In NCL, cancer remains the largest single cause of premature death. The three cancer screening programmes (breast, cervical and bowel) are delivered by the NHS through screening centres (bowel and breast) or in primary care (cervical).
Late-stage cancer diagnosis, compared with early-stage diagnosis, results in poorer survival rates, worse patient experience and significantly increased costs. Patients diagnosed through screening usually have early-stage disease, and five-year survival for these patients is 93 per cent, compared with less than 10 per cent for those with stage-four disease.
Cancer screening programme coverage* in NCL is lower than both the London and the national average. There is evidence that interventions delivered through primary care can have a significant impact on improving participation in screening, overcoming some of the barriers and inequalities experienced by different patient groups.
*Note on coverage and uptake: Coverage is the number of people screened within a designated time period (e.g. five and a half years for cervical screening) out of the total number of eligible people. Uptake is the number of people who attend screening within six months of being invited out of the total number invited.
Key messages for primary care from the Good Practice Screening Guide include:
- designate a cancer screening lead from a member of the practice healthcare team
- check patient contact details at each encounter and regularly maintain the practice list
- ensure that the practice has the most up to date mobile phone number for patients and has obtained the appropriate consent for using this number
- ensure that Prior Notification Lists (PNLs) for cervical screening are dealt with promptly
- ensure that advance lists (where available) for bowel screening are dealt with promptly
- ensure that "did-not-attend" (DNA)/non-responder reports are flagged in patient records using the correct codes and followed up promptly
- offer cervical screening opportunistically if due or appointment missed
- actively promote cancer screening within the practice
- participate in regional screening uptake improvement initiatives such as text messaging reminders for bowel and cervical screening
- do not omit patients with special or additional needs and ensure arrangements are in place for them
- do not omit patients with a previous cancer diagnosis (they may be at higher risk of a new cancer in the same or a different site)
- ensure all practice staff know how to use the bowel screening kit and how to request a new kit
- make screening and signposting information for each screening programme readily available.
See also the NHS screening page and the GOV.UK screening page for further national information.
Local borough screening pilots across NCL
Haringey cervical screening project
The federation is working with North Central and Welbourne primary care networks (PCNs) to pilot two projects that aim to improve cervical screening participation. Women at least six months overdue from practices across both PCNs will be contacted to book at the hub or their practice.
Enfield lung/cervical screening projects
The Enfield lung pilot aims to detect possible lung cancer symptoms via community pharmacies. The Enfield cervical pilot is increasing provision of nursing appointments for cervical screening via the Enfield Federation.
Cervical screening sample taker training project
NCL Training Hub has been commissioned to work in collaboration with nurse leads and federations to facilitate getting nursing associates, physician associates and practice nurses trained to carry out cervical screening. The training sessions are being delivered by the London Regional Cytology Training Centre. The Training Hub has also recruited nurses from each borough to act as mentors and assessors for staff that join the course.
NCL bowel screening calling project
Community Links continue to be commissioned to carry out calls to people being invited for bowel screening. They are currently focusing on contacting people that are newly invited to the screening programme, which includes people turning 56, 58 and 60 years old, as the age group continues to be extended.