Presentation on theme: "The NHS Cervical Screening Programme Kath Bainbridge North West QA Primary Care Development Nurse."— Presentation transcript:
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 Liquid based cytology introduced Lower age increased to 25
The Cervical Screening Programme National HPV vaccination programme introduced for 13 year old girls HPV triage piloted Cytology laboratory services move to cover larger areas 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 Cancer Trends in incidence and mortality, England 1989 to 2010
Map of mortality by Cancer Network,
Age-specific incidence rates and number of cases diagnosed by five year age group, England 2009
Age-specific relative survival, England (one-year) and (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.
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: or
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
Failsafes CONSIDER 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 points IndicatorPointsAchievement thresholds CS001. The contractor has a protocol that is in line with national guidance agreed with NHS CB for the management of cervical screening, which includes staff training, management of patient call/recall, exception reporting and the regular monitoring of inadequate sample 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 % CS004. The contractor has a policy for auditing its cervical screening service and performs an audit of inadequate cervical screening tests in relation to individual 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
Vault Samples New guidance in 2009 (reinforced in 2011) Women who have had a total hysterectomy have no cervix therefore not eligible for recall in NHSCSP All vault samples in the North West should be done in a colposcopy setting
The Future…… HPV Immunisation HPV Primary Screening pilots Evaluations in other countries for HPV Primary Testing are looking positive 6736(13) /abstract Women who have had a HPV vaccination?
Useful Websites england england 28Presentation title - edit in Header and Footer