https://publichealthmatters.blog.gov.uk/2016/07/15/health-matters-your-questions-on-bowel-cancer/

Health Matters: Your questions on bowel cancer

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We hope our latest edition of Health Matters – on the subject of improving the prevention and diagnosis of bowel cancer – will help you and other health professionals by compiling key facts, figures and evidence of effective interventions.

Where we can, we’re also committed to answering your questions and taking on your feedback. In this blog we’ve published the answers to a number of Health Matters bowel cancer screening questions we received from professionals across the UK at the launch teleconference (podcast available here).

We’d love to hear from you at healthmatters@phe.gov.uk.

Question 1 (Funding for the future roll out of the FIT test)

Will there be additional funding for CCGs for this? When are we supposed to be doing it from?

Answer:
We have been working in PHE with NHS and CRUK and Bowel Cancer UK colleagues to develop a plan to roll out FIT (faecal immunochemical test). We are currently working with NHS colleagues to confirm a realistic implementation date, but hopefully it will be early-mid 2018. There is extra resource to come to PHE so that we can do the planning, the QA, the resources etc. Within the 7a agreement there is also resource for the NHS to pick up endoscopy. We are going to try very hard indeed not to make the pressure on endoscopy more than it is now and so one of the jobs that we need to do is to set the sensitivity of the test to allow us to prevent putting more pressure on an already overstretched NHS. . Further guidance will be provided in due course.

Question 2 (approach to the roll out of FIT for next year)

It would be useful to know what approach you will be taking for the roll out of FIT next year. Will you be starting off with the areas that have got less than the average uptake or will you be using some other method?

Answer:
The aim is to make it as simple as possible and one of the things the FIT implementation group is discussing is the possibility of doing it in a ‘big bang’. This means that all hubs will ‘go live’ with the FIT kits on the same date. Patients already started with gFOBt will continue on that pathway. The group agreed it would be extremely complicated to start in areas with low uptake and an attempt to do so might slow down the implementation of the test as it will be done out of five national hubs.

Question 3 (FIT tests for people with symptoms)

Is there a role that the screening labs can have in the use of the FIT test for symptomatic patients, which is now recommended by NICE? It’s not a service that is currently available anywhere in my area. It would be good if we could think about that as a country rather than piecemeal. We have no labs offering FIT testing as all of the FOBt testing labs have been decommissioned everywhere. So we have no access to FIT testing labs for symptomatic screening and we would have to commission some. If we were starting with a blank piece of paper I don’t know if having ten different labs is the right way to go. There is a big procurement exercise to decide which test to use and where and it would be useful if this were done nationally. Currently there is no NHS plan as far as I know.

Answer:
Good question. We are working with NICE to make sure that it all fits together. In terms of the individual labs, it’s not something that has come up in our FIT implementation group but we’ll make sure that we flag to NHS colleagues that when planning to change the test for screening that they work with NICE to take the possibility of symptomatic testing into account.

Question 4 (GP endorsement of bowel screening invitations)

On your Health Matters web page, you said that London is about to introduce a programme to have GP endorsement letters to support the screening invitation. We are interested in a systematic roll out of such a programme in the south west, whereby in some automated way a letter arrives and if it was from your GP is there a role that the screening labs can get involved in doing this?

Answer:
This process raises the uptake slightly but as it’s a programme that is aimed at hundreds of thousands of people, that’s worth having the difficulty is that the GPS themselves need to sign up. I know that the London screening leads have been working on this and would be more than happy to give you advice about how to go about it. We could certainly work with the hubs to see if this is possible.

Question 5 (managing the GP endorsement letter)

In relation to the GP endorsement letter, and the fitting in of the London groups, I understand it has been quite a long process – several hundred individual practices have had to apply individually to get an advanced list of the their patients who are future candidates for screening, so that they can prepare an endorsement letter. Is there any way of making this process easier?

Answer:
That was how the pilot trial was done and how it has been rolled out in London. It’s a question for individual general practices whether they are prepared for their name or their practice’s name to be put onto a reminder letter without them knowing about it. We can explore that, clearly it wasn’t the case in the trial. NHS clinical commissioners could be asked about this, along with NHS England and we will pick this up, mentioning that this has been a suggestion.

Question 6 (timing the GP endorsement letter)

As a practice, we are intending to try and support bowel cancer screening by using the suggested letter template encouraging patients to take part in the screening programme. It would be really useful to know when the kits are sent to patients so we can time our letter accordingly. Is a kit sent when a patient turns 60? Or are patients called for by area, or by the practice they are registered with?

Answer:
Invitations are sent around the participants 60th birthday. If a participant hasn’t received their kit a couple of months after their 60th birthday it is advisable for them to contact the helpline (0800 7076060) to check that their details are correct. Additionally, the two-year gap between screening invitations is calculated from the date on which the previous screening episode was closed. In some cases (for example, if they had further tests), this could be several months after receiving the screening invitation. This, in turn, could delay the next invitation by several months.

