‘Blood in pee’ campaign: Impact on services

Local authorities and their staff can help to raise awareness of the ‘blood in pee’ Be Clear on Cancer campaign, by encouraging employees and local community groups to actively talk about the campaign. This will help to reinforce key messages communicated via the advertising.

Those who are at risk of developing bladder or kidney disease include: over 50s, smokers, those who are overweight or obese, or suffering from other medical conditions such as kidney disease or diabetes. You could brief community-based  organisations that cater to these groups and are already promoting healthy lifestyle behaviours, to reference the campaign and raise awareness of how stopping smoking for example, could reduce their risk of developing the diseases.

Distribute campaign materials to local community groups or encourage them to order their own materials to be displayed in their communal areas. Leaflets, posters and other collateral can be ordered via the Health and Social Care Publications Orderline.

Remind colleagues, they don’t need to be medically qualified to promote the campaign or to advise people to see their GP if they have symptoms. Simply advising people on what to look out for, and encouraging them to tell their doctor straight away if they do notice the sign or symptom can help save lives.

Follow the links below for more advice on how to open conversations about cancer and how you can source further training and support if needed.

Download a briefing for local authorities

Order free campaign materials

View downloadable resources

View TV and radio adverts

You can help to raise awareness of the main signs and symptoms of bladder and  kidney cancers and the risk factors associated with the diseases by familiarising yourself with the advertising, talking about the campaign, and  reinforcing the importance of seeing a GP if blood is found in the urine, even  just the once.

Within the workplace, you can combine talking about the campaign and the symptom of blood in the urine, with healthy lifestyle messages. For example, you could encourage staff to take part in Stoptober, since smoking is one of the main risk factors of bladder and kidney cancers. By stopping smoking, people will reduce their risk of developing the diseases.

This campaign is particularly relevant to employers within some manufacturing industries where employees are/were exposed to certain industrial chemicals. It has been estimated that in the UK, around 7% of bladder cancer cases in men and 2% in women are linked to occupational exposures. [1, 2]

Campaign materials including posters and leaflets are available to order. Please display these and distribute leaflets to help disseminate essential information about the signs and symptoms of bladder and kidney cancers.

Download a briefing for employers, trade unions and/or occupational health workers

Order free campaign materials

View downloadable resources

View TV and radio adverts

References

1. Parkin DM. Cancers attributable to occupational exposures in the UK in 2010. Br J Cancer 2011; 105(S2):S70-S72;  doi: 10.1038/bjc.2011.487

2. Rushton L, Bagga S, Bevan R, et  al. Occupation and cancer in Britain. Br J Cancer 2010; 102:1428-1437

Community champions, volunteers, and community and voluntary sector organisations are well-placed to proactively raise awareness about the campaign. As you may have experienced yourself, people often feel more comfortable opening up about a worrying sign or symptom of cancer with someone who is similar to them, yet more informed than themselves. For some, talking to a peer initially can be much less intimidating than the prospect of talking to a GP first.

You can help to disseminate the main campaign message of ‘If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor.’ by talking about the campaign with service users, colleagues, friends and family. Ask people if they’ve seen the adverts and if they know what the main sign or symptom of bladder and kidney cancer is. Aim to give people the confidence to get checked out if they have noticed blood in their urine by reassuring them that the chances are it’s nothing serious, but these cancers are more treatable if they are found early. Your encouragement could help save their life.

Campaign materials including posters and leaflets are available to order. Please display these and distribute leaflets to help disseminate information about the campaign. Familiarise yourself with the campaign adverts and understand which groups are at a high risk of developing bladder or kidney cancers. A summary briefing containing all the information you will need to support the campaign is available for you to print off and share with colleagues, or retain for your own reference.

Download a briefing sheet for volunteers and community groups

Order free campaign materials

View downloadable resources

View TV and radio adverts

Opening conversations about cancer can be difficult. Try asking people if they’ve seen the TV adverts or heard the radio adverts. Follow that up with asking if they can remember what the main symptom of bladder and kidney cancer is. These questions should help to initiate a conversation about the campaign.

People may offer information up voluntarily if they have previously, or recently, noticed blood in their urine. Others may not. It’s often best not to ask too many questions about signs or symptoms, or get involved in a discussion. Simply offer up the advice ‘If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor.’ Reassure people, the chances are it’s nothing serious, but these cancers are more treatable if they are found early.

