Community Links is currently delivering Year 3 of a three-year programme commissioned by North East London Cancer Alliance (NELCA) to improve cancer screening uptake and early diagnosis across Primary Care Networks (PCNs) in Barking & Dagenham, City & Hackney, Havering, Redbridge, Newham, Tower Hamlets, and Waltham Forest.

This data-driven, community-focused initiative supports PCNs to identify gaps in screening uptake, engage underserved populations, and embed long-term improvements in practice.

The following statistics were drawn from the end-of-service evaluation and played a key role in securing funding to extend the programme.

How It Is Delivered

  • PCN-Level Engagement: 100% of PCNs engaged with the programme; 96% received bespoke data packs and developed improvement plans through direct facilitator collaboration.
  • Data-Led Facilitation: Our facilitators create practice-level heatmaps, analyse IIF screening indicators, and guide Quality Improvement (QI) efforts using localised data.
  • Community Outreach: Facilitators support awareness events, deliver multilingual resources, and collaborate with system partners to increase visibility of screening offers.
  • Staff Training: The programme includes cervical cancer training, tailored bite-size modules for non-clinical staff, and ongoing in-practice awareness building.

Focus Areas

Bowel Cancer Screening

  • Prioritised support for PCNs performing below target on the IIF CAN-02 indicator (FIT compliance).
  • Targeted interventions helped practices achieve major gains — e.g., Clissold Park NW2 PCN increased from 75.9% to 97.4% uptake.
  • Case Study: In Tower Hamlets, facilitators partnered with GP practices to send multilingual SMS reminders and host community health events, resulting in both increased FIT kit returns and cervical screening appointments.

Breast Cancer Screening

  • Facilitators uncovered wide variation in coverage (1% to 91%) and addressed manual coding issues affecting accuracy.
  • Shared best practice examples, including Becontree Medical Centre’s local awareness campaign.
  • Developed a Standard Operating Procedure (SOP) to support GP teams in improving data quality and patient engagement.

Impact to Date (Year 2 Evaluation) 

  • 81% of PCNs rated the programme as excellent
  • 90% reported the support had improved early cancer diagnosis efforts
  • 95% found facilitators accessible and easy to work with

Screening Improvement Facilitators Programme – North West & South West London (NWL & SWL)

Delivered across NWL and SWL | Commissioned by RM Partners (RM Cancer Alliance)
April 2022 – March 2025

This programme supported GP practices across North West and South West London to improve bowel, breast, and cervical cancer screening uptake, particularly in underserved populations post-COVID.

How It Was Delivered

  • Facilitators worked practice by practice, agreeing on tailored actions to boost screening, guided by local data and NHS targets.
  • Supported the delivery of multilingual materials, digital tools, and health promotion strategies.
  • Focused on opportunistic screening promotion due to ongoing service recovery, particularly in breast screening.

North West London (NWL)

Bowel Cancer Screening

  • 440 bowel screening actions agreed across 177 GP practices
  • Notable improvements:
    Green Practice: +23.9 percentage points (pp)
    Clifford Road Surgery: +15.1pp
    Brunswick Surgery: +17.7pp
  • Year 3 – Phase 1: Average +1.33pp improvement
  • Year 3 – Phase 2:
    Walm Lane Surgery: +14.0pp
    Woodfield Road Surgery: +17.7pp

Breast Cancer Screening

  • 220 actions agreed
  • Focused on raising awareness through opportunistic engagement
  • Encouraged use of translated materials and partnerships with local health promotion teams

South West London (SWL)

Bowel Cancer Screening

  • 234 actions agreed across 66 practices
  • Notable improvements:
    Crane Park Surgery: +16.1pp
    Wallington Medical Centre: +14.4pp
  • Year 3 – Phase 1: Average +5.01pp improvement

Breast Cancer Screening

  • 95 actions agreed
  • Continued focus on opportunistic promotion, enhanced by multilingual content and digital appointment tools

Challenges & Recommendations

Challenges:

  • Limited practice capacity
  • Data system and coding issues
  • Language barriers and interoperability limitations

Recommendations:

  • Reinstate third-party calling (e.g. Community Links) for proactive outreach
  • Fund pop-up screening clinics
  • Develop QR-coded posters and leverage NHS App for engagement
    Improve access to dashboards and coding practices
  • Ensure translated, culturally sensitive materials are routinely available