Detecting Cancer Earlier Network Service 2014/15

Includes £40k for • opportunistic • targeted endorsement of bowel screening

Bowel cancer is the second most common cause of cancer death

5 year survivalPatients diagnosed at stage 1 = 93% Patients diagnosed at stage 4 = 7%

Tower Hamlets 60 new diagnoses per year30 deaths per year

NHS Bowel cancer screening programme

• 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 ……

Source: NHS England (London region) N&E London cancer screening team

Tower

Hamlet

s

Newham

City And Hack

ney

Barking A

nd Dagen

ham

Camden

Haringe

y

Islingto

n

Barnet

Waltham

Fores

t

Redbrid

ge

Enfield

Haverin

g 0%

10%

20%

30%

40%

50%

60%

34.92%

55.76%

Bowel screening uptake N&E London at 30 June 2013

Upt

ake

of b

owel

scre

enin

g

National target 60%

Lower uptake associated with…

• Living in London• Multiple deprivation• South Asian and Muslim

populations• 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 patients)

• Prior notification lists provided by NHS Bowel Cancer Screening Service

All results were highly significant

Bowel Screening Project 2012

Protocol

Patients with bowel cancer, palliative care needs or opted out were excluded

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

Discussion• 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

search tools: - 60 year olds - ‘DNAs’

Replicating the protocol through the Network Service

Use searches to: 1. Phone people who in the last month

- turned 60- had a DNA result

Use script provided to support kit completionRequest a replacement kit if necessary 0800 707 6060Record on bowel screening template

Targets for payment: 70% of people contacted by phone around 60th birthday50% DNAs contacted by phone

2. If unable to contact by phone send letter using templateRecord on bowel screening template

Targets for payment: 30% 60 year olds sent endorsement letter 40% DNAs sent endorsement letter

Finally - opportunistic endorsementAn EMIS pop-up flags patients with a DNA result in the last 2 yearsUse opportunity to endorse bowel screening during consultation, LTC reviews or NHS Health Check

BUTDon’t rely on pop ups…..1. They can be disabled by the practice2. If “bowel screening endorsed” is recorded, flag will disappear for

good3. Most practices have received electronic results for < 2 years4. SO if patient is 60 – 74, check result on bowel screening template

Target for payment:30% of patients aged 60 – 70 with bowel screening discussion recorded