BACKGROUND:
Bowel cancer (BC) is the second largest cause of cancer death, but early detection improves survival. Community pharmacies (CPs) are easily accessible and well-positioned to support early detection by spotting symptoms and making referrals at an early stage. However, little is known about their current practices, perceived barriers and training needs in this context.

METHODS:
A cross-sectional survey was conducted with pharmacy staff (n=142 pharmacists; n=176 non-pharmacists) in London and Wales. The questionnaire, co-designed with CP staff, clinical experts and PPI representatives, explored five domains: frequency and initiation of BC consultations, capacity to take on additional responsibilities, confidence and training needs and potential referral pathways. Responses were analysed descriptively.

RESULTS:
Key barriers to offering confidential BC consultations were a lack of time among pharmacists (61.3%) and insufficient training among non-pharmacists (40.2%). While 61.3% of pharmacists reported having the knowledge to discuss BC symptoms, only 19.5% of non-pharmacists reported the same. However, most pharmacists (76.8%) and over a third of non-pharmacists (37.4%) agreed that spotting potential BC symptoms is part of their role. Over half of both groups reported insufficient training in recognising (52.8% pharmacists, 61.5% non-pharmacists) and discussing BC symptoms (51.4% pharmacists, 63.2% non-pharmacists). Confidence in referring users to GPs was greater among pharmacists (71.8% vs. 32.8%). Across all groups, online learning was the most preferred training format (83.1% pharmacists, 46% non-pharmacists).

CONCLUSIONS:
Pharmacists reported greater knowledge and confidence in discussing BC symptoms but reported limited time to engage in consultations. In contrast, non-pharmacist staff may have greater capacity to support early detection efforts if provided with appropriate training. Enhancing targeted, flexible training, particularly on communication and symptom recognition, could enable pharmacy teams to contribute more effectively to the early detection of BC. Ultimately, this could help reduce inequalities in health outcomes and relieve the burden on the NHS.