GP surgeries

Invitation

The screening organisation invites all men and women aged between 55 and 75 years of age to participate in the bowel cancer screening programme. They receive a stool test (FIT) every two years as long as they fall within the target group and have not been referred for further treatment.

Your patient will receive a pre-announcement three weeks prior to being invited for the bowel cancer screening for the first time.
The invitation kit comprises an invitation letter, a leaflet, the stool test, user instructions, a pouch in which to place the stool test and a prepaid envelope.

The stool test contains a personal barcode. The stool test must only be used by the person receiving the health screening invitation.

Reminder

If your patient does not respond, the screening organisation will send a reminder 8 weeks after the initial invitation. If your patient does not respond again, he or she will be invited again in two years - until the age of 75.

Participate or not?

Patients undergoing treatment for bowel cancer do not need to participate in the health screening. Patients being treated by a gastrointestinal and liver services specialist or internist will be advised to consult with the specialist about their possible participation.

Patients who have undergone a colonoscopy in the past five years are advised to consult their GP regarding the usefulness of participation. As GP, you know your patient’s medical history and you can use this to offer appropriate advice.

If your patient has questions about participation in the bowel cancer screening programme, please visit www.thuisarts.nl/darmkanker.

Screening

Patients participating in the health screening should twist open the green cap of the stool test, insert the ridged section of the sample stick into the stool in four different places and twist the sample stick back into the stool test to close it. The test should then be placed in the supplied pouch and the prepaid envelope and sent by standard post to the screening laboratory.

Read the stool test user instructions.

Result

The screening laboratory analyses the stool test and sends the result to the screening organisation. Your patient will receive a letter with the result within ten working days.

• No follow-up appointment is needed.
  No blood was found in the stool. If your patient will not have reached the age of 76 in two years, he or she will receive an invitation for another health screening.

  As with every medical examination, the health screening cannot give 100% certainty. There is always a chance that bowel cancer has not been detected. If your patient has bowel complaints, blood in his/her stool or has suffered from constipation or diarrhoea for a longer period, we recommend that they make an appointment with their GP and not wait for the next health screening invitation.

• A follow-up appointment is needed. 
  Blood was found in the stool. This could be a result of bowel cancer, but could also have other causes. That is why a follow-up consultation is needed. The hospital or independent treatment centre will investigate the cause.
  
  Your patient will receive the results, as he or she requested the test. At your patient’s request, we will send you a notification if a follow-up consultation is needed.

• The stool test is unclear.
  Your patient will receive a new invitation and stool test kit.

Follow-up consultation

If follow-up consultation is needed, together with the result letter your patient will receive an invitation for an admission appointment at a colonoscopy centre. The screening organisation will organise the referral. The health screening can only refer patients to specific colonoscopy centres that satisfy the national set quality requirements. In the result letter, we advise patients to contact their GP to discuss the details that are needed for the admission appointment.

The colonoscopy centre requires the participant’s medical details that are important for the admission appointment, including information regarding medication and medical history. It is also important that the colonoscopy centre is informed as to whether your patient has a family history of bowel cancer. When your patient has been contacted regarding the follow-up consultation, as GP you are responsible for the timely dispatch of the relevant medical details that are required for the admission appointment at the colonoscopy centre.

The follow-up consultation is comprised of two parts: an admission appointment and a colonoscopy.
The admission appointment takes place within 15 days of the result being sent. The colonoscopy takes place within 10 days of the admission appointment. If your patient decides to postpone the admission appointment, the stated time periods can no longer be guaranteed. After the colonoscopy, the colonoscopy centre will forward the results of the bowel examination to the GP, if your patient has given permission for this.

Health insurance and insurance excess
The follow-up consultation (admission appointment and colonoscopy) does not form part of the health screening programme. The costs relating to these examinations fall under the health insurance. Your patient may have to pay (part of) the costs him or herself. This depends on the level of your patient’s insurance excess and how much of this they have used. Your patient will be advised to contact their health insurer if they have any questions about this.

Reschedule follow-up appointment
If your patient was invited for an admission appointment but prefers to visit a different colonoscopy centre or would like an appointment at a different time, this is possible. We ask that your patient reschedules the appointment via our programme and not to make an appointment directly with the colonoscopy centre of their choice. If the appointment is made via us, we will receive the feedback from the colonoscopy centre regarding the results of the follow-up consultation and will therefore know when your patient needs to be invited again.

Patients can reschedule appointments by calling the information line or via My Health Screening.

Patient with higher ASA classification?

The approved colonoscopy centres all meet the national quality requirements. Independent treatment centres (ZBCs), however, may not treat patients with a higher ASA classification. This may be because these patients run a higher risk of complications and the fact that the ZBCs do not have the facilities (such as intensive care) to handle complications.

There is no clear definition regarding whether or not a follow-up consultation should be offered to patients with a higher ASA classification. As GP you can use your patient’s medical details to make the correct assessment.

If your patient has a higher ASA classification and has made an admission appointment at a ZBC, please discuss this with your patient as a matter of urgency. Both for your patient as well as from the viewpoint of available capacity, it would be inconvenient if your patient was later referred to a colonoscopy centre at a hospital after an admission appointment at a ZBC.