Bowel screening QI module

Learn how you can increase bowel cancer screening participation rates in your practice or health service.

About this module 

Research shows that strong primary health care involvement is associated with greater cancer screening participation rates. In particular, the following primary health care activities have led to higher participation rates: 

  • A patient centred approach, knowing your patient population to identify at-risk patients and people who are under or have never screened. 
  • Taking an all of practice approach.
  • GP endorsement of an invitation to take a cancer screening test.
  • Use of recall and reminder systems.
  • Participation in quality improvement programs incorporating audits and feedback on screening rates.

Watch the videos

Learn more about bowel screening in primary care and view the instructional video on how to use this module.



Key resources

Module components

Contact us:

An overview of bowel cancer screening

  • 1 in 13 men and 1 in 16 women in NSW will be diagnosed with bowel cancer during their lifetime.
  • 1 in 14 people in NSW will be diagnosed with bowel cancer by age 85. 
  • If detected early, bowel cancer can be successfully treated in more than 90% of cases. 
  • Bowel cancer is Australia’s second biggest cancer killer. 

Bowel cancer can also be described as colorectal cancer, colon cancer, rectal cancer or anal cancer, depending on the section of bowel where the cancer starts. 

The recommended strategy for population screening in Australia—as indicated in the clinical practice guidelines for the prevention, early detection and management of colorectal cancer—is immunochemical faecal occult blood (iFOB) testing every 2 years, starting at age 50 years and continuing to age 74 years.

The guideline is directed at those at average risk of colorectal cancer without relevant symptoms.

Discover more bowel cancer statistics.

The National Bowel Cancer Screening Program (NBCSP) is the Commonwealth Government-funded population-based screening program that aims to reduce deaths from bowel cancer by detecting early signs of the disease. 

  • Bowel cancer screening can detect cancers at an earlier stage when treatment can be more successful. 
  • The NBCSP sends out free bowel cancer screening tests to eligible Australians aged 50 to 74 every two years.    
  • The bowel screening test in an immunochemical faecal occult blood test (iFOBT) which detects very small amount of blood in the bowel motion. 
  • People aged 50 to 74 years who have a valid Medicare card or registration with the Department of Veterans Affairs are invited to participate every two years. 

The National Cancer Screening Register (NCSR) supports the delivery of the NBCSP by providing a national electronic infrastructure for the collection, storage analysis and reporting of screening program data. See further information.

The Healthcare Provider Portal and integration with clinical information systems enables providers (e.g. general practitioners, nurses, and other specialists) to access patient results and screening histories and submit bowel screening data electronically. 

Patients who are eligible to participant in the program National Bowel Cancer Screening Program   

  • have a Medicare Entitlement type of either: Australian citizen or Permanent resident 
  • have a current Medicare card or be registered as a Department of Veterans’ Affairs (DVA) customer 
  • have a mailing address in Australia 
  • are between 50 to 74 years of age 

If patients meet these criteria they are automatically registered for the Program and a bowel test kit will be sent to their address as recorded by Medicare or the Department of Veterans’ Affairs. 

The Participant Follow Up Function (PFUF) is a function of the NBCSP, performed by the Cancer Institute NSW (pillar of NSW Ministry of Health).  

  • PFUF Officers support participants to progress through the bowel cancer screening participant pathway, following a positive iFOBT result. 
  • Program letters are sent to participants and their nominated GP to provide iFOBT results and to prompt GP visits and referrals. 
  • Following reminder letters, PFUF Officers conduct follow-up calls to participants and their nominated GP where a participant has not progressed along the pathway according to the National Cancer Screening Register. 

For information regarding the NSW PFUF service, email 

Patient centred care

Knowing your patient population is essential to delivering patient-centred care. Having supportive systems and accurate information in clinical software is key to effectively identifying at-risk patients, so that you can ensure information is tailored and care is responsive to people’s individual needs and preferences.

Learn more information about patient centred care.

