Scope of this report

Summary

Bowel cancer screening aims to reduce mortality and the incidence of bowel cancer both by detecting cancers and removing polyps, which, if left untreated, may develop into cancer.

The findings in this report relate to the quality assurance visit on 25 June 2025 to Gloucestershire Screening Service which is commissioned by the Public Health Commissioning team of NHS England South West. Any commissioning findings are outside the scope of this report and will be followed up directly with the commissioner.

Quality assurance purpose and approach

Quality assurance (QA) aims to achieve and maintain national standards, promote continuous improvement in bowel cancer screening and support reducing health inequalities. This is to ensure all eligible people have access to a consistent high quality, effective, equitable and safe service wherever they live.

QA visits are carried out by the NHS England Screening Quality Assurance Service (SQAS).

The evidence for this report comes from the following sources:

• Monitoring of routine data collected by the NHS England
• data and reports from external organisations
• evidence submitted by the provider(s) and external organisations
• discussion with the commissioner in advance of the visit
• information collected during pre-review meetings with radiology on 18 June 2025 and pathology on 2 July 2025
• information shared with the SQAS as part of the visit process.

The screening service

The Gloucestershire bowel cancer screening programme (GBCSP) provides bowel cancer screening services for an eligible screening population of 166,354 (aged 50-74 years) across 79 GP practises within Gloucestershire. The service is commissioned by NHS England South West and is covered by NHS Gloucestershire integrated care board (ICB) and Aneurin Bevan Local Health Board.

The GBCSP started in January 2007 inviting men and women aged 60 to 69 years of age for the faecal occult blood test (FOBt) screening. In January 2010 the screening service extended the age range covered to 74 years. As part of the age expansion plan the service began inviting ages 56 in June 2022, ages 58 in August 2022, ages 54 in April 2023, and ages 50 and 52 in September 2024.

Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) is the host for the service, with Gloucestershire Health and Care NHS Foundation Trust as an associated trust. All programme co-ordination and administration for the service is based at Cheltenham General Hospital (CGH). Colonoscopy, specialist screening practitioner (SSP) and pathology are all based from CGH, with radiology delivered from Gloucestershire Royal Hospital (GRH).

Colonoscopy is also delivered from Stroud Hospital as an associated site, with expansion to include Cirencester Hospital planned. The service delivers 5-6 SSP clinics each week by telephone or in person when required. The service currently delivers approximately 8 colonoscopy lists per week and offers a regional service for bowel cancer screening tertiary complex polyp referrals.

The screening programme Southern hub based in Guildford undertakes:

• the invitation (call and recall) of individuals eligible for FIT screening
• the testing of screening samples, and
• onward referral of individuals needing further assessment.

This element of the pathway is outside the scope of this QA visit.

Findings

This is a well-run and high-quality bowel cancer screening service, with excellent colonoscopy key performance indicators and standards achieved. Whilst the service had capacity and delivery challenges in 2023, the team have worked hard to recover and are planning well for the future anticipated demands on the service. There is a strong team cohesion and excellent working relationships with the Trust Executive Board.

Immediate concerns

The QA visit team identified no immediate concerns.

High priority findings

The QA visit team identified 4 high priority findings as summarised below:

• Assurance on the provision of enhanced sedation/propofol lists in the Trust
• Lead Radiologist job plan and description to be formalised
• Two recommendations regarding the use of multiple spreadsheets to manage patient pathways in both administration and SSP teams, where the bowel screening IT system should be used where ever possible

Examples of practice that can be shared

The QA visit team identified several areas of practice for sharing, including:

• All screening episodes outcomes and letters are checked by 2 SSP’s for accuracy, which is good practice
• Excellent colonoscopy practice, demonstrated with high KPIs
• Strong Patient Safety Incident Response Framework (PSIRF) established within the Trust

Recommendations

The following recommendations are for the provider to action unless otherwise stated.

Next steps

The screening service is responsible for developing an action plan in collaboration with the commissioners to complete the recommendations contained within this report.

SQAS will work with commissioners to monitor activity and progress of the recommendations for 12 months after the report is published. After this point SQAS will send a letter to the provider and commissioners summarising progress made and will outline any further action(s) needed.

Appendix A: References

1. Bowel cancer screening accreditation Bowel cancer screening accreditation
2. Bowel cancer screening programme: guidelines for CTC imaging Bowel cancer screening imaging use
3. Bowel cancer screening programme: standards Bowel cancer screening programme standards
4. Bowel cancer screening: guidelines for colonoscopy Bowel cancer screening colonoscopy quality assurance
5. Bowel cancer screening: helping people with learning disabilities Bowel cancer screening helping people with learning disabilities
6. Bowel cancer screening: managing incidents Bowel cancer screening managing incidents
7. Bowel cancer screening: pathology guidance on reporting lesions Bowel cancer screening reporting lesions
8. Bowel cancer screening: programme overview Bowel cancer screening programme overview
9. Bowel cancer screening: programme specific operating model Bowel cancer screening programme specific operating model
10. Bowel cancer screening: specialist screening practitioner Bowel cancer screening specialist screening practitioner
11. Cancer screening: informed consent Cancer screening informed consent
12. Joint advisory group on GI Endoscopy The JAG
13. Key Performance Indicators NHS screening programmes Antenatal, newborn, young person and adult NHS population screening: reporting data definitions
14. Managing Safety Incidents in NHS Screening Programmes Managing safety incidents in NHS screening programmes
15. NHS BCSP Quality Assurance arrangements for the NHS Bowel Cancer Screening Programme, Draft version 2.1 (December 2010)
16. NHS England Serious Incident Framework – Supporting learning to prevent recurrence (March 2015) Serious incident framework
17. NHS population screening: pathway requirements specifications Bowel cancer screening pathway requirements specifications
18. PHE Screening inequalities strategy PHE Screening inequalities strategy
19. Public health profiles Public health profiles
20. Section 7a screening service schedules no 26 2024-2025 NHS Bowel Screening Programme No 26 Screening Centres Service Schedule 2 Final Clean – Vaccinations and Screening – FutureNHS Collaboration Platform
21. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update