Aim To demonstrate the quality improvement associated with the implementation of a specialist Family History of Bowel Cancer Service in secondary care. Method Outcomes assessed: 1. Adherence to the BSG Guidelines for colonoscopic surveillance of individuals with a family history of colorectal cancer; 2. Adherence to the Revised Bethesda Criteria for the identification of colorectal cancer patients with suspected Lynch Syndrome; 3. Identification of inherited colorectal cancer risk syndromes; 4. Colonoscopic Adenoma Detection Rate. Data was collected for a 21-month period prior and subsequent to the establishment of this service, for all patients who underwent colonoscopic surveillance for a family history of colorectal cancer and all patients newly diagnosed with colorectal cancer. Analysis compared the number of colonoscopies performed, not indicated by BSG guidelines; the average number of years patients were screened early; the adenoma detection rate; and the rate of MMR tumour testing, before and after the implementation of the service. Results Following the establishment of the service there was a reduction in number of colonoscopies not indicated by BSG guidelines, (39.6% vs 5.8%, p<0.001, chi squared test); surveillance colonoscopy took place at a more appropriate age (10.6 vs 5.9 years too early, p=0.01, t-test). There was an increased adenoma detection rate (17% vs 31.9%, p<0.01, chi-squared test), and increased tumour MMR testing (3.4% vs 91.8%, P<0.01, Chi squared test). Conclusion The introduction of a Family History of Bowel Cancer Service results in improved patient care through improved guideline adherence for colonoscopic surveillance and increased cancer detection rates.