If you or your employees are regularly having conversations about cancer, you may wish to learn more about cancer awareness training delivered by Cancer Research UK. Talk Cancer training workshops aim to equip community based staff and local volunteers with the information and confidence they need to talk about cancer, and to help address common barriers which people often report as reasons for not wanting to visit their GP.

Find out more about Talk Cancer awareness training

A number of information and data resources are available to support you in the run up to, and during the ‘blood in pee’ campaign.

View downloadable resources

You are likely to see more patients coming to your practice and presenting with blood in their urine as a result of the campaign, but it is anticipated that this will be manageable.

It’s difficult to predict the exact increase you can expect to see. Results from the regional ‘blood in pee’ pilot showed an overall increase in the number of patients presenting with visible haematuria during the campaign period:

• Across 54 GP practices this equated to an additional 0.29 visits per practice, per week – a statistically significant 32% increase in GP attendances, compared to the same period the previous year. [1]

We recommend your practice reviews the uplift in GP presentations experienced during the autumn 2013 national ‘blood in pee’ campaign, as this will help you to plan for the upcoming campaign.

References

1. Be Clear on Cancer: Evaluation Summary May 2014

NHS Improving Quality will work with the Strategic Clinical Networks (SCNs) to help secondary care colleagues prepare for the campaign. SCNs and NHS Trusts have been asked to plan for an increase in patients being referred for diagnostic tests and treatment.

It’s difficult to predict the exact increase you can expect to see, however looking back at past campaigns may help. Results from the second national ‘blood in pee’ campaign showed an overall increase in the number of patients presenting with visible haematuria during the campaign period:

• On average each trust saw approximately six urgent GP referrals for suspected urological cancers per week. The peak of referrals was approximately two months after the campaign activity started. [1]

The impact on services will vary by trust and be influenced by the size and age profile of your local population. Think back to the last ‘blood in pee’ campaign in 2016 and the impact it had on your area. Consider the number of requests for appointments, diagnostic tests and urgent GP referrals that you had during and after the advertising. Use this information to help you plan for the 2018 campaign.

Download NHS trusts briefing sheet

References

1. NCIN data November 2015 

NHS Improving Quality will work with the Strategic Clinical Networks (SCNs) to help secondary care colleagues prepare for the campaign. SCNs and NHS Trusts have been asked to plan for an increase in patients being referred for diagnostic tests and treatment.

It’s difficult to predict the exact increase you can expect to see, however looking back at past campaigns may help. Results from the second national ‘blood in pee’ campaign showed an overall increase in the number of patients presenting with visible haematuria during the campaign period:

• On average each trust saw approximately six urgent GP referrals for suspected urological cancers per week. The peak of referrals was approximately two months after the campaign activity started. [1]

The impact on services will vary by trust and be influenced by the size and age profile of your local population. Think back to the last ‘blood in pee’ campaign (October – November 2014) and the impact it had on your area. Consider the number of requests for appointments, diagnostic tests and urgent GP referrals that you had during and after the advertising. Use this information to help you plan for the 2016 campaign.

Download NHS trusts briefing sheet

References

1. NCIN data November 2015 

As a GP, you can:

1. Be prepared. It is difficult to predict the exact demand each campaign will have on NHS services,  but think back to the last ‘blood in pee’ campaign and note the impact it had in your local area. Consider the number of requests for appointments, diagnostic tests and urgent 2WW referrals that your practice had during and after Be Clear on Cancer advertising.

• It is likely you will see a modest increase in the number of people who come to see you with visible haematuria as a symptom during the campaign period. During the regional ‘blood in pee’ campaign, a 32% increase (equivalent to 0.29 visits per GP practice, across 54 practices) in GP visits for ‘blood in pee’ was observed. [1]Continue to use your clinical judgement and refer for investigation as appropriate.
• However, the number of new diagnoses of these two cancer types per GP is typically small - put into perspective, a GP will see a  bladder or kidney cancer case once every 29 months. [2]

It is worth remembering, around 1/5 of all cases of bladder and kidney cancer cases each year are diagnosed via emergency presentation, [3] which can have a detrimental impact on a patient’s chances of successful treatment. Only a small proportion of those diagnosed are currently referred via the two-week wait referral system (30% of bladder cancers and 19% of kidney cancers), [4] so there is a clear role for GPs in improving the early diagnosis of these cancers.

