1. NHS Calderdale and Kirklees
Cervical Screening
GP Registrars Training Information

2. Topics to be covered: Cervical screening programme basics
Training guidance and further resources
Responsibilities as sample takers
Responsibilities as employers
Quality/safety – Incidents
Local Pathway
Cervical Sample Taker Database (CSTD)
Monitoring Performance

3. Cervical Screening Programme Basics
The programme covers women age 25-64
25-49 every 3 years
50-64 every 5 years
65+ only if not screened since 50 or had recent abnormal tests
The majority of cervical screening samples are taken in primary care

4. Useful Websites Quality Assurance Reference Centre (QARC)
NHS Cervical Screening Programme:

5. Update training Components E-learning – accredited package
NHSCSP publication 23: Taking Samples for Cervical Screening (April 2006):
Training requirements for medical and nursing professionals are equivalent.
“Sample takers should undertake a minimum of one half day’s update training every three years.”
NEYH Sample Taker Training Guidance (July 2012):
“All sample takers in in the NEYHQARC region irrespective of their place of work and job description are required to adhere to the requirements of this training guidance”
Components
E-learning – accredited package
Localisation training
Specific event
Optional visits to the care pathway
Annual review of audit data
Inadequacy; abnormality; TZ rates
Direct towards update training part – not mandatory but recommended practice – even attending local sessions useful as an update of local issues.

6. E - learning
This course covers theoretical information - but it doesn't guarantee clinical competence.

7. HPV e-learning module
 An e-learning course has been developed, which takes approximately mins to complete:
Following completion of the course sample takers can take an assessment by following this link:

8. Responsibilities of Sample Takers, Employers and Sample Taking Co-ordinators
Handout of this document
Applies to all sample takers, not just nurses and in all sample taking settings
Colp follow up – DNA failsafe responsibilities too

9. Quality/Safety and Incidents
“All screening programmes do harm: the challenge is to ensure that programmes are implemented in such a way that they do more good than harm at reasonable cost”
Raffle, A. & Gray, M. (2007) Screening: evidence and practice. Oxford University press

10. Essentials High coverage of the population (80% or more)
Well trained professionals
High quality cervical sample taking
High quality cervical sample analysis
Evidence-based, high quality treatment and clinical management
Efficient failsafe systems for all elements of the pathway

11. Err on the side of caution…
Inform / discuss with the Screening Manager / Co-ordinator
The QARC should be notified within 24 hours of any problem which may be a suspected Serious Incident
The responsible person in the provider/PCT should complete the template form

12. Incidents in primary care
Incorrect method (e.g. not including the brush head in the pot due to being trained in a different technique)
Incorrect use of screening e.g. sample-taking when visible cancer on the cervix
Using out of date vials
Taking samples without training or a code
Employing an untrained sample taker
Incorrect labelling of samples / not matching with forms
Code-sharing
Poor technique e.g. not visualising cervix

15. Local pathway
Overview

16. Pathway & players WYCSA Call/recall General practice, hospital
Woman registers with GP
Woman receives invitation
Call/recall
Woman has cervical sample taken
General
practice, hospital
or community
clinic
Treatment
Woman invited for treatment
GP Input into:
Call/Recall - PNL/FNR and exception reporting
Sample Taking – sending to lab quickly – 14 day TaT
Labs – ensuring results returned for each sample
Colp Referral – Failsafe actions if not attended = GP gets notified for each refusal then a final letter
Sample sent to laboratory
Cytology
Colposcopy
Colposcopy clinic
Laboratory / WYCSA
Result sent to woman & sample taker
Woman invited for colposcopy

17. - Mention younger age groups rates declining

19. CERVICAL SAMPLE TAKER DATABASE www.cstd.neyhqarc.nhs.uk

20. Cervical Sample Taker Database
Web based database - register of all the sample takers in the North East, Yorkshire and the Humber
Performance management tool (results of samples, reports on performance)
Cervical sample taker training record tool
Local training days and events in your area advertisement
National, regional and local cervical screening guidelines and protocols held
All sample takers need to obtain a new cervical sample (smear) taker code to replace their existing code
A NEW CODE WILL NOT AUTOMATICALLY BE SENT TO YOU!
The new code will begin with a letter followed by four numbers e.g. A0001
Access will be given to the Cervical Sample Taker Database
QARC REQUIRE ALL SAMPLE TAKERS TO BE REGISTERED BY END SEPT 2012
- GP - must get a code– contact practice manager/sample taking co-ordinator – change location on personal details if changing location

21. How to get a new sample taker code
Sample Taking Coordinator & General Practice Manager to apply for access to database
QARC approves access and Sample Taking Coordinator receives an confirming that their access has been granted
Sample Taking Coordinator logs into the database and completes a form to add new sample taker
New Sample Taker Code request approved by QARC and Sample Taker receives an with their new sample taker code and log in details for sample taker database.
Laboratory informed of new sample taker code

22. CSTD Links www.cstd.neyhqarc.nhs.uk/admin www.cstd.neyhqarc.nhs.uk
For the sample taking coordinators to register and to add sample takers:
For sample takers:

23. Sample Taker Performance

24. Sample Taker Performance
Audit of inadequates, TZ rate (women under 50) and abnormals by QARC
Monthly download
Use lab data to
Produce funnel plot
RAG rated (how near
to lab average)

25. Sample Taker Performance cont
Sample Taker Code
Sample Taker Inadequate %
RAG Rating
Example 1
1.25%
Green
Example 2
7.50%
Red
Sample Taker Code
TZ %
RAG Rating
Example 1
80.00%
Amber
Example 2
90.00%
Green

26. Sample Taker Performance cont
‘A Guide for Practices and Sample Takers to Understanding
Sample Taking Performance Data’
If RED – recommend looking at data in more depth. QARC/PCT can support this. They may recommend an internal WASP assessment should take place.
Practice responsibility to ensure staff are competent

27. TZ Rates Good technique: Get a good view of the cervix
Anchor the brush in the os
5 clockwise turns with firm pencil pressure

28. For further information
Calderdale & Kirklees Cervical Screening Programme
& NHS Calderdale
Dr Jill Farrington
District Coordinator / Consultant in Public Health Medicine
Sharron McMahon
Public Health Screening Manager
Sarah Januszczyk
Public Health Secretary
NHS Kirklees
Dr Mercy Vergis
Consultant in Public Health
(PA)  

29. Finally...
Any Questions?