Populations with lower levels of participation in cancer screening can experience higher cancer incidence and mortality.1,2,3 There are various community groups who are less likely to participate in bowel cancer screening including: 

  • Aboriginal and/or Torres Strait Islanders  
  • Culturally and linguistically diverse communities 
  • People with disability 
  • People who live very remotely 
  • People in the lowest socioeconomic (SES) group 
  • People of Diverse Genders and Sexualities 

The annual National Bowel Screening Program monitoring report (Australian Institute of Health and Welfare) presents national participation data on some of these community groups. 

Tips to promote and encourage bowel cancer screening among under-screened patients  
  • Understand your under-screened patient population by cleaning up your practice data and seeking support from your PHN. This will help you decide which population group/s your practice will prioritise. 
  • Seek patient feedback to understand what prevents them from participating in bowel cancer screening and the actions your practice can take to promote bowel cancer screening as being safe, comfortable and accessible for patients. The RACGP Patient feedback guide provides a comprehensive guide on methods for collecting and acting on patient feedback. 
  • Remind patients that bowel cancer is common, when detected early can be successfully treated in more than 90% of cases. 

For patients who are discouraged by the ‘yuck’ factor, reassure them that: 

  • Only a very small amount of stool is required to complete the test and they can complete the test without having to handle their own stool.  
  • The toilet liners are completely biodegradable and can be safely flushed down the toilet. 
  • The samples are kept in a sealed tube and a zip-lock back, so they cannot see the sample in the tube and it’s completely safe to be kept in the fridge.  
National Bowel Cancer Screening Program (NBCSP)

The NBCSP website provides a comprehensive range of culturally appropriate educational and promotional materials for health professionals and communities.  

Cancer Institute NSW  
  • Do the test webpage – provides culturally appropriate information for including personal story videos  

Ngununggula - Walking and Working Together: A manual for health professionals supporting Aboriginal people with Cancer

Developed by The Illawarra Aboriginal Medical Service. This project has been a collaboration between the AH&MRC, University of Sydney (Michelle Dickson), UOW, and Menzies SHR and Coordinare PHN, and funded by Cancer Australia. 

Access the following resources:

  • Manual for health professionals supporting Aboriginal people with cancer.
  • Quality Improvement appendices.
  • Cancer webinars.

View the resource >

RACGP Resource Hub

Supporting effective, culturally safe primary healthcare.

View the hub >

More information

Do any of your patients need, or prefer to speak languages other than English? 

Access an interpreter through the Translating and Interpreting Service (TIS National) Doctors Priority Line on 131 450.

Family Planning NSW ‘Just Checking’ website provides a range of information and resources to encourage participation of people with intellectual disability in bowel, breast and cervical cancer screening.  

ACON’s ‘Get Your Kit Together’ campaign raises awareness of bowel cancer and importance of regular bowel cancer screening among LGBTQ (lesbian, gay, bisexual, trans and queer) people aged 50-74 in NSW.  

Always make sure to accurately record a person's gender in the practice software system (note: this might be dependent on the practice software and the options they have available). It is important to ask about gender to build understanding and rapport as well as build accurate practice data. Lack of accurate data for gender diverse people can lead to non-inclusive health programs and services and poorer health outcomes. It is best practice to include a two-step method when asking a gender question.


Question 1: How do you describe your gender?

Question 2: At birth, were you recorded as:

- Man or male
- Woman or female
- Non-binary
- Use a different term (please specify)
- Prefer not to answer

- Male
- Female
- Another term (please specify)
- Prefer not to answer (this inclusion is optional)

For more information, see ACON’s best practice gender, sexuality and intersex indicators or ABS indicators.

Team approach

The toolkit recognises that each team is unique. It provides examples of members’ roles and responsibilities in Quality Improvement projects. Having a team member who champions quality improvement within your practice can be the key to successful quality improvement activities. 

TIP: The National Screening Register has integrated with Medical Director, Best Practice and Communicare software enabling access and submission of patient screening data directly from within a patient record. 

Learn more information about team approach.

General practice has an important role in the National Bowel Cancer Screening Program. Patients are more motivated to take part in a bowel screening if recommended by their primary care provider. General practices can encourage their patients to participate by promoting the program in their practice, providing clinical advice, and following up patients who have not screened. 