2. Talk about the campaign. It may prompt people who’ve previously ignored blood in their urine to come and see you. The primary target audience of over 50s in particular, may be embarrassed, not find it easy to communicate their symptoms, be worried about wasting your time, or be fearful of painful or prolonged treatment if it is cancer.

3. Make the most of available support. There is a wealth of information to support you when making urgent  referral decisions.

• NICE guidelines for suspected cancer: If blood in urine is painless; your patient is over 40 with recurrent or persistent urinary  tract infections associated with blood in urine; or has blood in urine with no  identifiable infection, NICE guidelines recommend making an urgent referral via  two-week wait (2WW).
• A British Medical Journal learning online  education tool: ‘Tackling late diagnosis of cancer’
• Guidance on safety netting to improve early cancer diagnosis in primary care

4. Work with your GP lead. The NHS and local authorities were encouraged to work together in planning for this campaign. Your CCG may have a GP cancer lead, who can give you further information relating to your area. Many GPs have found it useful to work more closely with secondary care clinicians to make improvements in the patient pathway too.

To source contact details for the GP lead in your area, email beclearoncancer@nhsiq.nhs.uk with ‘GP lead query’ in the subject line.

5. Encourage your colleagues to support the campaign. Practice nurses, receptionists and practice managers all have an important role to play. Make sure everyone is aware that  the national ‘blood in pee’ campaign was re-run and encourage them to visit  this site, so they can support the ‘blood in pee’ campaign and can prepare for  more patients coming to your practice as a result of the campaign.

As the gatekeepers to investigation and referral, you occupy a pivotal role in a patient’s pathway to early diagnosis. With your support, we aim to improve patient outcomes for bladder and kidney cancer, by detecting more cases earlier.

Review NICE guidelines for suspected cancer

Review British Medical Journal online education tool ‘Tackling late diagnosis of cancer’

Review guidance on safety netting

References

1. Be Clear on Cancer: Evaluation Summary May 2014

2. http://www.hscic.gov.uk/catalogue/PUB10394/nhs-staf-2002-2012-medi-dent-...

3. Incidence data supplied by South West KIT based on NCRS and NCDR datasets

4. http://www.ncin.org.uk/publications/routes_to_diagnosis 

As a pharmacist, you can:

1. Make it part of your day. During your regular consultations, such as medicine-use reviews, or in conversations with customers, be aware that people might want to talk about the campaign. It may prompt those who have previously ignored their symptoms or discounted them as a one-off, to do something. People may come to your pharmacy looking for over the counter (OTC) medicines or advice for a symptom that could be a sign of bladder or kidney cancer.

2. Give permission. We know from research with this target audience that they often seek permission to visit their GP. People try to gauge if their symptoms are severe enough, others think the GP will not want to see them or it will be a waste of their doctor’s time. Be confident and urge any customers that mention having blood in their urine to visit their GP, whether it’s just the once or as part of a recurring urinary tract infection (UTI). If you feel comfortable, tell the customer to mention that their pharmacist or a member of the pharmacy team has sent them. It may be the push they need to get themselves checked out.

GPs will be following NICE guidelines, which states: a patient with blood in urine which is painless, or who is over 40 with recurrent or persistent UTIs associated with haematuria, or who has blood in urine with no identifiable infection, should be urgently referred.

3. Promote the campaign. Put up posters in your pharmacy and ensure you have some ‘blood in pee’ campaign leaflets readily available for customers.

4. Talk about it. Tell your friends, family, customers and colleagues about the Be Clear on Cancer ‘blood in pee’ campaign. We need to talk about cancer and make it less of a taboo subject. This campaign gives us all the chance to do that.

If your customer/patient complains of blood in their urine, even if it’s just the once, or is using an OTC medicine to treat repeated UTIs, urge them to visit their doctor.

Download all briefing materials for free from the Campaign Resource Centre

As a practice manager, you can:

1. Brief colleagues: Your whole team needs to be aware of this campaign and why it ran – tell your patient groups too. Direct GPs and Nurses to the briefing sheets available and encourage everyone to watch the TV adverts on NHS Choices to understand what your patients would have seen during the  campaign.

Inform receptionists there may be an increase in the number of patients requesting appointments – it is essential patients are welcomed when they seek help. From research we know that making a GP appointment is a significant barrier to many people, for various reasons, e.g. they don’t want to waste the GP’s time or think they won’t be able to get an appointment easily.

