Detecting Cancer Earlier Network Service 2014/15

1. Detecting Cancer Earlier Network Service 2014/15 Includes £40k for opportunistic targeted endorsement of bowel screening

2. 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

3. 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%

4. It’s not that easy to participate ……

5. National target 60% Source: NHS England (London region) N&E London cancer screening team

6. Lower uptake associated with… • Living in London • Multiple deprivation • South Asian and Muslim populations • Low levels of English literacy • Being male “Intervention generated inequality”

7. Increasing bowel screening uptake: what works in East London? • Targeted GP endorsement • Telephone outreach

8. 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

9. All results were highly significant Bowel Screening Project 2012

10. Targeted endorsement 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

11. 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

12. Replicating the protocol through the Network Service search tools: - 60 year olds - ‘DNAs’

13. Use 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

14. 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….. 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