1. Practice Nurse Leads LLMC Forum
Cervical screening Updates and Issues Within the NHSCSP Programme
Allison Ferdinand
NHS England London
Commissioning Manager Cervical Screening – Primary Care
21st March 2019

2. National Update Primary hr/HPV Testing
Primary high risk Human Papilloma Virus (hr/HPV) testing national roll out complete by December 2019
Some earlier implementation of the hr/HPV primary screening differ CCG to CCG from mid April

3. Hr/HPV testing No change to the clinical procedure
Change in the consultation/information given to women ensure informed consent, letters and information leaflets women receive
Hr/HPV 16, 18 High-risk HPV is the “driver” for pre-cancer-cancer sequence
hr/HPV positive samples – approx % of samples screened will be HPV +ve necessitating cytological screening
hr/HPV is a more sensitive test than cytology, (but can still have false negatives)

4. Impact on Laboratories
Reduction of cytology labs nationally 9 for England
From 9 laboratories in London to One
Currently tendering processes are taking place
Laboratories are expected to be awarded in mid April

5. Trainee Sample Takers
It is vital that all sample takers (ST) accurately document their ST code on the request form
Trainees will need to ensure documentation of their trainee code to support their training
Trainee sample takers - to assess clinical competency, samples obtained by trainees will have a slide processed for cytological examination and reporting, this is to include the Transformation Zone (TZ) for women under 50 years

6. Colposcopy
National office stipulated that colposcopy units adhere to the national colposcopy guidelines protocols:-
Women will be referred back to general practice following treatment for their repeat hr/HPV tests
It is vital to check on open Exeter for previous tests and test due date and avoid samples being taken too early

7. National and Local Issue With TATs
National Turnaround Times (TATs) target of 98% is to ensure all women receive their result within 14 days
Turnaround times are well below this nationally London TATs vary across the CCGs/laboratories with Royal London achieving circa 1.4% with significant numbers of samples to process

8. Cervical Screening: Turnaround Time (TAT) London CCGs – monthly trends
Source: Open Exeter
Restricted access: Please be aware that the data presented here is unpublished, use for internal management purpose only

9. Reasons for National and Local Issue with TATs
Significant pressures within the laboratories:-
Capita incident
iPLATO SMS Texting
Screening campaign in January – Jo’s Trust
Jade Goody 10 year anniversary
PHE National be clear on cancer campaign cervical screening
Screeners retiring or leaving as they find other jobs.
No new screeners in training.
National measures are in place to manage and improve this by introducing resilience plans

10. Local Resilience Plans/Earlier Implementation of hr/HPV Primary Testing
Resilience plans refer to the earlier implementation of Primary hr/HPV testing this will reduce the backlog of samples needing to be processed and improve the Turnaround times (TATs)
RLH/Barts Lab- will be implementing hr/HPV primary screening:-
Tower Hamlets
Newham
City and Hackney in mid April 2019
HSL NCL will implement hr/HPV primary screening :-
Camden & Islington – 15th April 2019
Barnet, Haringey, KCW – 7th May 2019
Enfield and Herts – June (date to be confirmed shortly)
NWP NWL will implement hr/HPV primary screening –
Brent & Harrow – May 2019

11. hr/HPV Primary Screening Training
Local face to face training is currently being delivered/planned for those CCGs who will be impacted by the earlier roll out
On line national/PHE training is available, on successful completion download certificates and upload to Loncstd profile, check all fields, name, employer/s, address etc

12. Failsafe
Ensure failsafe processes continue/are introduced, i.e. a result must be returned for every sample taken within the TAT
Practices generally receive results by 12 day of sample being received (as delays in TATs improves with hr/HPV implementation). Check a result is received by day 14 and actioned as relevant
This is different to Sample takers auditing their results

13. Acceptance Policy
Guidance for acceptance of cervical screening samples in laboratories and pathways, roles and responsibilities 2017
RLH lab is seeing an increase in the rejection of samples due these being unlabelled Error code 3
Identify the woman, asking for her full name, DoB and address
If T-Quest forms (GP generated labels for the vials) are used please:-
- Use the label with the full patient details and history
- attached label to the vial (do not leave the label on the form)
Double check the details on the form and vial are correct have 3 identifiers, Full name, DoB, NHS Number on vial
General reminder that women invited to the programme (first call) letter is sent at 24.5yrs, samples can be taken without risk of this being rejected by the laboratory

