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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%

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Detecting cancer earlier network service 2014 15

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
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
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%



National target 60%

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


Lower uptake associated with
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

Increasing bowel screening uptake: what works in East London?

  • Targeted GP endorsement

  • Telephone outreach


2012 bowel screening project
2012 Bowel Screening Project London?

  • 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
All results were highly significant London?

Bowel Screening Project 2012


Protocol

Targeted endorsement London?letter on headed paper

9 practices invited patients to health promotion session

Protocol

9 practices followed up with scripted calls by trained bi-lingual advocates

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


Discussion
Discussion London?

  • 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 London?

the Network Service

search tools: - 60 year olds - ‘DNAs’


Use searches to
Use London?searches to:

  • 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 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

Finally - opportunistic endorsement London?

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…..

They can be disabled by the practice

If “bowel screening endorsed” is recorded, flag will disappear for good

Most practices have received electronic results for < 2 years

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


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