Last reviewed: 15 October 2025
Last reviewed: 15 October 2025
NHS England 2025/26 Network Contract Direct Enhanced Services (DES)
Under the DES contract, Primary Care Networks (PCNs) are expected to help improve local uptake of national cancer screening programmes. This includes:
Using data on OHID Fingertips to understand any variance in screening programme uptake and take corrective action
Auditing non responders to the cancer screening programmes, to analyse why uptake may be low and work with the NHS England regional public health commissioning teams, Cancer Alliances and ICBs to identify and action improvement priorities
Making use of resources available to identify initiatives, including our Primary Care Good Practice Guide(PDF) and Macmillan’s cancer screening quality improvement toolkit
Adopting an ‘Every Contact Counts’ approach, ensuring screening history is checked at every appointment
Visit our GP Contract Hub for tools and guidance.
The Scottish Equity in Screening Strategy 2023-26
In this strategy, the Scottish government outlines national efforts to reduce inequalities in screening. Key points include:
Developing accessible information and communication resources across the full screening pathway
Collect and use data on a wider range of person characteristics to strengthen our understanding of where inequalities exist across the screening pathway
Identify and address service and individual-level barriers to participation
Public Health Wales Screening Equity Strategy 2022-25 The key points in this strategy for addressing inequalities in screening in Wales include:
Sustained community engagement to support communities and groups with historically lower participation in screening
A focus on developing accessible public information and sharing clear and consistent messages on the purpose of screening
A commitment to collaborate with partners to improve quality and timeliness of data to inform inequalities, and taking a locally-led community approaches to addressing inequalities
Northern Ireland Department of Health Cancer Strategy 2022-32(PDF)
Develop plans to reduce sensitivity levels of the FIT incrementally and to extend the age range in line with the recommendations from UK NSC.
Improve access to timely endoscopy services across all Trusts to accommodate reductions in sensitivity levels and widening of age bands.
Increase uptake of all cancer screening programmes in Northern Ireland.
The Bowel Cancer Screening Programmes in the UK have significantly evolved since their rollout began. Below are examples of optimisation activity that could enhance the programme in the future, some of which are already being tested.
The UK National Screening Committee (NSC) recommends that screening for bowel cancer should be offered to people aged between 50 and 74, every two years.
The bowel cancer screening programmes in England and Wales and Scotland now invite people from aged 50 to 74. In Northern Ireland the adoption of UK NSC’s recommendation is outlined in their 2022-32 cancer strategy.
From late August 2025, NHS England will start sending digital pre-invitations to eligible people who have previously completed Bowel Cancer Screening. NHS England are continuing to work on digitalising other communication types – find out more on their digital screening webpage. We will provide updates when any changes are made.
FIT measures micrograms of human haemoglobin per gram of faeces. The definition of a positive or negative result can be changed by altering the numerical FIT threshold.
The FIT screening threshold is 80µg Hb/g in Scotland and Wales, 120µg Hb/g in England and Northern Ireland. In England, a programme is underway to begin lowering the FIT threshold from 120 to 80µg/g across several early adopter sites.
The UK National Screening Committee (NSC) recommends that the optimal threshold is 20µg Hb/g. Although lowering the threshold increases test sensitivity, enabling earlier identification of cancers and adenomas, it also increases demands on services such as colonoscopy and pathology. The UK NSC recommends working towards this optimal threshold over time, with careful planning and consideration for capacity, feasibility, and the potential of risk stratification.
Bowel cancer screening programmes could also explore the potential of adopting risk stratification. This involves grouping individuals by their risk of developing cancer and tailoring screening approaches based on their risk levels. Those identified as at higher risk of developing bowel cancer may be offered more frequent screening or follow-up tests at a lower FIT threshold, while those at lower risk may undergo less frequent screening and avoid unnecessary follow-up procedures.
A better understanding of the requirements and implications of a risk-stratified bowel cancer screening programme is needed to realise the potential benefits. That’s why we’re funding Bowel Star UK; a large multi-centre research study to better understand this, plus demonstrate whether a risk-stratified bowel cancer screening programme would be safe, acceptable, and feasible.
Stay up-to-date with the latest cancer research information.
