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GPs go forth

Coroner warning over patient death after 16-month wait from 'urgent GP referral'

An elderly patient with coronary artery disease waited an ‘unacceptably long’ period of 16 months from GP referral to surgery, ‘significantly’ deteriorating by the time he finally received treatment, a coroner has warned.

In a report to prevent future deaths, Rachel Galloway, assistant coroner in Manchester City, said she was concerned about the lack of national guidelines for referrals from primary care to secondary care, and from secondary care to tertiary care, for patients with valve disease.

The report looked into the death of 82-year-old Stuart Clarke and concluded he died as a result of the disease - but this was 'exacerbated by complications arising out of an aortic valve procedure'.

According to evidence provided by Mr Clarke’s consultant cardiologist, the pathway to receive a surgical procedure was ‘unacceptably long’ and if the surgery had been carried out in a timely manner, the outcome ‘might’ have been different.

Giving evidence at the inquest, Mr Clarke's cardiologist said the normal referral pathway in this case would involve the GP referring the patient to the local hospital – Royal Oldham Hospital. They said it is then the duty of the local hospital to refer to the tertiary centre for special assessment, which was Wythenshawe Hospital.

Mr Clarke went to his GP in February 2018 with symptoms of breathlessness, who referred him to the Royal Oldham Hospital.

Mr Clarke's family told Pulse the GP referral to the cardiologist, according to their letter, was an urgent referral.

But the hospital kept cancelling or postponing the appointment until they 'eventually' saw a cardiologist, who then said he would refer Mr Clarke to Wythenshawe Hospital, according to Helen Clarke, Mr Clarke's wife.

Mrs Clarke said: 'The problem was every time we had appointments they were cancelled or postponed and it just went on and on.

'Every time I rang up, they kept saying "well he's not an urgent case" but you see, it did say on the letter "you are an urgent referral". This was in November.'

However, Mr Clarke was not seen at Wythenshawe Hospital until January 2019, and it took until 25 June 2019 for him to undergo necessary transcatheter aortic valve implantation (TAVI) surgery.

Mr Clarke did not recover from surgery and his condition declined. He died on 27 June 2019 at Wythenshawe Hospital.

The coroner outlined concerns relating to the national referral guidelines, and said there still wasn't national guidance on referrals for patients with valve disease.

Ms Galloway said: ‘By the time that Mr Clarke underwent the TAVI procedure on the 25th June 2019 he had deteriorated and was significantly less well than he had been in the months following his initial presentation to his GP in February 2018.

‘During the course of the inquest, I heard that steps are being taken at local level to ensure more timely intervention in similar cases.

‘However, I was concerned that there remain no national guidelines for referral from primary care to secondary care and/or from secondary care to tertiary care for patients with known valve disease.’

The coroner has sent the report to NHS England, NHS Improvement, NICE, the Department of Health and Social Care, and the British Cardiovascular Intervention Society, who are under a duty to respond by 6 January 2020.

Another coroner report recently questioned a hospital chain’s ‘lengthy’ discharge policy after a patient’s GP was left with vital information.

Readers' comments (18)

  • And there are many many more cases waiting out there with our outrageous waiting times in Northern Ireland
    5 yrs plus for neurology and up to 8 years for a hip or knee replacement
    Sadly we are powerless to effect change as GPS and remain hostages to fortune as well as our imperiled patients

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  • I'm confused about the lack of guidelines being highlighted when the issue is about resources and availability. You can have all the guidelines saying whatever they want but it doesnt matter if services are stretched or not there.

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  • Cancelling of outpatient appointments for no reason and placing to the back of the cue happens all the time and yet nothing is done and very rarely reported. Hospitals have to be made to accept responsibility

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  • Don't see why NICE shouldn't say something - time to intervention has a major influence on outcome and must be evidence based......

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  • doctordog.

    Surprised they didn’t try to blame the GP.

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  • @doctordog - you may have noticed that the hospital did try to blame the GP - they said the letter was not urgent!
    What is urgent anyway? several services now interrupt our next consultation to ask questions to enable downgrading from a 48 hour response, when we are just trying to improve on a 6-month one!

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  • Horrendous problem that has not changed one iota in 40 years.

    Except the glorious halcyon,sunlit, balmy days of fundholding,when it was unheard of.

    The LMC are of course utterly ineffectual,I am not even sure why it was worth typing that.

    No educational meeting or institution has ever addressed this,and most senior academics refuse to accept it exists.They prefer endless specialist speakers on hypertension, and to drown in models of the consultation.

    Educational supervisors sit in meetings listening to specialists who refuse to acknowledge this problem and never say a word.

    Any attempt to raise it ,they block with sycophantic drivel.

    Worst of all the coroners focus narrowly on the patient who has died.

    We need a global medical accidents investigation bureau, to replace GMC,CQC,etc

    A bureau to investigate and highlight system,not individual failures

    This would be a good place to start



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  • As socrates says, this all seems to be entirely missing the point - delayed, cancelled, re-appointed, then letter sent to wrong address or after the date of the appointment, so patient misses appointment and needs re-referral, is all an entirely normal pattern for referrals at the moment. I have a patient who missed an appointment in August for reasons that I completely believe are down to the hospital and not to him; re-booked appointment is in March, despite my letters to explain and try to expedite. I made an urgent referral to the Mental Health Team a couple of weeks ago, patient has heard nothing, so I ask staff to chase up; message comes back yesterday to say there are no urgent appointments, so referral has been downgraded to routine. No advice to or discussion with me about this. If she dies by suicide, will it be my fault?

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  • yep

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  • Everyone Chill. The Tories are in power again. Everythings going to be alright

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