Detecting Cancer Earlier Network Service 2014/15
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Transcript of 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
5 year survivalPatients diagnosed at stage 1 = 93% Patients diagnosed at stage 4 = 7%
Tower Hamlets 60 new diagnoses per year30 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
Tower
Hamlet
s
Newham
City And Hack
ney
Barking A
nd Dagen
ham
Camden
Haringe
y
Islingto
n
Barnet
Waltham
Fores
t
Redbrid
ge
Enfield
Haverin
g 0%
10%
20%
30%
40%
50%
60%
34.92%
55.76%
Bowel screening uptake N&E London at 30 June 2013
Upt
ake
of b
owel
scre
enin
g
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 completionRequest a replacement kit if necessary 0800 707 6060Record on bowel screening template
Targets for payment: 70% of people contacted by phone around 60th birthday50% DNAs contacted by phone
2. If unable to contact by phone send letter using templateRecord on bowel screening template
Targets for payment: 30% 60 year olds sent endorsement letter 40% DNAs sent endorsement letter
Finally - opportunistic endorsementAn EMIS pop-up flags patients with a DNA result in the last 2 yearsUse opportunity to endorse bowel screening during consultation, LTC reviews or NHS Health Check
BUTDon’t rely on pop ups…..1. They can be disabled by the practice2. If “bowel screening endorsed” is recorded, flag will disappear for
good3. Most practices have received electronic results for < 2 years4. 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