In north central London, 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). The reference guide in the downloads area highlights good practice in primary care.
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 north central London 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 & Uptake: Coverage is the number of people screened within a designated time period (e.g. 5.5 years for cervical screening) out of the 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.
- 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 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
- 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
Local borough screening pilots across NCL
Barnet SMS reminder pilot for cervical screening non-responders
This one-year pilot started in August 2019, paused and recommenced during 2020, and ended in May 2021. It aimed to ensure women who had never attended or whose last attendance was over three to five years ago receive a text reminder. Data collection to seek impact on attendance and latterly, if these women have a higher likelihood of receiving a positive HPV result.
Haringey cervical screening project
The federation have been running OOH clinics. Women at least 6 month overdue from 19 practices (those with the lowest coverage) contacted to book at the hub or their practice. Target 2,796. Hub appointments are held in the evenings /weekends. Follow up calls made. DNA rates of booked high due to reluctance to attend a screen during the lockdown. Due to Covid pressures and hub staff being redeployed to support the vaccination programme, capacity has been constrained to carry out the calls to women to them in for an appointment.
Islington cervical screening project
Run by the federation, calling patients either missed due to Covid or generally not responded. Launched pre You Screen and about 28-30 practices involved. Patients would also receive link to videos and info.
Enfield lung/cervical screening projects
Enfield lung pilot aims to detect possible lung cancer symptoms via community pharmacies.
Enfield Cervical Pilot Increasing provision of nursing appointments for cervical screening via the Enfield Federation.