Decision Report 201503835

Summary

Over a period of time, Ms C began to experience constant bloating, was unable to lose weight and was concerned about other symptoms. She attended her GP, who examined her stomach and said there was excess fluid but he was not concerned. The GP's note of this consultation said that Ms C was doing well with her diet, had lost three stone, but felt she was putting weight on despite not changing anything. He arranged routine blood tests which came back normal. Ms C's symptoms got worse. A few weeks later she attended a different GP. The GP found what she thought was a cyst on Ms C's left ovary and a scan confirmed this. Surgery removed a very large (30 centimetres by 24 centimetres) cyst. Ms C complained that the care and treatment she received from the first GP was inadequate.

We sought independent advice from a GP adviser. The adviser considered the relevant General Medical Council (GMC), Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for Health and Care Excellence (NICE) guidance. They concluded that the note of the appointment was not of a reasonable standard as it was sparse in detail, showed evidence of only a very limited recorded history, and no evidence of a medical examination. The adviser explained that Ms C's symptoms required examination and follow-up, neither of which was recorded. They also considered that the note did not show evidence of good communication or working in partnership with patients so it was not of a reasonable standard. The adviser explained that, in line with SIGN and NICE guidance on the investigations needed to exclude ovarian cancer, Ms C should have had a particular blood test and a scan. Therefore, we found that reasonable investigations were not carried out.

We upheld Ms C's complaint and made several recommendations.

Recommendations

We recommended that the practice:

• ensure the GP apologises to Ms C for the specific failings identified by our investigation;
• ensure the GP familiarises himself with the SIGN and NICE guidelines in relation to the presenting features of possible ovarian cancer, and identifies this as a learning need for his yearly appraisal;
• ensure the GP reviews his medical record-keeping and provides evidence of improvement;
• ensure the GP reviews and reflects on his communication with patients; and
• ensure they make certain their complaints handling procedure is fully compliant with the Patient Rights (Scotland) Act 2011 and the Scottish Government 'Can I help you?' guidance.