Bowel Cancer Screening Locally Commissioned Service Specification

Transcription

1 Service Specification No. Service Bowel Cancer Screening Locally Commissioned Service Specification Commissioner Lead Public Health: Jessica Ayeh-Kumi Provider Lead GP Practices in Camden and Islington Period April 2014 March 2015 in Islington July 2014 March 2015 in Camden Date of Review January Population Needs 1.1 National/local context Bowel cancer is the third most common cancer in the UK and is the second most common cause of cancer death, after lung cancer 1. If diagnosed at an early stage (Dukes stage A) the 5 year relative survival rate is 93.2%. This falls to less than 6.6% at Dukes Stage D 2. The Bowel Cancer Screening Programme has been running in the UK since It aims to detect asymptomatic individuals at an early stage, when treatment is more likely to be effective, and to detect and remove polyps. The programme screens individuals aged every 2 years using Faecal Occult Blood testing (FOBt). Evidence from a meta-analysis of 4 randomised controlled trials showed a 15% reduction in bowel cancer specific mortality with biennial screening 3. However, participation in the Bowel Cancer Screening Programme is low. Uptake of bowel cancer screening in 2012/13 was 44.4% in Camden and 44.9% in Islington. This was lower than the London uptake of 47.82% in 2012/13 and lower than the national target of 60%. 1.2 Evidence Base Evidence suggests GP involvement can increase the uptake of bowel cancer screening. Specifically the following interventions have been found to have a positive impact on bowel screening uptake: Endorsement letters Some evidence has found that letters from GPs to patients due for screening have been shown to increase uptake by nearly 6% (5.8%, 95% CI %). Letters signed with electronic GP signatures were found to be more effective than letters sent on behalf of the practice in general. 4 1 Cancer Research UK. Bowel Cancer Statistics. January [Online]. Available from [Accessed 17 th February 2014). 2 National Cancer Intelligence Network (NCIN). Colorectal Survival by Stage. London: ONS, Hewitson P, Glazsiou P, Towler B, et al. (2011). Screening for colorectal cancer using the faecal occult blood test: an update. The Cochrane Database of Systematic Reviews. [Online]. Available from: [Accessed 17th February 2014) 4 Hewitson P, Glazsiou P, Towler B, et al. (2011). Screening for colorectal cancer using the faecal occult blood test: an update. The Cochrane Database of Systematic Reviews. [Online]. Available from: [Accessed 17th February 2014)

2 Telephone or face-to-face advice The use of telephone calls and written reminders to patients about screening, have been found to be more successful than written reminders alone 5,6,7 A recent study in three East London boroughs found significant increases in uptake following targeted telephone and face-to-face health promotion Outcomes 2.1 Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely This LCS will support the following and Public Health Outcomes Framework s indicators: to reduce under 75 mortality rate from cancer. 2.2 Local defined outcomes This LCS will also contribute to Camden and Islington s key health and well-being priorities: 3. Scope Preventing and managing long term conditions to extend both length and quality of life and reduce health inequalities, including reducing early death from cancer. Aims and objectives of service The overall aim of this LCS is to increase the uptake of the bowel cancer screening programme and decrease the premature mortality rate from bowel cancer in Camden and Islington. Specific objectives are: - To increase GP and practice staff engagement in bowel cancer screening and to support the proactive promotion of bowel cancer screening to the eligible population through general practice. - To follow up those individuals who did not send back their test kits and encourage them to complete the test. - To ensure that practices regularly update bowel screening participation and test results in their electronic patient records. Service description 1. The practice will appoint a named lead for the LCS (ideally the existing cancer screening lead) who will be primarily responsible for the overseeing and implementation of the LES. 5 Telephone Outreach to Increase Colorectal Cancer Screening in an Urban Minority Population. Basch C, Wolf R.L., Brouse C.H, Shmukler C, Neugut A, DeCarlo L.T, et al. American Journal of Public Health. 96 (12) (2006). 6 Myers R.E, Ross E.A., Wolf T.A, et al. Behavioural Interventions to increase adherence in colorectal screening. Med Care. 1991; 29: Myers R.E., Ross E, Jepson C, et al. Modelling adherence to colorectal screening. Prev Med. 1994; 23: Shankleman J, Massat N, Khagram L, Ariyanayagam S, Garner A, Khatoon S, Rangrez S, Colorado Z, Hu W, Parmar D, Duffy SW Evaluation of services aimed at improving awareness of bowel cancer screening and increasing uptake Submitted to British Journal of Cancer January 2014