The National Bowel Cancer Screening Program provides a range of resources and to support the role of primary care in bowel cancer screening. 

The NBCSP website has links to a range of resources for primary care providers, including:  

  • The participant screening pathway is a flowchart that shows the pathway through the National Bowel Cancer Screening Program, it identifies what stage people are contacted throughout the process and who contacts them.  

Information for health professionals and providers managing bowel screening participation:  

  • The role of health professionals in the National Bowel Cancer Screening Program.   
  • Reporting participant information the National cancer Screening Registry.  
  • Managing bowel cancer screening for participant with special considerations. 


  • A collection of resources for the health sector to encourage and support conversations with patients about bowel cancer screening.  
  • A collection resources for the general public to promote participation in bowel cancer screening.  
  • Promotional materials including posters and brochures which are available in multiple languages. 

Demonstration kits are available to order from These kits along with the instructions on how to do the test are helpful to walk through how to do the test with patients.   


The NBCSP has a series of online training modules tailored for GPs, practice nurses and Aboriginal and Torres Strait Islander health professionals.  

'Getting to the bottom of bowel screening' Webinars

A series of webinars providing valuable insights to GPs and health professionals to help drive participation in the National Bowel Cancer Screening Program (NBCSP) campaign.

Cancer Screening Education for General Practitioners (True Relationships)

A free online course by True Relationships on which provides information, resources and tools to support promotion and management of patients through bowel, breast and cervical cancer screening.  

National Bowel Cancer Screening Program webinar for nurses working in general practice

A one-hour online seminar on bowel cancer, screening and how nurses working in general practice can approach bowel cancer screening with patients.  

GPs play a key role in ensuring that program participants progress through the screening pathway.

GPs deliver clinically appropriate advice, services and treatment and report on data on participants and their outcomes to the National Cancer Screening Register. GPs can encourage patients to participate in bowel cancer screening by5:

  • GPs are best placed to support decision-making around bowel screening. See information about CRC risk prediction tool.
  • Encouraging eligible people to participate if they receive a screening test and the test is clinically relevant for them. 
  • Order a bowel screening test kit for a patient using the health care provider portal of the National Cancer Screening Registry (NCSR).  
  • Assessing people with a positive result and refer them for further examination as clinically indicated – for example, a colonoscopy. 
  • Notifying the NCSR about referrals or non-referrals for colonoscopy or other bowel examination for participants with a positive result. This can be done by returning the program’s GP Assessment Form by fax, post or electronically through the Health Care Provider Portal
  • Informing patients at average to slightly above average risk that the approved guidelines from the NHMRC National Health and Medical Research Council (NHMRC) recommend screening every 2 years, starting at age 50 and continuing to age 74.
  • Managing patients identified as being at increased risk of bowel cancer as per the NHMRC-approved guidelines.
  • Managing patients (of any age) with symptoms as per the NHMRC-approved guidelines. 


Direct Access to Colonoscopy (DAC) is a virtual model of care that allows otherwise healthy patients, who have returned a positive iFOBT, to be assessed and triaged over the telephone rather than attending a face-to-face appointment with a specialist.

Direct Access to Colonoscopy services are being rolled out across NSW at a number of public hospitals. Find out more about DAC Model of Care

Find out more about your local DAC service by:

  1. Download your local health district referral form (via your LHD website)
  2. Access referral form from your local HealthPathways

Practice nurses have an important role to play in encouraging and supporting patients to participate in the NBCSP.

Primary Care Nurses can encourage patients to participate in bowel screening by:  

  • Promoting the NBCSP in your practice. 
  • Conducting screening audit of practice records. 
  • Talking to your patients aged 49 to 74 about screening. 
  • If appropriate, order a bowel screening test kit for a patient using the health care provider portal of the National Cancer Screening Registry.  
  • Sending a letter to 49-year-old patients to encourage participation in the program. 
  • Finding out when patients will receive a kit via NCSR and, if appropriate, encourage participation.  
  • Showing patients how to use a bowel screening test kit - have a sample kit available for demonstration. 
  • Helping patients complete the participant forms. 
  • Referring patients (of any age) with symptoms, bowel disease or family history of bowel disease to a GP. 

