A failed referral: Anna’s story

Doctor appointment
5 minute read

National law firm, Enable Law, has settled a case for a widower whose wife died from lung cancer after her GP failed to refer her for investigations years earlier.


The facts

‘Anna’ (name changed for anonymity) went to see her GP in November 2014 because she had been suffering with a cough, on and off, for around a year.

The GPs note of the consultation recorded that;

  • The cough followed an earlier chest infection
  • She was a non-smoker
  • There were ‘no wheezes’ (although the GP did not record whether he examined her chest)
  • And there were no ‘red flags’ (specific signs or symptoms which might indicate a serious condition)

Anna’s GP advised that she should trial an inhaler and be reviewed again if she did not get better. In December 2014, Anna saw her GP for another complaint but the GP’s notes did not say whether the cough was still present.

Three years later, in December 2017, Anna went back to her GP complaining again of a cough. This was a cough that she had for around two weeks but meant that she coughed up pink phlegm after a prolonged period of coughing. She was examined, prescribed cough syrup and advised to see a GP if the cough got any worse.

In April 2018 Anna returned to her GP. This time she was suffering with headaches and cramping, involuntary movements and numbness in her arms. An urgent referral to the local Hospital’s Neurology Department was made.

Before the referral appointment was able to take place, Anna had to go to A&E because her symptoms had gotten worse. Following investigations, Anna was diagnosed with metastatic lung cancer. The cancer had started in her lungs but it had also now spread to her brain, bones and breast.

Anna underwent an intensive course of chemotherapy but, as the cancer had spread and was at a very advanced stage, it was sadly not possible to cure her and she passed away in August 2019, aged 58.

The case

Anna, and her husband, approached Enable Law shortly before she died. They suspected more should have been done by her GPs over the years and that her lung cancer should have been investigated earlier than it was.

After she died Anna’s husband continued the claim, working with the team at Enable Law, which was led-by Associate, Morgan Lister.

To investigate the case, Enable Law obtained advice from independent medical experts, including; a GP, a Consultant Oncologist and a Consultant in Respiratory Medicine. Their assessment and advice focused on the GP appointment in November 2014.

The guidelines

NICE (the National Institute for Health and Care Excellence) publishes guidelines which recommend appropriate care and treatment for people with certain (diagnosed, or suspected) conditions and diseases.

NICE had published guidelines, back in 2005, for the treatment of patients with coughs. These guidelines were still in place at the time of the consultation in November 2014 and recommended that an urgent referral for a chest x-ray should be made were the patient had:

  • Haemoptysis (coughing up blood), or
  • Other unexplained and persistent (i.e. lasting more than 3 weeks) symptoms and signs including:
  • Chest / shoulder pain
  • Breathlessness
  • Weight loss
  • A cough

In light of these guidelines the independent GP advised that, because Anna’s cough in November 2014 was not explained and was persistent / chronic (since it had been on and off for around a year), she should have been referred for an urgent x-ray – and it was negligent to just prescribe the trial of an inhaler.

Had Anna been referred at that time, then the Consultant Oncologist and Consultant in Respiratory Medicine both agreed that the tumour in her lung would have been visible on an x-ray. Therefore, she would have gone on to have urgent CT scans and a biopsy taken of the tumour. A diagnosis of lung cancer would then have been made in December 2014, and she would have undergone surgery to remove the tumour in January 2015.

The Consultant Oncologist also considered that, because of this earlier diagnosis and treatment, the surgery would have likely cured her – since the cancer would not have had a chance to spread to other parts of her body. She therefore would have had a normal life expectancy.

Support and solutions

Based on the advice obtained from the medical experts, a case was established against Anna’s GP.

It was alleged that the care provided at the consultation in November 2014 was negligent and, had she been referred for an urgent x-ray, this would have shown there was a problem. Anna would then have received earlier treatment which would likely have cured her cancer, meaning that she would not have died.

The GP did admit that surgery in 2015 would have likely cured Anna. However, they argued that the care provided was not negligent.

As part of their defence, Anna’s treating GP also obtained advice from another independent GP. On the basis of that advice, it was argued that the cough might have been caused by as part of an allergy, and so it was reasonable to trial an inhaler first. It was also argued that coughs (even chronic coughs) are very common and, although this was against the NICE guidelines, a chest x-ray was not required.

In support of that argument, the GP highlighted that the NICE guidelines changed the next year (in 2015). Under these new guidelines, which it was said would have reflected common GP practice in 2014, a referral for an urgent x-ray would not have been recommended.


As Anna’s GP disputed the allegations Enable Law had made, it was agreed that all parties involved would hold a confidential out of court meeting to discuss the claim and see if a resolution could be reached.

Throughout the meeting Anna’s GP continued to deny that his care was negligent. Our team of experts however negotiated and agreed a financial settlement of £350,000 for Anna’s estate, widower and children.

When asked about the settlement and case, Morgan Lister, Associate at Enable Law, commented:

“The circumstances of this case were extremely sad and Anna’s death, understandably, had a huge impact on all of her family.

Whilst the GP denied the care was negligent, the NICE guidelines were clear – and, under the guidelines in place at the time, she should have been referred for more investigations.

The successful outcome will, of course, never be able to replace Anna. Hopefully the resolution will nevertheless give the family an opportunity to move on to the next chapter in their lives and highlight, to others, the importance of seeking medical advice as soon as you have any concerns.”

Find out more about Enable Law and its services on its website: https://www.enablelaw.com/


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