GP is suspended for six months for failing to make an urgent referral

BMJ 2012; 345 doi: (Published 30 November 2012) Cite this as: BMJ 2012;345:e8153
  1. Clare Dyer
  1. 1BMJ

A GP has been suspended from practice for six months with immediate effect for failing to urgently refer a 73 year old man for hospital investigation.

In December 2008 Jonathan Ashton received a radiologist’s report on a computed tomography scan of the patient’s upper abdomen that recommended referral to gastroenterologists and noted that malignancy could not be ruled out.

But Ashton failed to refer the patient to hospital until July 2009, when the patient presented with low haemoglobin levels and results of tests for faecal occult blood had come back positive. Even then Ashton, 57, who practised in Carlisle, made a routine rather than an urgent referral.

An endoscopy, carried out in September 2009, showed that the cancer was too advanced to treat, a fitness to practise panel at the Medical Practitioners Tribunal Service in Manchester was told.

The panel considered it a significant factor that the referral letter showed that Ashton apparently thought that there had been an earlier referral to the gastrointestinal team after the radiologist’s report and was aware that there had been “no outcome.” It also noted that the patient did not meet the National Institute for Health and Clinical Excellence’s criteria for an urgent referral, “given the absence of iron deficiency anaemia and dyspepsia.”

But the panel’s chairwoman, Pamela Mansell, said, “The clinical presentation and Dr Ashton’s knowledge of the patient’s history demanded that this patient be referred urgently. This was because what was potentially being missed was cancer, which could be life threatening.

“This omission fell seriously short of the standards of conduct that patients and the public are entitled to expect from a registered medical practitioner.”

She said that the panel had paid specific regard to the fact that the failure was a single incident in “a previously long, unblemished medical career.” Nevertheless, the omission was “sufficiently grave as to amount to serious misconduct.”

Ashton did not give evidence at the hearing, and Mansell said that, although the GP admitted the factual allegations, he continued to deny any fault. While he had shown little insight into his actions, the panel accepted that his failings constituted “a single incident of a patient complaint in a 33 year career” and that there had been no evidence of repetition.

He now works in cosmetic surgery, where his workplace supervisor had described him as “a conscientious doctor who is aware of his skills and limitations within the field of cosmetic surgery.” The panel also took into account the personal circumstances he found himself in at the time and considered that six months’ suspension was “sufficient to mark the seriousness of his misconduct.”


Cite this as: BMJ 2012;345:e8153