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 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 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 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 completion Request a replacement kit if necessary Record on bowel screening template Targets for payment: 70% of people contacted by phone around 60 th 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 BUT 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 template Target for payment: 30% of patients aged 60 – 70 with bowel screening discussion recorded