The NHS Cervical Screening Programme

Kath Bainbridge North West QA Primary Care Development Nurse

What We'll cover

• Aims and Outline of NHS Cervical Screening Programme

• Cervical Cancer causes and incidence

• Coverage

• Quality Assurance

• Call and Recall

• GP’s Responsibilities and QOF

• Women in Special Circumstances

Aims of the NHS cervical screening programme

• To reduce the number of women who develop invasive cervical cancer and the number who die from it.

• Regular screening is offered so that conditions which might develop into cervical cancer can be identified and treated

The Cervical Screening Programme

• Started in 1960s• 1988 – All Health Authorities run a

cervical screening programme for women aged 20-64, with call recall system

• 2003 -Liquid based cytology introduced• Lower age increased to 25

The Cervical Screening Programme

• 2008 - National HPV vaccination programme introduced for 13 year old girls

• HPV triage piloted• 2010 - Cytology laboratory services move

to cover larger areas• 2013 - HPV Primary testing pilots

Elements of the Cervical Screening programme

• Sample Taking

• Transportation to Laboratory

• Laboratory Screening Service

• Call and Recall

• Colposcopy

Risk Factors for Cervical Cancer

• Infection with HPV

Co-factors that modify the risk

• Smoking

• Long term oral contraceptives (> 5 years)

• 5 + full term pregnancies

• Previous exposure to other STIs e.g. chlamydia

• Immuno-suppression

• Not being screened

Cervical CancerTrends in incidence and mortality, England 1989 to 2010

Map of mortality by Cancer Network, 2006-2010

Age-specific incidence rates and number of cases diagnosed by five year age group, England 2009

Age-specific relative survival, England 2007-2009 (one-year) and 2003-2005 (five-year)

The Programme aims for 80% coverage

- Coverage is the proportion of women eligible for screening who have had a test with a recorded result at least once in the previous 5 years.

- Women are eligible between 24yrs and 6 months – 64 yrs.

- Screening frequency 3-5 yearly - If overall coverage of 80 per cent can be achieved, the

evidence suggests that a reduction in death rates of around 95 per cent is possible in the long term.

78.0

78.5

79.0

79.5

80.0

80.5

81.0

81.5

82.0

2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

COVERAGE (%

)

Coverage (less than 5 years since last adequate test) for the period 2001-2013. Target 80%

25-29 30-34 35-39 40-44 45-49 50-64 50-54 55-59 60-6465

67

69

71

73

75

77

79

81

83

85

NHS Cervical Screening Programme: % coverage (25-64- less than five years since last adequate test ) by age. England 2002-2003 to

2012-2013. Source HSCIC

2002-2003 2012-2013

Age Group

% c

ove

rag

e

CUMBRIA CWW GREATER MAN-CHESTER

LANCASHIRE MERSEYSIDE

< 80% coverage 59 145 450 204 220

>=80% coverage 23 28 56 27 14

5%

15%

25%

35%

45%

55%

65%

75%

85%

95%

25-64 Coverage (3.5/5.5) by Area Team for June 2014.Source: Open Exeter Practice Report (July 2014).Number in

Table = No of Practices

Area Team

Pra

ctic

es (

% o

f to

tal

nu

mb

er w

ith

in A

rea

Tea

m)

Quality of Cervical Screening Programme

• Overseen by NW QARC

• Systematic approach to performance monitoring and addressing underperformance

• Sample taker training

• Sample taker database

• Failsafe mechanisms

• Clear process for managing SUI

• Access to quality colposcopy service

Clinical Issues in Cervical Screening

• Sample acceptance policy

• Incidents and significant events

• High Inadequate Rates

• Sampling and accuracy

• Pathway for abnormal bleeding in under 25’s

The cardinal symptom of cervical cancer in this age group is postcoital bleeding, but persistent intermenstrual bleeding, which is more common also requires attention.

Call and Recall

• Call and recall or Primary Care Support Services

• Contact practice with Prior Notification List (PNL)

• Send invitation letters

• None Responder cards

• Open Exeter

• Ceasing

• Will always give advice and information on request

• contact details: lasca.screening@nhs.net or 01772 221344

GP Responsibilities• Failsafe systems

• PNL’s and ceasing women

• Management of results and referrals

• Quality assurance re sample takers – qualifications and update training

• QOF – points, exception reporting

FailsafesCONSIDER PATIENT PATHWAY

• Housekeeping issues -identify patient , paperwork , labels , equipment expiry dates ..

• Transport- issues

• Who registers all samples sent and checks all results received?

• What about non responders?

• Who checks abnormal results dealt with?

• Who checks histology results in newly hysterectomised patients?

• Who responds to failsafe queries from lab and deals with them and deals with critical incidents?

Employment and training issues.

Practices should check staff :

• Trained to take cervical samples• Had an update in the previous 3 years• Familiar with Surepath LBC system• Have access to Manchester Cytology 2015 Laboratory

Guidelines and The NHSCSP Good Practice Guide No 2 (2011)• Manager has completed sample taker spread sheet and

informs The CANE Area Team• They are on the Sample Taker Register• Undertake regular audit of sample taking and outcomes

Cervical screening QOF pointsIndicator Points Achievement thresholds

CS001. The contractor has a protocol that is in line with national guidance agreed with NHS CB for themanagement of cervical screening, which includes stafftraining, management of patient call/recall, exceptionreporting and the regular monitoring of inadequatesample rates

7

CS002. The percentage of women aged 25 or over and who have not attained the age of 65 whose notes record that a cervical screening test has been performed in the preceding 5 years

11 45-80%

CS004. The contractor has a policy for auditing itscervical screening service and performs an audit ofinadequate cervical screening tests in relation toindividual sample-takers at least every 2 years

2

Women in Special Circumstances• Learning Disabilities

• Physical disability

• Terminal illness

• Radiotherapy

• Female Genital Mutilation

• Pregnant/post natal

• Male to Female sex change

• Female to male sex change

• Lesbian and Bisexual women

• Immuno- compromised

The Future……• HPV Immunisation

• HPV Primary Screening pilots

• Evaluations in other countries for HPV Primary Testing are looking positive

www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62218-7/abstract

• Women who have had a HPV vaccination?

Useful Websites

• www.cancerscreening.nhs.uk

• www.cancerresearchuk.org

• www.nice.org.uk

• www.gov.uk/government/organisations/public-health-england

• http://www.nwcsquarc.org.uk

• http://www.jotrust.org.uk

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