14. Total errors in samples received in London’s laboratories
 Total sample errors
E1 - Vial received without form 19
E2 - Form received without vial 16
E3 - Vial is unlabelled
241
E4a - Vial is only partially labelled
1208
E4b - Multiple minor discrepancies (two or more) 52
E5 - Patient details on form and vial do not match
162
E6 - Insufficient patient details on form
361
E7 - Patient details differ from cytology records 44
E8 - Valid PIN not provided
E9 - Samples in poor condition - Vial, spilt, insufficient fluid 84
E10 - Form / vial details illegible 15
E11 - Out of programme sample (age, too early repeat, inappropriate vault)
767
E12 - Out of date vial 7
Total
3064
Number of repeat samples required
1424
Number of samples not discarded
1592
2998
Total No of Samples received
152852

15. NHS England London cervical sample taker database (Loncstd)
Registration issues –
Registrants not always:-
completing the registration, e.g. initial training
uploading certificates in the correct format
GP/employer details – substantive post and additional practices need to be provided
Loncstd team are receiving repeated s with same issue automated response informing of 3-5 working day response time

16. NHS England London cervical sample taker database (Loncstd) Trainee training and registration
Trainees will be issued a ST trainee code on Loncstd team receiving confirmation/receipt of attendance to theoretical training
Trainees must clearly record this on the request form to ensure appropriate management of the sample for their competency
Once completing competency, signed off by the training provider, their certificates must be uploaded – on checking their professional registration and certificates, their profile will be updated – ‘Qualified’ and issued revised code the laboratory will be notified and will cease to process a slide for cytology against their code

17. Review and update to Loncstd
Work is underway to update the Loncstd database
Maintenance of the database:-
Trainees on the database ≥ 9 months (day one = first day of attendance to theoretical training day)
NHSE Loncstd team are contacting these trainee sample takers ensure they upload their training certificates and evidence of competence. Those who do not will be removed from the database, their employer and laboratory will be informed
Hr/HPV testing, still requires labs to undertake cervical cytology for trainee sample takers and report on TZ for the under 50 year old women. Errors, inadequate and pick up rates monitored for training purposes
Performance data – on update of database to be available

18. Review and update to Loncstd
The update of the database will assist in a more robust database
It is vital for sample takers to keep their profiles up to date, e.g. notify changes to:-
ST name to NHSEL though must be using the name as per professional registration
employer details
Locums - agency details
NHS to be informed should a ST:
ceases to work within London
retires
takes extended leave ≥ 12 months, sabbatical sick etc
professional registration has bee suspended or is under review, has caution/restriction etc against their code – managed case by case
Trainees experiencing difficulty completing training within 9 months from the first day of attendance to theoretical training must notify NHS England London

19. Health Professionals and Cervical Sample Taking
Clinicians who may undertake cervical sample taking/training those professionally registered:-
Nurses
Midwives
Doctors
Physician Associates
Note overseas trained cervical sample takers (non-medical professionals) are required to undertake the full NHSCSP sample taker training (UK training to full competency)

20. Nursing Associates
Nursing Associates (NAs) are a newly emerging professional group –NMC registered on qualifying
However, Nursing Associates (NAs) – are not permitted to undertake cervical sample taking training/procedure

21. Cervical Screening Coverage
National cervical screening coverage target is 80%
Nationally this is declining and locally
Interactive data is available on CCG Practice and Local Authority level at NHS Digital via the link:-

