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Patient saw eight GPs before cancer diagnosed.


Patients are at risk of having serious health conditions missed because of a lack of continuity of care provided by GPs, the NHS safety watchdog says.

The Health Services Safety Investigations Body said providing continuity of care should be in the GP contract.

Investigators highlighted the case of a 67-year-old patient who was seen by eight different GPs before his cancer was spotted as an example of what can go wrong.

As part of its investigation, the watchdog spoke to patients and GPs, analysed data and published an in-depth review of the care one patient received.

The patient, known as Brian, who had learning disabilities, schizophrenia and dementia, had received treatment for breast cancer, but had been discharged from the service.

Two years later he started developing pain in his back. During the following eight months, he saw two out-of-hours GPs and six GPs at his local practices as well as a physiotherapist and GP nurse, before he was sent for a hospital check-up in late 2020.

This found that a secondary cancer had developed on Brian's spine, but it was too late to offer him curative treatment and he was given end-of-life care and has since died.

The Health Services Safety Investigations Body said the lack of continuity of care resulted in the diagnosis of Brian's cancer being missed. A main difficulty was that the different GPs he saw missed the fact he was attending repeatedly for the same issue.

Senior Health Services Safety Investigations Body investigator, Neil Alexander, said Brian's case was a "stark example" of what can happen when there is a breakdown in continuity of care.

Neil Alexander, said: "He told our team ‘When I am gone, no-one else should have to go through what I did'."

The report criticised the fact that there is no specific requirement within the GP contract to ensure practices provide continuity of care and urged the government to address this. It said that did not necessarily mean always seeing the same GP but sharing information efficiently.

It added that many GP IT systems did not allow doctors to access clinical histories and information quickly and easily.

GPs interviewed said staffing difficulties and pressures on services meant that continuity of care had sometimes slipped down the priority list.

Mr Alexander said it was clear some practices were doing better than others. But he added: "We could see that all want to deliver the best care they can, but the extreme pressure of workloads and having to prioritise other essential requirements makes it very difficult."

A spokesman for the Department of Health and Social Care said continuity of care was "important", which was why all patients must be given a named GP. Added that all practices must try to comply with "reasonable requests" to see a particular GP. too.

The Royal College of GPs said changing the contract would not solve the problem on its own.

The college's vice-chair, Dr Victoria Tzortziou-Brown, said: "Delivering continuity of care is becoming increasingly difficult as GPs and our teams struggle with intense workforce pressures and patient need growing in both volume and complexity."