Strengthening screening to support the National Cancer Plan

As the National Cancer Plan places a renewed focus on early diagnosis and tackling inequalities, leaders at our recent roundtable highlighted that England’s screening programmes must evolve at pace to meet the scale of ambition. While progress is being made, significant gaps in public awareness, access and system capacity remain. 

Chaired by Professor Sir Mike Richards, the roundtable brought together senior clinical, operational and system leaders from screening, primary care, pharmacy, public health and community services. Their collective experience surfaced pressures that often sit beneath formal programme reporting, particularly around access and public behaviour. 

The roundtable highlighted a range of themes shaping how screening programmes need to evolve. The following stood out as offering the greatest opportunity for system leaders to drive meaningful change. 

Reaching underserved groups requires new models of engagement 

Leaders agreed that inequalities in screening participation continue to limit progress. Groups identified during the roundtable discussion included people who smoke, those living in deprivation, LGBTQ+ communities and people living with mental health conditions. For example, people with severe mental illness, are less likely to participate in cancer screening and are more likely to be diagnosed at a later stage.  

The group also highlighted opportunities to better align mental and physical health pathways. People already supported by mental health services could be helped to access screening while those diagnosed with cancer may require psychological support. Stronger integration between mental and physical health services was seen as a practical way to increase participation and reduce late-stage presentation. 

Deprived groups continue to show markedly lower uptake across multiple programmes. Barriers vary significantly by geography, ethnicity and cancer type, reinforcing the need for locally tailored delivery built with trusted community partners. 

Mobile services and community outreach have already demonstrated strong results. In the national lung cancer screening programme, for example, targeted Lung Health Checks delivered in community settings have reached high-risk groups who do not engage with traditional pathways. Current national uptake rates range between 35% and 75% across various pilot sites, with an average national response rate of approximately 50% as of late 2024, reinforcing the need for local adaptation. 

Public awareness is declining for some cancers and remains dangerously low for others 

Participants raised concern about declining engagement with established programmes like breast screening, alongside cancers where awareness has never been high enough to support early diagnosis. 

For example: 

• Oesophageal cancer sees around 9,200 new cases and 7,900 deaths each year, largely due to late diagnosis 
• Many people regularly buy proton pump inhibitors over the counter to manage persistent heartburn without realising it can be a red flag 
• Pharmacy teams see these patients first yet do not have a standard digitised route to refer them for review 

Heartburn Cancer UK shared evidence that when the capsule sponge test is taken into community settings, engagement can increase significantly. A recent awareness initiative involving London black cab drivers was heavily oversubscribed, illustrating the potential of targeted outreach. Evidence from the CYTOPRIME2 community testing programme reinforces this approach: among 1,815 people tested, 14.7% were referred for endoscopy and 5.3% were diagnosed with Barrett’s oesophagus. 

Leaders noted that without more coordinated national and local action, including clearer referral pathways, targeted awareness campaigns and better use of community settings, awareness gaps will continue to limit early diagnosis.

Workforce pressure is limiting the system’s ability to scale screening 

The discussion also highlighted the role workforce capacity plays in determining how far screening programmes can expand. While new initiatives aim to increase participation, the services that support screening pathways are already under significant pressure. 

 Across the system, shortages in key diagnostic specialties continue to constrain capacity. For example, nearly 976,000 scans breached the one-month reporting target in 2024, while workforce gaps are expected to widen in areas such as gastroenterology, where almost half of consultants are expected to retire within the next decade. Dermatology faces similar pressures, with more than 3.5 million attendances delivered by only 685 WTE consultants. 

 As screening expands, maintaining pathway flow will depend on the system’s ability to deploy flexible staffing models that can operate across both clinical and community settings. Clearer referral routes and better information sharing will also be needed to enable pharmacy teams and other community partners to play a more active role. Digital tools and AI were highlighted as potential enablers to reduce administrative workload and free up clinical time. 

Pharmacy offers untapped capacity that could transform screening pathways 

Participants described pharmacy as one of the most underused assets in screening. With frequent touchpoints and trusted relationships within communities, pharmacy teams could: 

• Prompt conversations with people at higher risk 
• Support higher FIT kit returns 
• Identify repeated over-the-counter purchases linked to cancer risk 
• Direct people back to primary care earlier 

However, system constraints persist. Digitised referral routes remain limited and pharmacy teams often lack the information needed to close the loop. Participants noted that structured electronic referral routes and better information-sharing would unlock significantly more value from pharmacy’s reach. Strengthening this interface was seen as a quick win with potential national impact. 

What comes next 

Xyla, part of Acacium Group, has published an executive briefing that explores these insights in greater depth, including the system challenges shaping delivery of the National Cancer Plan. The briefing sets out what leaders can do now to strengthen screening participation and how these insights intersect with diagnostic capacity, workforce pressures and operational delivery. It also highlights where immediate operational changes could improve uptake ahead of wider system reforms.

Delivering the National Cancer Plan – Executive briefing