How this PCN turned hairdressers into cancer screening champions

A Liverpool PCN is training hairdressers to help tackle anxieties and improve uptake of cancer screening. SWAGGA PCN assistant manager Andy Perry explains more.

Comprising 15 GP practices in South Liverpool and serving approximately 100,000 patients, SWAGGA PCN covers suburbs that vary enormously.

Index of multiple deprivation (IMD) data shows the wide variation in deprivation across the PCN, ranging from the least deprived in West Allerton with an IMD score of 12.9 to the most deprived with a score of 60.6 in Speke East. The IMD average for England is 21.7, while the Liverpool average is 42.4. Six of the PCN’s surgeries serve populations with deprivation levels above the Liverpool average.

Post-covid, £22,500 in funding was available to PCNs in Liverpool for projects addressing health inequalities. SWAGGA PCN successfully bid for funding to improve cervical cancer screening among vulnerable patient groups and decided to adopt an outreach approach.

The result was Bits ‘n’ Boobs, which began in 2023. The project was funded by Liverpool City Council, with technical support from Liverpool School of Tropical Medicine and Capacity Development International. Liverpool School of Tropical Medicine also supported the branding and development of the Bits ‘n’ Boobs logo.

In 2025, SWAGGA PCN created the Bits ‘n’ Boobs hairdressers project, where its GP lead and cancer care coordinators actively engaged with local hairdressers, supporting them to become informed partners in addressing screening anxieties and extending the reach of primary care into everyday community settings.

Aim

Initially, the PCN’s focus was on cervical cancer screening among asylum seekers, patients with a learning disability and those with severe mental illness. However, bowel and breast screening also needed a significant push to improve uptake in areas of high deprivation, as well as these three cohorts.

There was a clear understanding that traditional primary care models alone could not adequately address the complex health and social needs of SWAGGA’s diverse community.

Bits ‘n’ Boobs began with three community pop-up events in 2023. This expanded to 28 events in 2024 and 47 community events in 2025.

But the PCN knew there was more it could do. It wanted to empower non-healthcare professionals to become a first point of contact for conversations about screening anxieties. The team therefore decided to engage an unconventional community asset for health promotion: hairdressers.

The PCN initially applied for funding through the Cheshire and Merseyside Cancer Alliance’s targeted intervention for early diagnosis initiative. Although the bid was unsuccessful, the alliance passed it on to NHS England, which agreed to fund the hairdresser project with £17,000.

Approach

Hairdressers are brilliant conversationalists, but it was important that they were informed partners rather than an informal referral service. So, the PCN developed a structured training programme - Bits ‘n’ Boobs Champion Training.

The programme is led by the PCN’s GP clinical lead for cancer, Dr Jillian Kirkman. Alongside the cancer care coordinators, she trains hairdressers to have informed, supportive and meaningful conversations with customers about cancer screening.

Salons that complete the training receive a certificate and branded merchandise to display, showing they are Bits ‘n’ Boobs Champions.

This includes Bits ’n’ Boobs cups as clients will often have a cup of tea while getting their hair done. The cups have generated a lot of conversation, with customers asking what the branding means. Hairdressers can then open up conversations about smear tests, mammograms and faecal immunochemical tests (FIT) in a comfortable way.

There are also mirror stickers featuring the Bits ’n’ Boobs logo and a direct contact number for the PCN’s cancer care coordinators so patients can call for advice or appointments.

A Bits ‘n’ Boobs booklet was created for hair salons as an easy-read resource, using clear language, simple explanations, and eye-catching visuals to make cancer screening information accessible and engaging. By placing it in a relaxed, everyday setting, the aim is to spark informal conversations, raise awareness and help reduce barriers to screening.

Outcomes

Since the start of the Bits ‘n’ Boobs hairdressers project in March 2025, SWAGGA PCN has delivered Bits ‘n’ Boobs champion training to 15 salons in South Liverpool. Feedback from salons has been positive.

The initiative, together with the wider Bits ‘n’ Boobs programme, has seen cancer screening figures improve. For example, in March 2022, bowel screening uptake was 48%. By March 2025, this had increased to 67%. The proportion of abnormal FIT results that led to a referral rose from 8% to 87% over the same period. For breast cancer screening, the rate rise was more modest, rising from 62% in March 2022 to 68% in March 2025. 

The figures also suggest the PCN has reduced health inequalities.

In 2024, bowel screening rates varied from 32.2% in Speke, one of the most deprived areas, to 53.8% in the more affluent area of Allerton. As of December 2025, the lowest bowel screening rate was 44% and the highest was 65.2%.

Cervical screening rates in 2024 varied from 51% in West Speke to 82% in Garston. The PCN’s target was to focus on Speke patients and close that gap. By December 2025, the lowest rate was 70% and the highest was 93%.

Safety netting - that is, ensuring patients with potential symptoms of cancer are monitored throughout the diagnostic process until symptoms are explained or resolved – across all cancers rose from 16% in 2022 to 77% in 2025.

The prevalence of all cancers in SWAGGA PCN has risen from 4% to more than 5% since 2023, when Bits ‘n’ Boobs was launched. The PCN believes this demonstrates the value of developing community advocates to support earlier detection and encourage screening uptake.

Future

Bits ‘n’ Boobs demonstrates the power of extending health promotion beyond traditional clinical settings. By deploying its GP cancer lead and cancer care coordinators into everyday community settings, the PCN has helped overcome barriers to screening, including embarrassment and fears that screening may be painful.

Dr Kirkman has now been asked to formally deliver the conversation training at a local hairdressing college as part of its curriculum, helping to develop future community advocates.

Cheshire and Merseyside Cancer Alliance has partnered with SWAGGA PCN to develop a similar initiative with beauticians. An awards ceremony is being developed to recognise the vital role of health and beauty professionals in making conversations about cancer screening the norm. The awards will also serve as an opportunity to engage wider system partners.

Bits ‘n’ Boobs has become a successful and tried-and-tested model, and SWAGGA PCN is actively sharing its blueprint across Liverpool’s health economy, with a focus on scaling its benefits to neighbouring PCNs.