3 Health Promotion Materials 2. As a minimum practices should display: - Promotional posters in the waiting area and other appropriate areas e.g. the toilets, etc. - Leaflets promoting and explaining the bowel screening programme. Where a practice has a high number of patients from certain ethnic minority groups, posters and/or leaflets should also be displayed in the relevant languages (e.g. Sylheti, Bengali, Turkish and Somali) as well as in English. Practices may also wish to: - Use health screens to display bowel screening awareness DVDs, where these are available - Set up bowel cancer screening promotion display stands - Organise an awareness event at the practice and/or conduct an outreach event in conjunction with local community or religious groups A list of approved promotional resources can be found in Appendix 2. Endorsement Letters 3. Every month the London Bowel Cancer Screening Hub will send practices a list of which patients are due to be invited for bowel cancer screening in the following month (as long as practices have returned their data sharing agreement), via secure nhs.net addresses. - Each month practices should send a letter to all patients who are due to be invited for bowel cancer screening in the following month. - The letter should inform patients about the programme and encourage completion of the test kit. (A template letter can be found in Appendix 3 for practices to use or adapt.) - The letter should be addressed to the patient, printed on paper with the practice letter head and have the GP s electronic or actual signature. Follow-up with patients not completing kits 4. If a patient has not returned their kit four weeks after invitation, the London Bowel Cancer Screening Hub send the patient a reminder letter. The Bowel Screening Hub will also send practices a list of patients they have sent reminder letters to each month via secure nhs.net addresses (as long as practices have returned their data sharing agreement). - Practices should follow-up these patients and offer advice and further information about bowel cancer screening. - Follow-up must be carried out by an appropriately trained member of staff (GP, practice nurse or health care assistant) and must be either a face to face or telephone conversation. Follow-up can be either opportunistically when the patient attends the practice or proactively by telephoning these patients. - Suggestions on what information to discuss can be found in Appendix 4 and 5. Bowel Cancer Screening Results 5. Practices must record bowel screening test kit results, within two weeks of the information being sent to the practice from the hub. This data should be entered into the patient s record via the EMIS bowel screening template using the read codes specified (see Appendix 6). Reporting Practices should use EMIS WEB Read codes to record when a letter has been sent (9Ow5) or when health promotion advice has been given through face-to-face or telephone follow-up consultations (8CAy) (see Appendix 6). Payment for this activity will be made through routine quarterly extractions from EMIS.

4 Please see Appendix 1 for the payment schedule. Population covered All patients eligible for the bowel cancer screening programme, i.e. patients aged being invited for screening.

5 Appendicies Appendix 1: Payment Schedule Activity Detail Payment Payment Schedule Source of data Health Promotion Displaying health promotion materials within the practice 50 per practice End of LCS Health promotion report (appendix 7) Administration payment Entry of bowel screening results and other administration Letters Sending GP endorsement letters to all patients being invited for Bowel Cancer Screening Follow-up consultations Follow-up consultations (either telephone or face-to-face) with patients who have not returned kit after 4 weeks. 100 payment proportionate to the average practice list size End of LCS Signed agreement form 3 per letter Quarterly Remote data extraction of Read code 9Ow5 10 per consultation Quarterly Remote data extraction of Read code 8CAy

