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GP is suspended after retirement for failing to refer woman with symptoms of cancer

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1534 (Published 22 June 2022) Cite this as: BMJ 2022;377:o1534
  1. Clare Dyer
  1. The BMJ

A GP who failed late in his career to refer a woman with symptoms of cancer and a known precancerous condition to the fast track suspected cancer pathway has been suspended from the UK medical register after his retirement.

Prakashchandra Jain posed little risk of repeating his misconduct even if he returned to practice, said Ian Comfort, chairing the medical practitioners tribunal. But he said that a three month suspension would send a necessary signal to other doctors.

Under the two week rule GPs who find suspected cancer symptoms in their patients must arrange urgent hospital appointments, allowing the patient to see a specialist within two weeks.

Jain’s patient, referred to as Patient A, had Lynch syndrome, an inherited predisposition to many types of cancer, including stomach cancer. She was already in a screening programme, which in December 2019 discovered her carcinoma of the stomach. But she had already seen Jain in January, June, and July that year with highly suggestive symptoms.

She had consulted him in January feeling generally unwell, and he had ordered blood tests. These tests revealed iron deficiency anaemia. Jain’s failure to make a suspected cancer fast track referral on receipt of these results was the first of the allegations brought against him by the General Medical Council.

Jain, the principal GP at a practice in Cumbria who qualified in 1975, was also accused of misconduct for again failing to refer Patient A to the fast track after a second consultation in June, at which she complained of upper abdominal pain and he noted that she had lost weight.

At a further appointment in July she reported dyspepsia, further weight loss, burping, and recurrent diarrhoea, but he still did not make the mandatory referral. Jain’s counsel told the tribunal that the GP had recognised the seriousness of the situation and that after the second consultation in June he had sought to bring forward her regularly scheduled screening appointment instead of invoking the two week rule.

In the event, however, her screening review was not expedited, although Jain had specifically asked for this, but came two months later than originally scheduled. The tribunal noted that other healthcare professionals had missed opportunities to properly investigate and treat her.

Public interest

Patient A has since died. Her daughter referred the doctor to the General Medical Council in 2020, the same year Jain retired. In 2021 he relinquished his licence to practise. He had an otherwise unblemished record, and his practice at Askam-in-Furness was rated “good” by the Care Quality Commission.

Jain admitted his failure to refer to the fast track but denied a charge alleging that he had told Patient A at the June appointment that he had done all he could and that she “would just have to wait.” He would not have been so dismissive, he told the tribunal, and in any case the statement would be factually untrue, as he did take further steps after that date.

The alleged comment had been reported by Patient A to her daughter in December 2019. The tribunal decided that it “could not rely upon a comment” reported as hearsay when the person who had heard it passed it on only six months later. The allegation was found not proven.

Jain accepted at the hearing’s outset that he would be found guilty of misconduct and that his fitness to practise would be deemed impaired. Both his counsel and the lawyer for the General Medical Council agreed that a suspension would be appropriate. But the defence asked for a short suspension with no review hearing at the end of it, since the doctor was not returning to practice and it was “a public interest case only.”

The tribunal agreed. Comfort said, “A period of three months’ suspension would be sufficient to uphold the public interest in marking the seriousness of Dr Jain’s misconduct.”

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