Rolling out targeted lung health checks

When I was asked in 2019 to help roll out the targeted lung health checks it was an exciting moment.

As a general practitioner, I relished this fantastic opportunity to support the move to proactive care and prevent long term or terminal ill health.

My team and I, working in a place-based partnership, were able to use our wider connections in the integrated care system to help mobilise the roll out.

The TLHC programme

The targeted lung health check programme (TLHC) is a national scheme that identifies people aged 55-74 at increased risk of lung cancer. We invite them for a lung health check and chest CT scan if appropriate which can take place in a mobile unit or hospital setting.

The programme started in 2019 after a study showed CT screening reduced lung cancer mortality by 26% in men and between 39% and 61% in women.

In June 2023, it was announced that the TLHC would be the basis for a national targeted lung cancer screening programme. The programme is rapidly expanding across England to reach everyone who is eligible and has now sent over one million invites and detected over 3,000 lung cancers, over 74% at an early stage when lung cancer is more treatable.

South Yorks TLHC

In South Yorkshire, we were delighted to be one of 10 sites involved in the initial roll out and have so far diagnosed 309 lung cancers which would otherwise have gone undiagnosed, 73% of which were at an early stage with a high rate of survival.

79 other cancers have been detected so far, including breast cancer – including twice in men – kidney, lymphomas, and even a skin cancer.

Nearly two-thirds (65%) of the 20,000 people scanned had coronary artery calcification – which is a risk factor for heart attacks and strokes and often needs statins. A quarter of people had a non-cancerous lung disease such as bronchiectasis or emphysema.

Lung cancer and deprivation

The prevalence of lung cancer is greatest in areas of high deprivation, but within those areas some people will be at even higher risk and may also be disproportionately impacted by health inequalities.

In the planning for rollout in South Yorkshire, we wanted to ensure we reached as many people at the highest risk as possible, therefore the support of our analysts was crucial.

The South Yorkshire Bassetlaw Cancer Alliance Business Intelligence team presented us with lots of types of data to help us prioritise who to contact through a population health management approach.

We used a combination of deprivation data, ERS backlog rank (data comparing rates of lung cancers before covid) suggestive of areas where patients might be being missed in terms of lung cancer, smoking rates, and finally COPD rates.

These were all combined and a final ranking used. We then combined the practicalities of workforce and site availability with the data to get started and keep momentum.

So far, we have rolled out trucks in locations across Doncaster, Rotherham, Bassetlaw and Barnsley. To ensure we prioritised those at highest risk we started with the primary care networks (PCNs) with the highest deprivation rates where that was possible.

We are now in the very early stages of planning for Sheffield and are using the same matrix for prioritisation having also been able to include the PCN-level information. This gives us a good idea of where to go first so people know well in advance where the trucks will be.

Lessons learnt and future progress

For others rolling out this programme I’d say the practicalities are crucial. The team requires space for two articulated lorry trailers – not taking up the whole car park – with easy access, a flat surface and sufficient mobile phone reception to transfer the images.

Sites had to be easy to get to by car or public transport. Many smaller sites were quickly ruled out but we started at Rossington Miners Welfare in April 2021 and moved to a range of others across Doncaster including leisure centres, a pub, and retail parks. We also used Tesco car parks but found the Christmas period led to challenges with volume!

We have sent out over 100,000 invites so far and the scheme has been very successful but we know there is still unmet need we need to address. This is likely to include people who need a different approach and don’t engage with the NHS’s usual service offer, so our next step is to do more in this space.

There will always be challenges with rolling out new programmes but for many of the 309 people we’ve diagnosed so far, it’s been lifechanging. Scale that up across the country and the benefits are clear.

There’s a lot of talk about shifting care closer to home and moving from reactive to proactive healthcare. But this programme is a genuine example of the why, the what and the how coming together to show how when we work together it’s not just talk, it’s real action and it’s saving lives.

Watch a short film about how Population Health Management is being used in different ways across the country or join the Population Health Academy to find out more.

Dr Jason Page has worked as a general practitioner in Rotherham for the last 23 years.

In September 2019 he started work as Clinical Director of South Yorkshire and Bassetlaw targeted lung health checks, which has so far found over 350 cancers. He is also the Medical Director of Rotherham Place within South Yorkshire Integrated Care Board.

Jason is married to Nic, a paediatric oncologist, and has three children. On Saturdays he’s most likely found watching Rotherham United.