprazole to manage his pain symptoms. An ultrasound scan and urine dip test were requested.

7. By 12 March 2024, Mr B was still experiencing abdominal pain. He was re-examined by a GP at the Practice who thought he may have a slight swelling, as well as noted weight loss. The GP arranged a two-week wait referral for suspected cancer and further blood tests. These showed abnormalities which were not present on the initial blood tests.

8. Unfortunately, over the next few weeks, Mr B was in and out of hospital due to planned appointments and admissions. After being admitted to hospital on 29 March 2024, Mr B was diagnosed with pancreatic cancer which was spreading into his liver, lung, and spleen.

9. By 9 May 2024, Mr B’s condition had deteriorated, and he was put on end-of-life care. Mr B sadly died a few days later due to pancreatic cancer.

GP care 29 January to 12 March 2024

14. Mr A says the Practice failed to identify the potential signs of cancer in Mr B promptly despite several consultations.

15. We can see from the records that after Mr B first visited the Practice, there were four consultations until he was referred. These were on 29 January, 12 February, 22 February and 12 March 2024.

16. On 29 January, Mr B reported intermittent abdominal pain for the past six weeks with some nausea. We have considered the relevant records with support from our adviser. An appropriate examination was carried out on Mr B’s abdomen and no mass was found. He also had his weight and blood pressure taken. Appropriate testing such as stool testing was ordered, but there were no concerning results in respect of potential pancreatic cancer such as jaundice, liver issues, or anaemia.

17. Mr B reported similar but worse symptoms on 12 February 2024. The NICE guidance on Suspected cancer: recognition and referral apply:

Pancreatic cancer

1.2.4

Refer people using a suspected cancer pathway referral for pancreatic cancer if they are aged 40 and over and have jaundice. [2015]

1.2.5

Consider an urgent, direct access CT scan, or an urgent, direct access ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 and over with weight loss and any of the following:

• diarrhoea • back pain • abdominal pain • nausea • vomiting • constipation • newonset diabetes. [2015]

18. In terms of the NICE guidance, Mr B did not meet either of these criteria at the time of this consultation. Therefore, the GP prescribed him some antiacid medication for his symptoms which was appropriate.

19. On 22 February 2024, there is more detail about Mr B’s ongoing abdominal symptoms including different types of pain, bloating and flatulence, but no nausea. Our adviser has commented that examination of Mr B’s abdomen did not identify any mass. He had been taking his prescribed antiacid medication on and off since his last consultation. As Mr B’s symptoms had persisted, the GP decided to refer him for an ultrasound for possible gallstones.

20. During Mr B’s consultation on 12 March 2024, our adviser has added that changes were noted. On examination, a fullness (mass) was identified with some weight loss, as well as ongoing abdominal pain. Therefore, the GP correctly referred Mr B on the 2-week cancer pathway.

21. Prior to this consultation, Mr B’s reported symptoms did not justify referral for suspected cancer in accordance with the NICE guidance. We acknowledge Mr A’s expectation that Mr B should have been referred to onward services sooner. This must have caused some frustration for both. However, we consider that each of these consultations and the timing of Mr B’s referral was managed appropriately by the Practice, in accordance with the NICE guidance.

GP support 12 March to 17 April 2024

22. Mr A says the Practice offered inadequate support after Mr B was diagnosed with pancreatic cancer in March 2024 up until his hospital admission on 17 April 2024.

23. We can see from the records considered with support from our adviser that after Mr B was referred on the 2-week cancer pathway, he had further consultations with the Practice on 9 April, 11 April, 15 April, and 16 April 2024.

24. On 9 April, Mr B was given advice about pain relief during a telephone consultation. On 11 April, there was another telephone call and a home visit with advice about constipation symptoms. There was another home visit on 15 April with discussion about Mr B’s symptoms and further advice about his reported constipation. During a telephone discussion on 16 April, Mr B reported some good bowel movements. The GP agreed to monitor Mr B which is an example of good practice.

25. During the time Mr B was undergoing tests at the local hospital in relation to his cancer diagnosis, our adviser has commented that the hospital would be best placed for his ongoing care as they have the necessary information regarding his test results at the time. However, the Practice still had a general responsibility for Mr B as a patient and after he was discharged from hospital on 4 April 2024, we can see from the records that the Practice was in contact with him as described in the previous paragraph. This is the type of support we would expect to see from a GP Practice in the circumstances.

26. In summary, a GP would not usually be too involved in Mr B’s cancer work-up after his diagnosis. This was going on in the background at the local hospital. We appreciate Mr A’s view that Mr B was offered inadequate support by the Practice after his cancer diagnosis. We are sorry to hear that Mr A, and Mr B felt this way. Nevertheless, we consider there is evidence in the records that the Practice continued to adequately support Mr B during this period.

27. This concludes our investigation of the complaint. Please note there are legal restrictions on disclosing information that we give you. This means that you cannot share or make public any information or documents we gave you during our investigation. The legal restrictions do not apply to this final report.

1. We are sorry to hear about Mr A’s concerns regarding the GP care provided to his father, Mr B, by the GP Practice, but we have not seen any failings in the care provided to Mr B from 29 January to 17 April 2024. Therefore, our decision is to not uphold Mr A’s complaint.