Practice management and administrative staff play an important role in the organisation and delivery of services within general practice.

In relation to bowel cancer screening management and administrative staff can: 

  • Support systems in cancer screening 
  • Oversee and support data and systems with up-to-date patient records  
  • Directing patients to available cancer screening information in the practice 
  • Engage in QI activities by supporting practice facilitation or technical expertise 

Aboriginal Community Controlled Health Services (ACCHS) have an important role to play in supporting Aboriginal people in bowel cancer screening. 

  • Support early detection and diagnosis of bowel cancer. 
  • Provide strategies to encourage participation in NBCSP. 
  • The NBCSP has a collection of resources to support GPs and health workers to use when offering Aboriginal people bowel screening.  
  • Provide culturally appropriate early assessment, diagnosis, surveillance and treatment pathways. 
  • Encouraging Aboriginal patients to have their annual 715 assessments, which includes cancer screening.
  • If appropriate, order a bowel screening test kit for a patient using the health care provider portal of the National Cancer Screening Registry (NCSR).  
  • View more information on alternative access to bowel screening kits for Aboriginal people.

For more information visit the National Bowel Cancer Screening Program (NBCSP) website

More information

Ngununggula - Walking and Working Together: A manual for health professionals supporting Aboriginal people with Cancer. 

The manual was developed by The Illawarra Aboriginal Medical Service. The project has been a collaboration between AHMRC, University of Sydney (Michelle Dickson), UOW, and Menzies SHR and Coordinare PHN, and funded by Cancer Australia. 

Learn more

Quality Improvement

Quality improvement (QI) encompasses a combination of factors that can improve processes and systems within your practice, which ultimately improve patient outcomes.  

Learn more information about QI.

Refer to the Bowel Cancer Screening: a quick reference guide (PDF) which will help your practice to assess current processes in place to encourage participation in bowel cancer screening and identify where improvements can be made. The Quick Reference Guide includes a bowel cancer screening readiness checklist and example Model for Improvement based on the Plan Do Study Act cycle (PDSA). 

Quality Improvement (QI) activities in relation to bowel cancer screening can be broken down into three categories, depending on how engaged your practice is with QI. Ideally level one activities would be foundational and support progression to level 2 and further to level 3 as these are more involved activities 

Level 1 QI Activities

Introductory level, starts with improving data quality. Level 1 QI ideas include: 

  • Establish a practice register for bowel cancer screening within practice clinical software (e.g. eligible patients: screened within last 2-years, due for screening, never screened) 
  • Register with Sonic Healthcare - Pathology Service contracted to NBCSP to receive FOBT test results electronically within practice clinical software 

Download the Bowel Screening: QI activity - level 1 (PDF)


Level 2 QI Activities

Clinical level, based on addressing bowel cancer screening at a clinical level with activities focussed on care delivered by GPs and Nurses. Level 2 QI ideas include: 

  • Incorporate bowel cancer screening questions (e.g. screening history and family history) and advice into health assessments 
  • Put in place system prompts within your clinical software, that reminds clinicians when age-eligible patients are due or overdue for bowel cancer screening 

Download the Bowel Screening: QI activity - level 2 (PDF)


Level 3 QI Activities

Practice level, the team may choose to focus on bowel cancer screening as a major focus area for the practice. Level 3 QI ideas include: 

  • Take a practice approach to supporting priority populations (e.g. Aboriginal, culturally, and linguistically diverse, or rural and remote populations) to undertake screening for bowel cancer by identifying under-screened patients and encouraging them to screen through supportive clinical advice 
  • During bowel cancer awareness month promote bowel cancer screening to eligible patients through promotional information within the practice (e.g. posters/letters/SMS reminders) and conversations with clinicians 

Download the Bowel Screening: QI activity - level 3 (PDF)


Data and systems

Robust data and systems provide insight and understanding about your practice population and who is eligible for bowel cancer screening.

Understanding your practice population allows you to target preventative activities and supports staff to provide reliable care to help drive increased participation in bowel cancer screening.  

Refer to the information in the tabs below for tips on improving the quality of your bowel cancer screening data and systems.