6 Activity Detail Payment Payment Schedule Source of data Increases in uptake For practices with baseline uptake <48% (13/14): Approximately /15 Uptake Practices will be paid for - Increase in uptake < 3%: no additional payment months after the data from the increases in uptake over - Increase in uptake of 3-4.9%: 3 per eligible bowel screening end of the LCS Bowel Cancer the LCS period patient in practice that year. Screening Hub - Increase in uptake of 5-6.9%: 4 per eligible bowel screening patient in practice that year. - Increase in uptake 7-9.9%: 5 per eligible bowel screening patient in practice that year. - Increase in uptake >10%: 6 per eligible bowel screening patient in practice that year. - Increase in uptake >13%: 7 per eligible bowel screening patient in practice that year. For practices with a baseline uptake of 48% or more (13/14): - Increase in uptake < 2%: no additional payment - Increase in uptake of 2-3.9%: 3 per eligible bowel screening patient in practice that year. - Increase in uptake of 4-5.9%: 4 per eligible bowel screening patient in practice that year. - Increase in uptake of 6-8.9%: 5 per eligible bowel screening patient in practice that year. - Increase in uptake >9%: 6 per eligible bowel screening patient in practice that year. - Increase in uptake >12%: 7 per eligible bowel screening patient in practice that year.

7 Appendix 2: Approved Promotional Resources Recourse Type Leaflet/ DVD/ CD Leaflet/ DVD /CD Leaflet/ DVD/ CD Learning Disabilitie s leaflet Title Bowel screening kit instruction leaflet Bowel screening : the facts Bowel cancer screening: the colonoscopy investigation An Easy Guide to having Colonoscopy Produc ed by Notes & Links Languages Available in: Arabic, Bengali. Chinese, English, Farsi, French, Greek. Gujarati, Hindi, Italian, Kurdish, Polish, Portuguese, Punjabi, Somali, Spanish, Turkish, Ukrainian, Urdu, Vietnamese Also Available in : British sign language DVD, Audio set DVD, Animated video cations/kit-instructions.html Languages Available in: Arabic, Bengali. Chinese, English, Farsi, French, Greek. Gujarati, Hindi, Italian, Kurdish, Polish, Portuguese, Punjabi, Somali, Spanish, Turkish, Ukrainian, Urdu, Vietnamese Also available in: large print leaflet, British sign language DVD, Audio CD set (languages include English, Arabic, Bengali, Cantonese, Polish, Punjabi and Urdu). A brail version is also available. cations/information-leaflets.html Languages Available in: Arabic, Bengali. Chinese, English, Farsi, French, Greek. Gujarati, Hindi, Italian, Kurdish, Polish, Portuguese, Punjabi, Somali, Spanish, Turkish, Ukrainian, Urdu, Vietnamese Also available in: large print version, British sign language DVD and Audi CD set cations/colonoscopy-investigation.html cations/nhsbcsp-colonoscopy-learningdisabilities-leaflet.html Learning Disabilitie s leaflet Leaflet An Easy Guide to bowel cancer screening Understanding bowel cancer screening Macmill an cancer support cations/nhsbcsp-learning-disabilitiesleaflet.html understanding-bowel-cancerscreening.aspx

8 DVD/ VHS DVD Bowel Cancer Screening: It's Your Choice Animated Medicine: Bowel Cancer (DVD) DVD Bowel Cancer Screening kit Cartoon REME DICA Available in: English, Hindi, Punjabi, Gujarati, Bengali and Urdu, in addition to a British Sign Language option. It explains about receiving your invitation for screening, the screening process, and what the results mean cations/its-your-choice.html This DVD contains 3D medical animations of the growth and removal of a polyp via colonoscopy. This is a short animated film about the bowel cancer test kit and how it can be used. DVDs of the cartoon are available from the five regional B hubs, or from the national office of the Cancer Screening Programmes. cations/screening-kit-cartoon.html DVD Bowel Screening: Your test at home info@cancerscreening.nhs.uk Tel: This DVD features a short fictional bollywoodesque story to explain the bowel cancer screening programme simply. Available in both Hindi and English. cations/your-test-at-home.html Video Posters Spot bowel cancer early We've all done the test at home CR UK y/ A4 Poster cations/poster-test-at-home.html Posters Eat well, keep fit, use the test kit A3 Portrait cations/poster-use-test-kit.html Posters You can't always see the signs A3 Portrait cations/poster-signs.html

