A partnership approach to tackling health inequalities in cancer screening

Leicestershire County Council (LCC) has been working in partnership with Primary Care, Charnwood GP Network and Charnwood community groups to reduce health inequalities in cancer screening (cervical, breast and bowel) and support future work in a partnership arena that uses a population health management approach to tackling health inequalities. As part of the Charnwood’s PCN tackling Health Inequalities plan, the project involved exploring the perceptions, experiences and influences to attending cancer screening in communities with poor uptake. The five communities of interest identified were a) Bangladeshi, b) Polish, c) Homeless, d) Carers and e) Gypsy Roma Travellers.

To understand the experiences and influences to cancer screening within the specified groups, a qualitative approach was deployed. Six Focus Groups were formed with the community groups of interest which allowed a deep dive into their understanding and experience of cancer screening as well as their barriers and their enablers. A quantitative approach was also employed to look at the variation in screening uptake by GP practice and PCNs using data published by Office for Health Improvement & Disparities (National Practice Profiles).

There were similarities between the groups, as well as differences. The main themes that emerged from the focus group discussions included: Thirst for knowledge, Experience of healthcare, response to screening/experiences ad perceptions, cultural nuances, fear and fatalism and impact of being a carer. Key barriers and enablers are highlighted in the table below:

Arising from the research undertaken, the following recommendations have been made:

• Building trust and rapport - implementing co-production. Co-production of health events and information for the local community.
• Improving access to healthcare - exploring alternative times (weekends and evening) for appointments which could bring about more meaningful engagement from those who cannot access traditional appointments with primary care.
• Improving knowledge and awareness - using trusted sources to share information within the community. GPs and local health champions were identified as the most trusted sources for health-related information.

As a result of the recommendations made, two PCNs (Beacon and Carillon) within the Charnwood GP Network have started; Offering Saturday appointments via the extended access service to increase cervical screening uptake; Information has also been collected on patients that have declined bowel cancer screening to fully understand the reasons for the decline in offer and Making Every Contact Count approach has also been adopted, with staff undertaking the current training offer provided by Public Health.

The LCC Public Health team, along with University Hospitals of Leicester (UHL) colleagues and Charnwood GP Network also worked in partnership on a multidisciplinary outreach pilot which involved hosting Respiratory Outreach clinics across two PCNS (Carillon and Beacon). The clinics were used as an opportunity to provide holistic care to patients in the community.

In addition to the above, the Public Health team, along with ICB colleagues, provided an educational workshop session in September 2022 on how other members of the PCN can embed a population health management approach to tackling inequalities within the population. This was an opportunity to share any learning and resources with other PCN members.

A bowel cancer screening audit was also conducted to explore the outcomes of the telephone call intervention by the healthcare provider and the interventions effectiveness. The audit showed that for those who did not complete a bowel screening test, the main themes identified for not completing the screening test were round having other priorities, not interested and kit not being received. The enablers were focussed around receiving more information on how to order a kit, bowel screening, method of collecting a sample and bowel cancer.

The LCC Public Health team continues to work in partnership with the Charnwood GP Network to closely monitor the outcomes of the extended/enhanced access service and how this contributes to increasing cancer screening uptakes across Charnwood.