Primary care delegation

BACKGROUND  

A GP partner Dr N contacts MDDUS. Their practice has received correspondence from the Ombudsman, following a complaint by a patient Mrs G that her diagnosis of lung cancer was delayed.

Mrs G had attended the practice with chest symptoms and Dr N prescribed antibiotics and organised a chest x-ray. This showed some findings that could be consistent with infection, but a follow-up X-ray was recommended for 6 weeks later to ensure that there was not another underlying cause. Dr N tasked the administration team to arrange a follow up appointment at the surgery. They sent Mrs G a text message asking her to book an appointment. Mrs G however felt better after taking the antibiotics and did not contact the practice.

Mrs G returned with chest symptoms several months later, at which point another chest x-ray was arranged, leading to the diagnosis of lung cancer.

Mrs G raised concerns to the practice about a delay in the diagnosis. Dissatisfied with the practice response, she then complained to the Ombudsman, who opened an investigation. The Ombudsman identified concerns with the practice’s communication to Mrs G about the need for a follow up X-ray. The practice was asked to provide comments.

Dr N contacted MDDUS for advice and support with responding to the Ombudsman.

ANALYSIS/OUTCOME

An MDDUS adviser highlighted the importance of reflecting on adverse events, and referred to GMC guidance on delegation and referral. This says that you must give clear instructions when delegating, including what needs to be done, by whom and when. You must work with colleagues to ensure any tasks you delegate are actioned, including encouraging them to ask questions and seek support where needed. You should also check that your colleague understands what they are being asked to take responsibility for.

The adviser suggested the practice carries out a significant event analysis (SEA). Following review of internal communications and the comments from those involved, the practice identified that Dr N did not provide sufficient detail to the administrative team when asking them to arrange a follow up appointment. Dr N should have informed them of the reason for the appointment so they could have communicated to Mrs G the importance of returning even if she felt better.

The practice puts in place measures to ensure that similar incidents do not occur in future. They create a policy for results handling: this specifies that relevant details must be provided when asking colleagues to communicate results and any further actions needed, to patients.   

The adviser assists Dr N in responding to the Ombudsman. Dr N apologises to Mrs G and recognises that the quality of their communication internally could be improved. Dr N explains what steps they should have taken in hindsight and what changes they and the practice have made.

The Ombudsman’s report findings are consistent with those of the SEA and although they do request that an apology is provided directly to Mrs G, they acknowledge that the practice has already taken proactive steps to address the issues following MDDUS’ advice and assistance and no further action is required.