Improving the uptake of bowel cancer screening in East London through targeted GP endorsement

1. Improving the uptake of bowel cancer screening in East London through targeted GP endorsement Judith Shankleman Senior Public Health Strategist London Borough of Tower Hamlets

2. Colorectal cancer Second most common cause of cancer death in UK and in Tower Hamlets • 5 year survival - 93% for patients diagnosed at stage I - 7% for patients diagnosed at stage 4 • Tower Hamlets - 60 new diagnoses per year - 30 deaths per year

5. NHS Bowel cancer screening programme • Age 60 – 69 (extending to 74) • Aims to • identify and remove polyps + surveillance • identify early bowel cancer • At 60% uptake, population mortality reduced by 16% • Participants reduce their risk of dying from bowel cancer by 25%

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

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

8. Targeted GP endorsement and outreach was effective in increasing breast screening uptake in Tower Hamlets1 (from 53% to 69%) • 2011 bowel screening pilot targeted 60 yr olds, invited to health promotion sessions in 12 inner NEL practices • Targeted endorsement of bowel screening is cost effective and contributes to a reduction in health inequalities2 • 1Eilbert et al 2009 British Journal of Cancer • 2Ansari et al 2013 University of York Evidence for intervention

9. 2012 Bowel Screening Project • With Prof Stephen Duffy (QMUL); controlled trial in City & Hackney, Newham and Tower Hamlets • PCT commissioners negotiated with NHS BCSP(the Hub) for GPs in NEL to pilot monthly “prior notification lists” • 18 randomised large practices compared with 28 control practices of similar size • 9 practices randomised to offer group HP • 9 practices to offer HP over the phone

10. Protocol Commissioned community organisation with trained bilingual advocates Data sharing agreements between 18 practices and the Hub; monthly PNLs sent Jan to Dec 2012 People due to be invited identified by callers using practice registers Practices excluded patients with bowel cancer, palliative care needs or opted out

11. Letter of endorsement and customised national leaflet sent ahead of expected screening invitationPhone call after anticipated kit dispatch(up to 3 attempts) In 9 practices, reminder about HP session at practice In 9 practices scripted explanation and questions answered

12. Bowel screening uptake April to December 2012 Uptake highest for HP over the phone

13. All results were highly significant

14. Discussion • Only 50% targeted people reachable by phone • Practice registers did not always identify bowel cancer patients • Unusually high DNA rate for colonoscopy in screen +ve patients in NEL • £6 per person targeted

15. Next steps Tower Hamlets Network service 2014/15 “Detecting cancer earlier in primary care” £130k funded by Public Health Includes following protocol for targeted endorsement of bowel screening (£40k) to demonstrate ‘proof of concept’ PNLs for all practices to be negotiated search identifies 60 year olds due to be invited + recent DNAs