Report Date


Case Against

A GP Practice in the area of Swansea Bay University Health Board


Clinical treatment outside hospital

Case Reference Number



Not Upheld

Mr D complained about the care and treatment provided by the GP Practice to his late sister, Ms E, in the weeks leading up to her death in February 2020, and about the difficulties he had experienced in making appointments for Ms E. Ms E had undergone surgery and chemo-radiotherapy for advanced stomach cancer in 2017; although the chance of relapse was quite high, she had no gastrointestinal symptoms when she was last reviewed by a consultant surgeon in April 2019.

The Ombudsman could not reach a conclusion regarding what Mr D said about making appointments for Ms E, as the Practice could not provide any records or information about this.

The Ombudsman found that the GP should have considered that Ms E’s abdominal symptoms might have been related to her previous stomach cancer when he saw her on 29 January, rather than diagnosing and treating her for viral gastroenteritis. Had he done so, or given Ms E appropriate “safety netting” advice (to be alert to symptoms which would indicate her condition was worsening and what to do in those circumstances), it was possible that Ms E would have been referred to Gastroenterology or admitted to hospital before her death. However, it was unlikely that Ms E would have lived significantly longer, and thus Ms E had not sustained any injustice as a result of the failings. Therefore, the Ombudsman did not uphold the complaint.