Detecting Cancer Earlier Network Service 201415 Includes 40

Detecting Cancer Earlier Network Service 2014/15 Includes £ 40 k 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 ……

Bowel screening uptake N&E London at 30 June 2013 National target 60% Uptake of bowel screening 60% 55. 76% 50% 34. 92% 40% 30% 20% 10% Source: NHS England (London region) N&E London cancer screening team ve r in g ld Ha fie En ge db rid t es Re W al th am Fo r et rn Ba w ty ha Ba A nd m rk in Ha g. A ck nd ne Da y ge nh am Ca m de n Ha rin ge y Isl in gt on Ne Ci To w er Ha m le t s 0%

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

Bowel Screening Project 2012 All results were highly significant

Protocol 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

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 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 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