Learn more information about data and systems.

Use the lists of test results in the links below to check that the bowel cancer screening test results used by your pathology providers are recognised by the software that you use to create patient reminder lists (ie. data audit tools or your practice software). This will ensure that your practice generates accurate bowel cancer screening participation statistics and identifies patients who are due for screening.  

CAT4 (Scroll down to ‘Pathology codes’) 

If the test results used by your pathology provider are not listed, contact your Primary Health Network (PHN) for further support. 

Check your Sonic Healthcare iFOBT test results  

In some instances, Sonic Healthcare sends faecal occult blood test (FOBT) test results (for bowel cancer screening) via a hyperlink that is valid for 12 months. This format will not be recognised by data audit tools or your practice software. If you are not getting FOBT results via hyperlink, contact Sonic Healthcare on 1800 957 177 to ask for your results to come in HL7 PDF format.

A high-quality recall and reminder system for bowel cancer screening will allow your practice to: 

  • Systematically remind all eligible patients about bowel cancer screening (often reminders are only set for when a result comes in, overlooking patients who are not screening)  
  • Identify and appropriately engage under-screened patients 
  • Support clinicians to deliver better care to patients who are under-screened 
  • Track your bowel cancer screening participation rates (which is key to knowing whether what you are doing is working or not). 

It is important that the way your practice handles cancer screening recall and reminders is consistent. If you have multiple labels/codes for the same recall reason, it is difficult to accurately undertake recall searches. 

Below is an example of what multiple bowel cancer screening labels/codes might look like: 

CRC screening
Bowel screening

View bowel screening recall and reminder label/codes (PDF)

It is important to understand what diagnoses are excluded from bowel cancer screening by your practice software to minimise the chance of sending a screening reminder to a patient inappropriately.  

In addition to patients for whom “Not required” or “Excluded” has been manually selected in practice software, patients with the diagnoses listed in the links below will also be automatically excluded from bowel cancer screening eligibility lists:

Software provider  Bowel cancer screening exclusions  Viewing patients excluded from bowel cancer screening 
CAT4 Diagnosis codes that PEN uses to assign patients to ‘ineligible’  When you complete cancer screening searches using the provided recipes a pie chart will be produced, a section of which is ‘ineligible’, click on this section and export a list to excel using the standard process



Have an appropriate staff member (practice nurse or GP) review the list to identify any patients who may be eligible to return to bowel cancer screening. It is important to periodically review patients who have been excluded from bowel cancer screening to assess the appropriateness of them returning to screening based on clinical guidelines. The reason for the decision must be explained to them prior to inclusion back into screening reminder processes.

Your practice has the option of extracting a list of patients that your records show is overdue for bowel cancer screening. This provides you with a list that you can then utilise patient records via access to the NCSR.

Software provider  How to extract a list of patients overdue for cervical screening
CAT4 Cancer screening – reminder workflow (PDF)
POLAR See your PHN for support 

The NCSR will send back the pathology results for any person who has recorded results. This will allow you to identify people who are up to date with their screening and focus on those who are overdue.

The Healthcare Provider Portal is a self-service alternative for health professionals to access and submit bowel cancer screening data electronically in the NCSR.  

The Healthcare Provider Portal allows those with a provider number and a Provider Digital Access (PRODA) account to communicate with the National Register in order to:

  • Search for a participant and view their test results and screening histories 
  • Submit information and forms to the National Register – bowel (and cervical-related) program forms 
  • View and update your patient’s details 
  • Opt out, defer or cease your patient’s correspondence for either for bowel or cervical programs 
  • Nominate other people to assist your patient (such as a personal representative or another healthcare provider) 

The Healthcare Provider Portal is integrated with most clinical information systems to enable healthcare providers to access and report clinical data for the National Bowel Screening Program from existing clinical information systems, including Best Practice Saffron (Jan 2021), Medical Director 4.0 (Aug 2021) and Communicare (Dec 2021). 

For more information on accessing the portal, visit the website and/or contact your PHN for support in access. 

