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'GP negligence' to blame for sarcoma litigation cases, study claims

A study has said that negligence by GPs is the leading cause of sarcoma litigation cases, a claim which has been strongly challenged by GP cancer experts.

The study, by specialists from the Royal Liverpool University Hospital and published in the Journal of Surgical Oncology, investigated claims relating specifically to sarcomas made against the NHS trusts in England and Wales across a 15-year period.

Negligence was confirmed in 71% of the 53 claims and reportedly cost the NHS a total of £4.4 million, with an average of £84,000 per case - £14,000 higher than the average medical negligence claim.

Of the confirmed negligence cases, 89% were found to be due to a delay in diagnosis, with the study putting an emphasis on delayed recognition of sarcomas at a primary care level.

But cancer experts have rebuffed the claims, and have stated that delays are just as likely to occur at a secondary care level.

Cancer expert Professor Greg Rubin said: ’It’s important to understand that delays occur just as much in secondary care as not everyone is referred by their GPs.

’Specialists who do not specialise in sarcoma may not recognise the symptoms and create delays. It’s important not to attribute the delay to GPs.’

The nature of sarcoma itself –a rare and difficult cancer to spot due to its non-specific symptoms – has been cited as the main issue in referring sarcoma patients.

Professor Willie Hamilton, a professor of primary care diagnostics, further added: ’Sarcoma diagnosis in primary care isn’t easy, as they can occur in almost any part of the body and are also very rare.

’We do know that NICE recognised this and brought in – for the first time – specific recommendations for investigation of possible sarcoma. It’s an issue of rarity.’

The rarity of sarcoma, thought to account for 1% of all UK cancers, was reflected in the sample size of the study – a total of just 52 sarcoma related claims were made across the 15 year period.

Read the full study here: http://onlinelibrary.wiley.com/doi/10.1002/jso.24149/full

 

 

 

Readers' comments (19)

  • 1/3 of all consultations are musculoskeletal. Does that mean 1/3 of the 340,000,000 primary care consultations should occur in secondary care and, if so, they would pick up sarcoma quicker?

    How does earlier diagnosis help with outcomes in a symptomatic sarcoma? Isn't the prognosis generally awful anyway?

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  • Azeem Majeed

    The authors of this paper created a category 'Failure/delay diagnosis' and then seem to have assumed all 29 cases where this occurred were due entirely to GPs. What they should have done for each of these patients is assigned dates for first onset of symptoms, first visit to a GP and first referral to a specialist. This would have allowed them to see where the delays in diagnosis took place and what role was played by delay in GP referral versus delays in patient presentation or specialist assessment.

    The paper can be read at http://onlinelibrary.wiley.com/doi/10.1002/jso.24149/full

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  • Someone on another news topic blog made a comment today suggesting that we should just refer everything. This article just illustrates their point.
    There is no recognition of your conscientious approach to resources when you miss a cancer.

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  • So they looked at claims made against NHS Trusts (ie secondary care) and note the compensation cost to the NHS (ie secondary care) yet conclude that the blame for delayed diagnosis rests with primary care....?!

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  • There are 300 cases of sarcoma/annum in the UK, and thus rare. We might not see any in our career, or perhaps one or two.

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  • It would be helpful if there was a link to the paper so we can actually evaluate the validity of the claims.

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  • Good greif, i must pull my socks up. 52 claims over a 15 year period. Thats an incidence of 1.1555 x 10-8 (ten to power minus eight). Or alternatively you'll see 0.0023 cases in each of our average 30 year GP careers or one case every 450 years practicing as a GP.


    We really should not be missing these diagnoses.

    Regards
    Paul C

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  • oddly I never saw a sarcoma in 25 years of practice. we then had 5, yes 5, in a year (can't remember how/when they were diagnosed.

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  • Paul is absolutely right - I feel thoroughly deficient! Interesting we had one - late diagnosis by surgeons - we had referred as a suspicious hard groin mass but they (2nd care) felt it was a hernia... Big surprise at operation! Wish I had bought a lottery ticket that day!

    I will do an audit reflect & then go to the pub...

    What a load of Boll.....

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  • We GPs will always get caught by the very rare that present with ordinary symptoms. I had one = presented with muscle ache after exercise. Thought it was a torn muscle initially.
    If we want perfection from GPs, then we GPs will have to see far fewer patients a day, refer anything suspicious and hey presto, the NHS will collapse.
    Now if only I could MRI everything. But this is impossible.
    No doctor misses anything deliberately, and Sarcoma is so so easy to miss.
    If this level of accusations continue ie for knee surgery ad antibiotics and mental health etc on the budget and workloads, I personally would not recommend GP as a career if you wish to be sane and have a family life.
    I personally would not wish anybody to be a doctor even, when I see and hear of GMC, NICE, CQC, Re validation etc.
    No point doing the overdraft of medical career debt for this pain.
    Computer engineers are much sought after and much better paid.

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