9 Posters Take a seat A3 Portrait Links: cations/poster-take-a-seat.html

10 Appendix 3: GP Endorsement Letter INSERT GP PRACTICE HEADER Patient Name Patient Address Date Dear [insert patient name], RE: Important information about the Bowel Cancer Screening Programme Our records show that you are shortly due to be invited to take part in the Bowel Cancer Screening Programme. All those invited to take part receive a bowel cancer test kit through the post. We are writing to tell you about the bowel cancer test kit, which will be arriving in your post soon. The bowel cancer test kit is automatically sent to people aged 60-74, every two years. As you get older, your chance of getting bowel cancer increases. The test kit aims to detect bowel cancer at an early stage, in people with no symptoms, when treatment is much more likely to be effective. Bowel cancer is the second most common cause of cancer death in the UK. However it is also one of the most curable, if detected early. The test kit is used privately in your own home. A pre-paid envelope is provided for you to send the completed kit to an laboratory for processing. Results are posted back to you about 2 weeks later. Millions of people around the world have completed the test kit and continue to do so as it helps to save lives. This is why we are encouraging all patients at our GP practice to complete the test kit that they receive in the post. If you need further information and advice, please call the freephone helpline on or visit the website [Practices may also wish to insert a sentence with an alternative contact at the practice for patients to contact if they have any further questions. For example, You can also call Joanna Bloggs, Practice Nurse on if you have any further questions or queries. ] Yours sincerely (INSERT ELECTRONIC SIGNATURE OF GP) (INSERT PRINTED NAME OF GP)

11 Appendix 4: Follow-up advice for patients who have not returned kit If a patient has not returned their kit four weeks after their invitation, the London Bowel Cancer Screening Hub send the patient a reminder letter. If there is still no response 13 weeks after the reminder letter is sent the person is counted as a nonresponder and their episode is closed. The practice will then receive notification that the patient did not respond. The patient will be re-invited for screening two years later. As part of the LCS the Bowel Screening Hub will send practices a list of patients they have sent 4 week reminder letters to in the previous month via secure nhs.net addresses. Steps for following-up with these patients: i. An appropriately trained member of staff (GP, practice nurse or health care assistant) to discuss the bowel cancer screening with the non responders either opportunistically when patient attends the practice or proactively by telephone conversation. ii. iii. If they have difficulty communicating in English a consultation with an interpreter should be offered and arranged. Points to cover in consultation o Check whether the patient has received their test kit. o If they did not, check that the patient s address details on your records are correct. o Offer to order another test kit for the patient. Practices can order kits over the phone (using the freephone number ) - you will need to supply each patients name, address and Number when you make the call. o If the patient did receive the test kit, determine whether they are planning to complete it and send it back. o Discuss any practical problems they may have completing the test or any barriers/ concerns they may have with the test. Use appendix 5. o If they are willing to complete the test ask if they have an unspoilt test kit at home. If not, give them details of how to order another or offer to order it for them. o If the patient does not want to complete the test, explain that they should contact their GP with any symptoms of bowel cancer immediately.

