The new NHS England ‘ping and book’ screening service is set to exclude thousands of women

NHS England recently announced that a new ‘ping and book’ service for breast and cervical screening will launch via the NHS App from December 2024. ¹ Women with the App will receive notifications alerting them that they are due screening. From early 2026, they can book screening appointments through the App. The initiative promises to ‘revolutionise access to cancer screening’, ‘boost uptake’ by making it ‘as convenient as possible to book appointments’ and ‘save thousands of lives. ¹

We wish to express our concerns regarding app-based delivery of breast and cervical screening invitations, and to stimulate discussion. We believe this move could lead to delayed screenings and cancers diagnosed at a more advanced stage. More advanced cancers require more complex, costly treatment and have poorer outcomes. We outline two key reasons below.

Introducing digital processes to screening delivery is likely to deepen existing inequities in screening access and outcomes. There are well-documented differences in access to digital devices and digital competency between groups in society. Approximately 25% of UK adults lack basic digital skills and 10% are described as ‘internet non-users’.^2,3 Digital exclusion predominantly affects older adults, disabled people, those on long-term sick leave, and in lower socioeconomic households.^2,3 It follows that the NHS App is used significantly less by older adults, those in deprived areas or of ethnic minority background, and those with long-term conditions or complex care needs.^4,5 Many of the older target age group for breast (i.e. 50–70 years) and cervical screening (i.e. upper end of 25–64 years) are likely to lack access to devices that host apps (particularly those requiring an internet connection) or ability to operate this technology. While text reminders can moderately increase breast and cervical screening uptake, ⁶ evidence for apps is lacking. ⁷ Additionally, concerns over data security and low trust in the NHS, particularly among historically marginalised groups, may further deter app uptake.

Increasing individuals’ responsibility for booking appointments could lower participation. While cervical screening uses open appointments, many regions currently operate an ‘opt-out’ system for breast screening, with pre-arranged appointments communicated via letter. Timed appointments are shown to increase screening uptake.^8,9 Transitioning to an open appointment system risks disengagement, particularly in underserved populations where rates are already low and for groups who benefit the most from continued attendance (e.g. women with false positive and negative screening test results).^8–10 The announcement's phased approach – app invitations followed by emails, texts and letters – is encouraging, but delays between digital notifications and postal letters could delay participation and screening effectiveness. The potential benefits of app-based scheduling – such as easier access for some individuals and service efficiencies – must be balanced against concerns about widening inequities for others.

Digital modernisation of screening holds promise, but only if implemented with inclusivity at the heart of it. For example:

1. Continue a hybrid screening delivery approach for as long as needed, rather than dropping this in favour of a “fully digitalised” service. ¹

2. Establish suitable infrastructure to monitor participation by tracking booking and attendance rates to identify demographic groups at risk of disengagement and address emerging disparities.

3. Support equitable access by co-producing digital interventions aligned with system changes, such as culturally appropriate, user-centred health technologies with expanded language accessibility.

Others should have a say in these changes before they are implemented. Members of the public, NHS staff, voluntary and community sector, and experts are invited to share their experiences and ideas for improvement via the Change NHS online platform (live until early 2025). ¹¹ However, using a digital feedback method may exclude crucial perspectives. We hope people will use this opportunity to shape an inclusive approach to screening access.