TIP - To integrate GP practice software, practices are required to complete one linkage for authentication via PRODA account. Once integration is complete, the practice will have access to all the functionalities of the healthcare provider portal whilst working within their practice management system.

TIP - To access the Healthcare Provider Portal, you will need to create a Provider Digital Access (PRODA) account. Check with your PHN that this is set up for your practice to access the portal. 



GP practices can access support from an NCSR specialist. Book your walk-through with an NCSR specialist using this link – Please don’t delay the NCSR are there to help.

Establishing your baseline participation rates for bowel cancer screening will allow you to: 

  • Benchmark your performance against state averages. 
  • Compare your actual performance against your perceived performance (practices often find that screening participation in their practice is lower than anticipated). 
  • Track your improvement over time as a result of your bowel cancer screening quality improvement activities. 

Before you begin, it is important to decide: 

  • Where you will record your participation rates. 
  • How often you will monitor your participation rates (quarterly is recommended, as this allows some time to see change). 
  • How you will share and celebrate progress with the practice team (team newsletters, lunchroom display, team meetings, etc.). 
Goal 60%: The percentage of men and women aged 50–74 who have completed a bowel cancer screening test (iFOBT) in the previous 2 years.

Numerator: The number of active patients, aged 50–74 years, who have completed an iFOBT in the previous 2 years. 

Denominator: The number of active patients aged 50–74 years eligible for the National Bowel Cancer Screening Program. 


Connecting with patients through provision of cancer screening reminders is an important preventative activity. Patients who are reminded by their GP are more likely to screen.6 The RACGP’s Putting prevention into practice lists organisational change and targeted reminders systems as the two most effective implementation strategies for improving preventative care in general practice (p.42).7 

It is important to establish a bowel cancer screening workflow that systematises: 

Refer to the screening recall and reminder workflow (PDF) and modify as required to meet your practice’s needs and priorities. Ensure that data cleaning is completed prior to implementing the workflow to avoid sending bowel cancer screening reminders to patients who should not receive them.

92% of patients say they would be more likely to participate in bowel cancer screening if their doctor recommends it.

Consider surveying your patients to better understand their preferences for receiving bowel cancer screening reminders (e.g. SMS, emails, letters, phone calls, voice messages). NBCSP has developed template letters and SMS to support implementation of the bowel cancer screening recall and reminder workflow.

The recall and reminder workflow (PDF) incorporates bowel cancer screening into existing preventative practices for Aboriginal and Torres Strait Islander people, and those with (or at risk of) chronic disease. This is an excellent way to provide integrated person-centred care and lift screening participation rates among people who may have an increased risk of cancer due to age and/or lifestyle risk factors.   

The bowel cancer screening information below can be attached or embedded into your templates for Aboriginal and Torres Strait Islander health assessments (MBS item 715), 45 to 49 year old health assessments and GP Management Plans (GPMPs) and GPMP reviews:

Patient problems/needs/relevant conditions  Goals (changes to be achieved)  Required treatments and services, including patient actions  Arrangements for treatments/services (when, who, and contact details) 
Bowel cancer screening

Patient completes iFOBT received in mail close to even birthdays from age 50–74. 


The patient has increased familial or clinical risk and is screening as per clinical guidelines. 

Date of last bowel screening result: _________________ 

Date of next screening is approx. two years from the last negative screening result (bowel cancer screening kits are posted on even numbered birthdays from age 50–74): ______________________ 

GP to: 

  • confirm screening eligibility 
  • review family history 
  • discuss screening benefits (if under-screened) 
  • discuss bowel cancer lifestyle risk factors 

Patient to ensure their address is up-to-date with Medicare (so that they receive their bowel cancer screening kit) by: 

  • logging into their MyGov account OR  
  • by calling Medicare on 132 011 OR 
  • by visiting a service centre
  • Calling the National Cancer Screening Register (NCSR) on 1800 627 701 

Patient to complete iFOBT kit received in mail, as per enclosed instructions. 

GP can order iFOBT from the NCSR (which will be delivered to the patient's home address) via the Healthcare provider portal or integrated practice software.  

Patient to make an appointment with GP if any support is required to complete the kit. 

GP to set a screening reminder (if appropriate).