How the faecal immunochemical test is changing bowel cancer referrals and what it tells us about the power of NICE guidance

Bowel cancer is the second biggest cancer killer in the UK. Early detection significantly increases survival rates, reducing the need for intensive treatment and offering a high probability of a complete cure (around 90% for stage 1). That is why getting the right people into the right pathway quickly matters so much.

The faecal immunochemical test (FIT) helps to do exactly that. It’s a simple at-home test that detects tiny amounts of blood in poo. Collecting the sample takes minutes. A positive result triggers urgent further investigation. A negative result means we can often reassure patients and consider less urgent investigations or avoid unnecessary procedures.

FIT identifies people at high risk before they become more seriously unwell and brings them into the right pathway at the right time. But it does something equally important for the majority of patients: it gives them faster answers, and for many, the reassurance that they do not need any further investigation at all.

Nobody wants a colonoscopy unless they really have to have one. FIT helps us support a decision to avoid that and for most patients, that's a real relief. It also means we can direct colonoscopies to the people who are most likely to benefit, freeing up capacity across the system.

The evidence is clear and now NICE guidance is helping to drive adoption across the country.

Lessons from the North East: early adoption in action

We began using FIT for symptomatic patients early, building on NICE’s 2017 diagnostics guidance, which recommended offering FIT to adults with certain low-risk symptoms. When strong evidence emerged supporting its use for people meeting the urgent suspected cancer criteria, backed by both the British Society of Gastroenterology and the Association of Coloproctology of Great Britain and Ireland, we were well placed to act. There was real enthusiasm from secondary care colleagues to use FIT in the cancer pathway. As the primary care lead, my role was to make sure GPs felt supported to use it.

To make it work in practice, we needed a system that was consistent, reliable and easy to use. We consolidated all testing through a single lab in Gateshead and adopted a fully postal process. Kits go directly to patients and straight back to the lab. Every kit is pre-labelled and sent out with consistent patient information, reviewed for accessibility by our local learning disability network. If you are housebound or live in a rural community, you are closer to a postbox than a GP surgery. The kit comes to you.

We also built safety netting into the process from day one. If a kit is not returned within 14 days, an automatic alert goes to the GP. A second alert follows at 28 days. The system does not rely on busy healthcare staff remembering to chase a result.

The results have been striking. Our conversion rate, the share of referrals that lead to a confirmed cancer diagnosis, is currently the highest in the country, with referral numbers falling. We're getting the right people through the door and that's exactly what FIT should do.

Addressing inequalities in FIT uptake: using data to close the gap

FIT works best when everyone who needs it can use it. Our data shows that patients in more deprived areas are less likely to return their kits, and we see a similar pattern linked to ethnicity. NICE's own guidance acknowledges this directly. It calls for further social research to find the best ways to improve access and return rates among groups where engagement has been lower.

In the meantime, the data we already have can help us act now. Because we consolidated testing through a single lab, we receive monthly practice-level reports on return rates. My team can quickly spot where uptake is lower and ask the question: what are the higher-performing practices doing differently? Where practices serve similar populations but get different return rates, the data points us to where those conversations need to happen.

Taking action in the community – Billy’s story

But addressing inequalities cannot rest with primary care alone. Some of the most important work happens in communities, through organisations already present in the lives of those who are hardest to reach.

In the North East and North Cumbria, our Learning Disability Network has trained peer educators to deliver cancer awareness sessions through Be Cancer Aware. For a community where health inequalities can be acute, this kind of grassroots education makes a real difference.

Billy's story shows why this matters. After taking part in Be Cancer Aware, Billy knew to visit his GP when he noticed blood in his poo. His GP gave him a FIT kit but Billy was not sure how to use it. He turned to one of our peer educators Lindsey Fothergill. Lindsey took the time to sit with Billy, walking him through the process using a sample kit and fake poo until he felt confident. Billy returned his kit, went on to have a colonoscopy, and doctors found and treated bowel cancer. He is now in the follow-up stage, receiving regular check-ups.

Billy's outcome depended on community education that reached him, and on practical, personalised support that helped him complete the process. That is what genuinely inclusive healthcare looks like.

Getting this right requires more than just a good test. For FIT symptomatic testing to fulfil its potential, we need primary care engagement, safety-netting processes that follow up when kits are not returned, and community organisations that support education and awareness.

The confidence to act: NICE guidance and a national shift

In August 2023, NICE published healthtech guidance recommending FIT for assessing patients with symptoms of bowel cancer. Before that guidance was in place, some GPs had concerns about whether using FIT in the cancer pathway was the right thing to do. Having that official backing removed that doubt and gave doctors the confidence to act. Through my role at the Northern Cancer Alliance, I’m aware that some areas were holding back, waiting for NICE before they committed. NICE guidance has removed those barriers. It's a genuine catalyst for change.

The national data backs this up. The proportion of urgent referrals accompanied by a FIT result has risen from under 60% in June 2023 to almost 80% in June 2025. In 2024 to 2025, there were 140,000 fewer referrals for suspected bowel cancer than expected and yet the number of cancers detected has remained stable. This suggests that FIT is helping to identify which patients need urgent investigation and which can be safely managed in primary care.

FIT also makes economic sense. NICE's own modelling confirms that it represents a cost-effective use of NHS resources, primarily because it reduces the number of unnecessary colonoscopies. Colonoscopy capacity is limited, and waiting times can be long. FIT helps the NHS do more with less. By identifying who truly needs a colonoscopy, it frees up capacity for the people who need it most.

This is what good guidance does. It takes innovation that is working on the ground and gives the whole NHS the confidence to adopt it.

Discover what support looks like

The FIT story shows what is possible when innovation, clinical commitment and national guidance come together. Whether you’re an NHS decision maker or a healthtech developer, NICE guidance can help you take the next step.

If you're an NHS decision maker considering healthtech solutions for your trust or integrated care board, explore NICE's healthtech guidance to understand how evidence-based recommendations can support confident adoption decisions.

If you're a healthtech developer with a promising technology seeking to scale use across the NHS, discover how NICE's healthtech guidance can support your innovation journey.