NHS Resolution has published a comprehensive thematic review examining 105 completed claims relating to delayed cancer diagnosis in general practice over a seven-year period to March 2023.
The report, ‘Delayed diagnosis of cancer: a thematic review of general practice indemnity claims’, analyses claims data to identify learning opportunities and improve patient safety across the healthcare system.
The report emphasises that many general practice consultations are safe, with GPs referring people on urgent suspected cancer pathways in record numbers. The analysis covers a comparatively small number of cases where there were identified failures in the pathway.
Key findings from the analysis include:
- 65.7% of patients were diagnosed with stage 3-4 cancer, compared to national early diagnosis rates of around 54% for stages 1-2
- 40% of cancer diagnoses were made following routine referrals or emergency department attendance, rather than urgent suspected cancer referrals
- Remote consultations featured in 53% of claims, highlighting the increased importance of comprehensive history taking when physical examination is not possible
- 73.5% of claimants aged under 50 years were female, indicating potential gender disparities in early-onset cancer detection
Helen Vernon, Chief Executive of NHS Resolution, said: “This report reflects our commitment to sharing learning from claims to improve patient safety. While the number of clinical negligence claims is low given the volume of care delivered in general practice, each one represents a missed opportunity for earlier cancer detection. By understanding these patterns, we can work with the NHS to strengthen cancer pathways and support better patient outcomes.”
The report identifies three key areas for improvement: optimising diagnostic processes, enhancing communication within consultations and across the healthcare system, and empowering patients through increased self-referral pathways and escalation mechanisms.
Professor Peter Johnson CBE, National Clinical Director for Cancer at NHS England, said: “Catching cancers at an early stage means the chances of successful treatment are much higher, so we don’t want anyone’s cancer diagnosis to be delayed. Cancer remains one of the most pressing healthcare challenges, with around 950 people diagnosed each day. This valuable report from NHS Resolution helps us understand where delays occur and highlights opportunities for improvements, supporting our work to strengthen cancer pathways and provide earlier diagnosis.”
The five cancer types with the highest number of settled claims were colorectal cancers (20%), skin cancers (18%), breast cancers (13%), prostate cancers (13%), and urological cancers excluding prostate (9.5%).
NHS Resolution’s Safety and Learning team worked with clinical advisory groups including representatives from NHS England, the Health Services Safety Investigations Body, Royal Colleges, and academic institutions to develop the report’s recommendations.
The report suggests system-wide improvements including better integration of digital systems to detect repeat attendance across healthcare interfaces, enhanced training for remote consultations, and increased use of non-specific symptom pathways for challenging cancer presentations.
The findings align with the recently introduced Jess’s Rule, which encourages GP teams to ‘reflect, review and rethink’ if a patient presents three times with the same or escalating symptoms – a principle supported by NHS England and the Royal College of General Practitioners.
Notes to editors:
The report analysed 105 closed settled claims relating to delayed cancer diagnosis in general practice, notified over a seven-year period up to March 2023. “Closed” means the claim has been completed and is no longer active. All legal proceedings have finished, and no further action is required from NHS Resolution or the claimant. “Settled” means the parties (NHS Resolution and the claimant) reached an agreement without going to trial.
All patients visited general practice three or more times before referral and diagnosis, which is the research based standard definition for an avoidable delay
Claims data represents a small fraction of the millions of consultations delivered in general practice annually and does not capture all instances of delayed diagnosis.
The total cost of the 105 settled claims was £6.1 million, including damages and legal costs, with £2.2 million paid directly to claimants.
NHS Resolution’s Clinical Negligence Scheme for General Practice (CNSGP) launched in April 2019, with the Existing Liabilities Scheme for General Practice (ELSGP) launched in April 2020.