2. Prepare for the campaign. It’s difficult to predict exactly how many more patients will come through your doors as a result of the campaign. It is anticipated that this will be manageable. Results from the regional ‘blood in pee’ pilot showed an overall increase in the number of patients presenting with blood in urine during the campaign period:

• Across 54 GP practices this equated to an additional 0.29 visits per practice, per week compared to the same period the  previous year.[1]

We recommend you review the uplift in GP appointments experienced during autumn 2013, when the first national ‘blood in pee’ campaign ran, as uplift is likely to have varied across the country. This will help you to plan for the campaign.

Be prepared for an increase in the number of people sent for diagnostic tests and referred via the urgent two-week wait (2WW) referral system too.

• The first national ‘blood in pee’ campaign saw a statistically significant increase of 26% in the number of 2WW referrals for suspected urological cancer, during the campaign period.

You may not have noticed the impact of the campaign straight away – during the regional ‘blood in pee’ campaign, the North of England Cancer Network team noted it caused a steady increase in demand, rather than a sudden spike, and this lasted up to three months after the campaign had finished.

3. Promote the new campaign. Display posters and leaflets, and encourage your colleagues to talk about the ‘blood in pee’ campaign. TV advertising is incredibly powerful at raising awareness of symptoms, but it is often face-to-face discussions that influence behaviour change. Talking might prompt someone to make an appointment or open up about their symptoms.

Watch TV ads and listen to radio ads on NHS Choices 

Download all briefing materials for free from the Campaign Resource Centre

References

1. Be Clear on Cancer: Evaluation Summary May 2014

If you are a member of the pharmacy team you can:

1. Be confident and follow your normal protocol. If you are concerned about a customer and feel uncomfortable talking about cancer, ask your pharmacist to speak to them. Or, if that isn’t possible, urge the customer to go  to see their GP and get their symptoms checked out. It may be nothing serious,  it might be an infection or kidney or bladder stones, but may still need  treating. If it is cancer, it’s better for it to be detected early.

Opening conversations about cancer can be difficult. A Cancer Research UK Nurse who specialises in communicating about cancer advises:

’It’s important for pharmacy staff to feel confident and to try and make  cancer a normal part of conversation. Practise and find phrases that you are comfortable with. For example, if you wanted to mention cancer as part of a medicine-use review, talking about it in the same breath as heart disease, stroke and diabetes may make it easier. If you are worried about someone who has repeatedly bought an OTC medicine for a suspected cancer symptom, you could ask:  “What does the doctor say about that?” or “Do you think it might be a good idea to discuss your symptoms with your GP?”’

As a nurse, you can:

1. Make every contact count. You are well placed to be vigilant for patients who may have concerns about a symptom of bladder or kidney cancer. The campaign could have prompted people who have ignored symptoms or have had recurring UTIs to talk to you; however they may be afraid, embarrassed, or worried about what might follow if it is cancer.

• If a patient comes to see you about something unrelated, e.g. new patient check or a specialist clinic, or if you are treating patients with a long-term condition, ask if they have any other concerns
• Use these opportunities to discuss healthy lifestyle changes too
• Have campaign leaflets at hand in clinics and when out in the local community

2. Give permission. Our target audience can delay going to see their GP and often seek permission to make an appointment. Where relevant, encourage patients to visit their GP. Suggest they see their GP again if their symptom doesn’t go away. For extra reassurance, tell them to mention that the nurse sent them. It may be the nudge they need to get themselves checked out. Recommend they come back and tell you how they got on.

3. Encourage your colleagues to support the ‘blood in pee’ campaign. Encourage people you work with to watch the TV adverts and listen to the radio ads on NHS Choices

• Brief health care assistants about the campaign so they can bear it in mind in their day-to-day work and direct all colleagues to  the relevant briefing sheets available on this site
• Be prepared for more patients mentioning symptoms to you as a result of the campaign.

View guidance on ‘safety netting’ to support you in making sure patients with persistent symptoms continue to be followed up. Reassure patients that if symptoms persist following an initial visit with their GP, they should make a further GP appointment.

Download all briefing materials for free from the Campaign Resource Centre

Public Health England and its partners pay for all national advertising, and campaign materials are provided to local teams free of charge. In the early years of Be Clear on Cancer, some grants were available for networks to apply for, to help boost local activities. Such grants are no longer available.