Low-level gamma-ray spectrometry, particularly in underground laboratories, is used to measure radioactivity in diverse close geometries, often placing samples directly on the detector which favours strong cascade summing effects. Monte-Carlo modelling of the efficiency is extended to cascade summing effects from complete decay sequences including positron emitting radionuclides. The effect of geometrical uncertainties on the overall uncertainty is presented. The results reinforce the need for radiography of the detector and inclusion of the detector shielding in the model.