Question 7 (future availability of FIT kit from GP surgeries)

As a cancer prevention lead for a local authority, we work a lot with GP surgeries and one of the questions that comes back a lot is ‘can we have a stock of the FOBt test?’ and obviously the answer to that is no. Will that situation change when FIT is introduced?

Answer:
We can certainly explore that. I think the difficulty is for people to enter the cohort for screening on an ad hoc basis. The answer is ‘watch this space’.

Question 8 (GPs ordering the FOBt test on behalf of a patient)

I’ve just recently conducted a study myself across some GP practices regarding the screening reminder and we managed to increase screening by 10%. But I have found a big swell of frustration from GPs is around not being able to order a kit on behalf of the patient. I’ve been told it is because of a unique identification number. Could we not use the person’s NHS number for this?
Answer:
We can certainly explore it. We have got various other pieces of work going on to see if we can get people into the cohort and invited in ways other than the core call recall system and we can certainly explore that in relation to your specific request. As ever, it’s an IT issue but it shouldn’t be beyond us to work this out.

Question 9 (Bowel scope)

In this Health Matters edition there didn’t seem to be much of a mention about the bowel scope as another aspect of the screening programme. I know there’s a commitment for bowel scope to reach all hubs by the end of this year but just wonder if there has been any progress on how well coverage is going. Is it the case that each centre would be delivering some but not all of the population that they cover?
Answer:
You are correct – the prime ministerial commitment to rolling it out and to have each hub engaged in it by the end of December this year continues to be on track. We are getting to the harder end of the roll out so that the places that were keen have done it. Now we are working with the places that are yet to start, making sure that they have the capacity, the accreditations that are required and that the waiting lists are not a problem in the rest of their endoscopy service. So we are on track to have everyone signed up by the end of the year but we won’t say it’s easy. First we want national availability of the service and then we’ll move towards coverage of the whole target population.

Question 10 (promoting bowel cancer screening locally)

One thing I would like to share with you: I coordinate a cancer awareness programme in my area. We have thirty volunteers that go out and about in the local community. They raise awareness of the top four cancers but more importantly they have the bowel cancer screening kits with them and they have good success in the local area persuading local people to do the bowel screening. We are going to our local screening hub for a tour of the lab so that our volunteers can get a better idea of how it all works.

Answer:
That’s really helpful; involvement right across the public health system to understand what bowel screening is, whether it’s for them, what their choices are and to encourage them to take the test. We need to share as much of the good practice as we possibly can. Please send an update of your work to the screening helpdesk; we will share that with other areas trying to do the same sorts of things.

Question 10 (information for patients)

We are currently trying to raise awareness about cancer screening with our local population. I liked your infographics and I wonder if you had any national communications plan (a bit like Be Clear on Cancer)? I’ve found it difficult to get the local communications team on board in my local authority and it would be helpful to have one place where we can put all of the cancer information on one piece of paper and use it to talk about all the different screening programmes. A simple thing that explains to patients that at this age you are going to be invited and make sure you go when you are invited. It would be useful to keep your infographics in a central place so that we can access it.
Answer:
We probably need to correspond about exactly what you want because in terms of the cancer screening programme we write to everyone in their own home, it’s a privilege that screening programmes have that other programmes don’t. We might be able to make that information more comprehensible, more salient and support that with material that you can use at the local authority level. We do have a number of materials relating to screening and we will tell you about the location of these when we contact you.

Question 11 (infographics)

Firstly, thanks for putting together this edition of Health Matters – there’s a lot of really good information in there, particularly on the checklists for the screening programme and the infographics about the barriers that will be helpful for us to use locally. One thing that is missing is a simple infographic that explains to people what the outcomes and benefits of screening are. The questions that we constantly get asked are how many lives are actually going to be saved as a result of bowel cancer screening, whether it is with FOBt or FIT or through the bowel scope and what is the difference in terms of overall death rates. Some of that information is within Health Matters but an infographic which sets it out in terms of people would be really helpful eg information about quality of life and is it going to save my life?
Answer:
That’s a good idea. We have noted this idea for a future infographic and will consult (the questioner) when we develop this as you are the people who are having these conversations and have the best insight into what is required.

Do please keep on sharing your stories about things that have gone well or not so well or on ideas for improvements in the future, by contacting us either at healthmatters@phe.gov.uk or directly to anne.mackie@phe.gov.uk.

Health Matters

Health Matters is a resource for professionals which brings together the latest data and evidence, makes the case for effective public health interventions and highlights tools and resources that can facilitate local or national action. Visit the Health Matters area of GOV.UK or sign up to receive the latest updates through our e-bulletin. If you found this blog helpful, please view other Health Matters blogs.

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