GP failed to consider that cancer might have come back

What happened

Ms N (who previously had breast cancer) consulted the GP about worsening back and shoulder pain since taking a shower five days before. The GP diagnosed muscle strain and advised painkillers. Ms N also mentioned a cough she had had for a year. The GP treated her for acid reflux (when acid comes up the gullet from the stomach) which can cause a persistent cough. She advised Ms N to come back if her symptoms did not get better. Ms N did not return but went to A&E with worsening back and shoulder pain three months later.

Chest X-rays at that time were clear, but shortly afterwards another GP at the Practice referred Ms N to the hospital in view of her continuing cough. Tests revealed that Ms N's breast cancer had come back.

What we found

The GP examined Ms N appropriately and advised her correctly on follow up. However, she did not give enough consideration to Ms N's past history of cancer. She should have looked more thoroughly for worrying signs and symptoms of this returning. She should also have sent Ms N for a chest X-ray in view of her history and her continuing cough. National Institute for Health and Care Excellence (NICE) guidance says people with a persistent cough for longer than three weeks need an urgent X-ray. The GP's diagnosis of acid reflux was not supported by what she recorded in Ms N's notes. We upheld this aspect of Ms N's complaint but we did not uphold the complaint about the GP being dismissive at the consultation, which had lasted 11 minutes.

Putting it right

The GP has apologised to Ms N and has acknowledged the failings we identified. She also agreed to draw up an action plan to show how she will avoid such failings in future.