Abstract

Executive Summary
This manual presents the Call For a Kit (CFAK) programme, a patient navigation intervention designed to increase participation in the NHS Bowel Cancer Screening Programme among people who have not responded to a previous screening invitation and provides practical guidance for organisations wishing to implement, adapt, or sustain it in their own populations.
The problem. Despite improved participation following the introduction of the faecal immunochemical test (FIT), substantial inequalities persist in bowel cancer screening. Uptake is consistently lower among people living in deprived areas, some ethnic minority communities, people with disabilities, people with severe mental illness, and those with lower health literacy. Bowel cancer outcomes in Lancashire and South Cumbria remain poorer than the national average.
The intervention. Established as a pilot in 2015 and now an established service, CFAK is delivered by trained Health Promotion Officers who act as link workers. They identify non-responders through GP practices, offer personalised consultations (face-to-face, telephone, or video), address practical, emotional, informational, cultural, and system-level barriers, and facilitate access to replacement FIT kits alongside community engagement and awareness raising activities.
Evidence of impact. The programme is supported by a substantial evidence base including a regional needs assessment, quantitative and qualitative evaluation, patient experience research, economic evaluation, and ongoing service learning. Findings demonstrate that CFAK successfully engages non-responders, generates additional FIT kit returns, and is particularly effective at reaching groups with historically low screening participation, including some ethnic minority communities and people with disabilities or long-term conditions.
Six key lessons. Successful implementation depends on: (1) relationship-based delivery built on trust and personalised support; (2) offering face-to-face consultations where possible, given their higher FIT completion rates, while recognising that meaningful support can also be delivered effectively through telephone and video consultations according to patient needs and preferences; (3) strong GP practice partnerships for identifying and recruiting patients; (4) tailoring approaches to individual needs and circumstances; (5) investing in workforce training, supervision, and reflective practice; and (6) digital systems that support rather than hinder patient-facing work.
Recommendation. Organisations seeking to reduce inequalities in bowel cancer screening should consider adopting the CFAK framework, adapting delivery to local circumstances while maintaining its core principles: patient navigation, relationship-based support, informed choice, and inequality reduction.

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