Bowel cancer screening: out of area screening
Published 28 September 2021
Applies to England
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This document provides guidance on the screening (continuation of the bowel cancer screening pathway) of people at a different NHS bowel cancer screening centre from the one the screening programme invites them to attend. Attending an alternative screening centre is called ‘out of area screening’.
A small percentage of people ask to attend a different screening centre to the one they are invited by. The original (or host) centre is the one the persons’ GP practice is allocated (‘attached’) to – usually due to it being geographically closest. The original centre is the ‘inviting’ service. The screening centre that has been chosen by the individual is the ‘receiving’ service.
This guidance standardises practice in England for people who are making such a request. Note: it does not apply for people who are moved to a different screening centre due to mutual aid (one screening centre taking on another’s patients due to capacity or other issues).
Wherever possible, services should try and accommodate requests from people asking for screening out of their area, to help maximise screening participation and satisfaction.
1. Reasons for out of area screening
People may ask to attend an alternative screening centre due to many reasons, such as:
- difficulty in travelling, or having to travel further to their designated screening centre
- wanting to attend screening near to their place of work
- physical difficulties accessing their local screening centre
- wanting to attend a centre nearer to family or friends
Services have a responsibility to screen participants who request to have bowel cancer screening at their centre. The national bowel cancer screening service specification reinforces this responsibility to encourage participation in the programme. As the numbers of people making these requests are small, the impact on the receiving service is also likely to be small. However, accepting requests from people ‘out of area’ should not compromise or have significant impact on the provision of screening by a service.
Where a person requests to have their screening colonoscopy in a different UK country to be nearer a relative or friend for care, the inviting (host) centre should make a referral via the symptomatic pathway, not via screening.
2. Reasons for declining an out of area screening request
Sometimes accepting an out of area is not possible, due to organisational issues. This is usually if a receiving screening centre has service delays for their own invited population, such as longer colonoscopy waiting times. Accepting additional people into the screening centre could make such delays longer. If the requested receiving centre is not able to accommodate an individuals request to attend, the host centre should advise the individual accordingly and provide them with an appointment (at the host centre).
3. Process for managing out of area screening requests
The following steps outline the process from receipt of request to provision of screening.
- The individual contacts the programme hub or host (inviting) centre to request an appointment at a different screening centre.
- The programme hub or host centre contacts the requested service to determine if they can accept the out of area request.
- Every effort should be made to meet the request. If the request is declined, the requested (receiving) service must provide a valid reason for doing so. If the request is declined with good reason (for example due to capacity issues), the programme hub or host centre must call the individual to explain the situation, and offer them a convenient appointment at the host centre.
- If the request is accepted, this will be valid for the current screening episode only. The receiving service should call the individual to tell them their request is accepted, and offer them a convenient screening appointment.
- If the individual needs further investigations or surgery following screening, they remain the responsibility of the receiving centre for this ongoing treatment (for the duration of the current screening episode).
- If the individual requires ongoing surveillance as part of their bowel cancer screening pathway, they remain the responsibility of the receiving centre that has performed their procedure. The receiving centre becomes their new centre for future surveillance invitations. They revert to the original centre once returned to routine invitation recall.
4. People moving from NHS bowel cancer screening to private healthcare services
After receiving a screening result informing them they require further tests, some people may opt to use the private sector for their diagnostic tests. In such cases, the original centre that invited the person should close their screening episode on the bowel cancer screening system (BCSS). It is desirable for the screening centre to complete the cancer data set with information from the private sector if the information is available.
5. People in very high risk groups
People who are at very high risk of bowel cancer (for example due to having Lynch syndrome) may ask to go to a screening centre where they have already been having care or surveillance of their condition. Wherever possible, the requested receiver organisation should try and meet such requests.