Improving uptake of bowel cancer screening through targeted GP

Detecting Cancer Earlier
Network Service 2014/15
Includes £40k for
• opportunistic
• targeted
endorsement of bowel
Bowel cancer is the second most
common cause of cancer death
5 year survival
Patients diagnosed at stage 1 = 93%
Patients diagnosed at stage 4 = 7%
Tower Hamlets
60 new diagnoses per year
30 deaths per year
NHS Bowel cancer screening
• Age 60 – 69 (74 from 2014)
• Aims to
- identify and remove
polyps + surveillance
- identify early cancers
• At 60% uptake, population
mortality is reduced by 16%
• Participants reduce their risk
of dying from bowel cancer
by 25%
It’s not that easy to participate ……
Bowel screening uptake
N&E London at 30 June 2013
National target 60%
Uptake of bowel screening
Source: NHS England (London region) N&E London cancer screening team
Lower uptake associated with…
• Living in London
• Multiple deprivation
• South Asian and Muslim
• Low levels of English literacy
• Being male
“Intervention generated inequality”
Increasing bowel screening uptake:
what works in East London?
• Targeted GP endorsement
• Telephone outreach
2012 Bowel Screening Project
• 18 randomised practices (4,000 patients)
compared with 24 control practices (5,000
• Prior notification lists provided by NHS Bowel
Cancer Screening Service
Bowel Screening Project 2012
All results were highly significant
Targeted endorsement letter on headed paper
9 practices invited patients to health
promotion session
9 practices followed up with scripted
calls by trained bi-lingual advocates
Patients with bowel cancer, palliative
care needs or opted out were excluded
• Uptake was 9% higher in the ‘health promotion over phone’
practices (45%) compared to control practices (36%)
• People who have ever completed a kit have around 80%
uptake at subsequent invitation - regardless of intervention
• Uptake in ‘never-screened’ people increased from 13% to 24%
in HP over phone practices
• Only 50% targeted people were reachable by phone; can this
be improved?
• Cost effective; £6 per person targeted
Replicating the protocol through
the Network Service
search tools:
- 60 year olds
- ‘DNAs’
Use searches to:
1. Phone people who in the last month
- turned 60
- had a DNA result
Use script provided to support kit completion
Request a replacement kit if necessary 0800 707 6060
Record on bowel screening template
Targets for payment:
70% of people contacted by phone around 60th birthday
50% DNAs contacted by phone
2. If unable to contact by phone send letter using template
Record on bowel screening template
Targets for payment:
30% 60 year olds sent endorsement letter
40% DNAs sent endorsement letter
Finally - opportunistic endorsement
An EMIS pop-up flags patients with a DNA result in the last 2 years
Use opportunity to endorse bowel screening during consultation,
LTC reviews or NHS Health Check
Don’t rely on pop ups…..
1. They can be disabled by the practice
2. If “bowel screening endorsed” is recorded, flag will disappear
for good
3. Most practices have received electronic results for < 2 years
4. SO if patient is 60 – 74, check result on bowel screening
Target for payment:
30% of patients aged 60 – 70 with bowel screening discussion

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