12 Appendix 5: Promoting bowel screening - a reference guide Patients often seek advice from their GP and practice nurse when considering undertaking a screening programme. It is therefore important for healthcare professionals to be aware of the key messages and benefits of the programme. We have produced the following reference guide which can be used either when promoting bowel screening or following up patients that have not returned test kits. What is Colorectal Cancer? Colorectal (bowel) cancer refers to either cancer of your colon (large intestine/bowela part of your digestive tract) or rectum (back passage- where stools are stored before you pass them). It is one of the most common cancers in UK. It is more common in older people - 8 out of 10 people diagnosed with bowel cancer are over 60. The National Bowel Cancer Screening Programme The chances of surviving bowel cancer are much better if it is detected at an early stage 9 out of 10 people survive for 5 years or more. When the cancer first starts to develop, there are typically no symptoms for weeks or months. The bowel cancer screening programme has been developed for people aged 60-74, every 2 years. The aim of the screening programme is to detect cancer at an early stage where there is a good chance that treatment will cure cancer. Regular screening can reduce deaths from bowel cancer by 15%, equivalent to 1 in 6 fewer people dying from bowel cancer. Screening can also detect polyps (growths) on inner lining of the bowel- these are not cancers but may develop into cancers over time if left. If detected they can easily be removed which reduces the chance of cancer developing. The screening process involves sending people a Faecal Occult Blood test (FOBt) in the post. The FOBt kit allows small samples of stool to be collected at home and can then be posted back to the screening centre for testing. It is quick and easy to perform- there are clear instructions on the kit. The stool samples are tested to detect small amounts of blood in the stool. It detects very small amounts of blood that are unnoticeable to yourself but common in people with bowel cancer. How to Complete Test Kit 1. Prepare the kit by writing the date on the appropriate flap 2. Collecting the Sample. You could collect the sample on: - Folded piece of toilet paper - Hand covered in small plastic bag - Clean disposable container - Putting cling film over toilet bowel You need to take samples from 3 different stool samples on different days. For each of them: - Take two samples from different areas of the stool, using the cardboard sticks provided - Spread the samples thinly over the first and second window

13 - Repeat the same steps for the 2 nd and 3 rd stools that you take samples from - In total you should have 6 stool samples from 3 different stools. 3. Put the kit in the freepost envelope and post it back To Request another Kit/ Answer Any Further Queries Call freephone line on Alternatively GP practice can order a kit from the hub via provided it is via nhs. net account - you will need to supply each patients name, address and Number Being Bowel Aware (adapted from choices) Report any of the following: blood in poo or bleeding from your back passage. a change to normal bowel habits that persists for more than three weeks, such as diarrhoea, constipation or passing stools more frequently than usual abdominal pain unexplained weight loss As bowel cancer progresses, it can sometimes cause bleeding inside the bowel. Eventually, this can lead to the body not having enough red blood cells. This is known as anaemia. Symptoms of anaemia include: fatigue, tiredness breathlessness In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms of a bowel obstruction include: a feeling of bloating, usually around the belly button abdominal pain constipation vomiting

14 Appendix 6: Bowel cancer screening EMIS template A bowel cancer screening EMIS template and appropriate READ codes will need to be used when recording activity relating to bowel screening LCS and the results of the screening test kits. These are outlined below. Read code 5-byte Abbreviation Description 9Ow bow scrn admin Bowel cancer screening programme administration 9Ow5 bow scrn letter Endorsement letter sent 686A FOB NEGATIVE Bowel cancer screening programme faecal occult blood test normal 686B FOB POSITIVE Bowel cancer screening programme faecal occult blood test abnormal 68W2 2 yr follow up Bowel cancer screening programme 6867 FOB SPOILT Bowel Cancer screening programme: faecal occult blood testing kit spoilt 686C FOB INCOMPLETE Bowel cancer screening programme faecal occult blood testing incomplete participation 9Ow2 dna bowel screen No response to bowel cancer screening programme invitation 8CAy advise after dna Advice given about bowel cancer screening programme 8IA3 BOW SCR OPTOUT Bowel cancer screening declined 9Ow3 not elig bow scn Not eligible for bowel cancer screening programme

15 Appendix 7: Template for reporting bowel screening health promotion activities Practice Name: Practice Cancer Screening Lead: Telephone: Date: 1. What bowel screening health promotion activity(ies) did you undertake between April 2014 and March 2015? Please provide a brief description in the box below 2. Why did you choose this activity? 3. When did the activity take place? 4. What resources did you use? 5. What worked well? 6. What worked less well? 7. Comments/ suggestions for future bowel cancer screening promotional activity. Please send the completed form by no later than Friday 3 rd April 2015 to Public Health at CIPH@islington.gov.uk or Public Health Cancer Lead, Public Health, 222 Upper Street (Third Floor), London N1 1XR.