22. Coverage Data August 2018
PHE and NHSE. Data can be shared for management purposes only, for the enhancement of NHS screening programmes. It MUST NOT be put in the public domain (this includes communications and minutes of meetings that may end up in the public domain).
Cervical Cancer Target Age(25-64) 3.5/5.5Y Coverage
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
Feb-18
Mar-18
Apr-18
May-18
Jun-18
Jul-18
Aug-18
England
71.5%
71.3%
71.2%
71.1%
70.8%
70.9%
71.4%
London
65.3%
65.1%
64.9%
64.8%
64.6%
64.7%
65.0%
65.2%
Midlands
72.9%
72.7%
72.6%
72.5%
72.2%
72.4%
72.8%
73.0%
North
73.4%
73.2%
73.3%
73.5%
South East
72.3%
South West
74.6%
74.4%
74.3%
74.2%
74.0%
74.1%
74.5%
74.7%
74.8%
North East London STP
66.0%
65.5%
65.6%
North Central London STP
63.9%
63.2%
63.0%
62.9%
62.8%
63.1%
63.3%
63.4%
63.5%
North West London STP
61.4%
60.7%
60.6%
60.5%
60.3%
60.4%
60.8%
60.9%
South East London STP
69.5%
68.9%
68.7%
68.4%
68.5%
68.8%
69.0%
South West London STP
68.1%
68.0%
67.9%
67.7%
67.8%
68.2%
68.3%
North East London
64.4%
64.2%
64.1%
64.0%
64.5%
NHS BARKING AND DAGENHAM CCG
66.8%
66.5%
66.6%
66.4%
67.0%
67.2%
67.4%
67.5%
67.6%
67.3%
NHS BARNET CCG
62.6%
62.5%
62.4%
62.3%
62.7%
NHS CAMDEN CCG
55.2%
54.7%
54.3%
54.1%
54.0%
54.4%
54.6%
54.8%
55.0%
NHS CITY AND HACKNEY CCG
65.4%
NHS ENFIELD CCG
69.4%
69.2%
69.1%
69.3%
NHS HARINGEY CCG
66.3%
66.1%
65.9%
65.7%
66.2%
NHS HAVERING CCG
NHS ISLINGTON CCG
62.2%
NHS NEWHAM CCG
NHS REDBRIDGE CCG
63.8%
63.6%
NHS TOWER HAMLETS CCG
61.1%
NHS WALTHAM FOREST CCG
North West London
61.0%
NHS BRENT CCG
63.7%
NHS CENTRAL LONDON (WESTMINSTER) CCG
52.8%
52.3%
52.0%
51.9%
51.8%
52.1%
52.2%
51.7%
NHS EALING CCG
NHS HAMMERSMITH AND FULHAM CCG
56.5%
56.2%
56.0%
55.9%
55.5%
55.3%
55.6%
55.4%
55.1%
54.5%
NHS HARROW CCG
61.9%
61.7%
61.6%
62.1%
NHS HILLINGDON CCG
66.9%
67.1%
NHS HOUNSLOW CCG
NHS WEST LONDON CCG
54.2%
53.7%
South London
68.6%
NHS BEXLEY CCG
73.8%
73.9%
NHS BROMLEY CCG
73.6%
73.1%
NHS CROYDON CCG
70.0%
69.7%
69.6%
69.9%
70.1%
69.8%
NHS GREENWICH CCG
NHS KINGSTON CCG
65.8%
66.7%
NHS LAMBETH CCG
NHS LEWISHAM CCG
NHS MERTON CCG
NHS RICHMOND CCG
NHS SOUTHWARK CCG
NHS SUTTON CCG
72.0%
NHS WANDSWORTH CCG

23. Coverage and Uptake Initiatives
Jo’s Cervical Cancer Trust:-
January cancer prevention week campaign
June Cancer awareness campaign
PHE March 2019 starts the ‘be clear on cancer’ focus on cervical screening overcoming barriers, high level media awareness
NHS England London – SMS texting with iPLATO
Currently iPLATO project has 89% practice sign-up (as of 7th January 19)
iPLATO successfully extracted on average 91% of mobile phone numbers from GP clinical systems across London of those identified for a cervical message. Of these, 83% were successfully delivered

24. Transgender Population and Cervical Screening
Call recall are not able to invite trans man if he is registered as a man on the general practice records. Practices will have to keep a record and invite the patient in. The individual should maintain their own record of screens to also ensure they appoint for 3 or 5 yearly and takes this information with them should the change practices.
Below are some resources to support practices with transgender populations:-
1. Good practice cancer screening guide for primary care in London
2. Information for trans people
3. RCGP (NI) guidelines for Care of Trans Patients in Primary Care

25. Federation/Hub delivery of Cervical Screening
NHS England London in the process of finalising guidance for practices working across federations, this opens access to cervical screening
Very essential areas for consideration:-
HMR101 request form document details of sender/where the sample was obtained in addition to the woman’s practice details
Failsafe processes, woman’s practice responsibility
Direct referral to colposcopy responsibilities

26. Management of Screening Incidents
Incidents occurring in the cervical screening programme must be reported in line with the national
Managing safety incidents in NHS screening
programmes
using the screening incident assessment form (SIAF) accessed at:-
send the completed SIAF to
&

27. Key NHSCSP documents
NHS Cervical Screening Programme Guidance for the training of cervical sample takers Published November 2016
NHS Cervical Screening Programme Guidance for acceptance of cervical screening samples in laboratories and pathways, roles and responsibilities
Published April 2017
NHS population screening: improving access for people with severe mental illness Published 15 March 2019
new national guidance for screening providers and commissioners to help improve access to screening for people with severe mental illness

28. Thank you for listening
Any questions?