- Doctors: Pardip Sandhu
- Nurse: Jo Young
6th July 2016
Date of Next Review
The aim of our cervical screening programme is to reduce the incidence of cervical cancer by promoting its screening. In collaboration with Public Health England (PHE) we provide a reliable system for calling and recalling all women who are eligible for cervical screening based on the NHS Cervical Screening Programme Good Practice Guide No.2 (July 2011).
The % of patients aged from 25 to 64 whose notes record that cervical smears have been performed in the last five years. We should be hitting at least 80% of patients.
- Explain how the patient will be informed of her result and give written Ashcroft Surgery results information sheet.
- Take the cervical sample as per national guidance [Pages 29-30 Good practice guidance]
- Complete request form with accurate name, demographic and clinical details, visualisation of cervix sampler used, adequate sampling, previous abnormalities & treatment.
- Record sampler ID on request form.
- Document consultation on SystmOne template.[see page 31 good practice guidance]
- Verify the sample labelling and request form and send the sample the same day to the laboratory.
Informing the patient of the smear result
Public Health England (PHE) is responsible for sending all result letters for cervical cytology tests directly to the patient. The practice receives the actual result, but does not see the letter sent to the patient. For abnormal smear results, PHE will ensure the patient receives the result before the colposcopy appointment.
- If the result is normal: the system will automatically set a next call date for three/five years. The patient will be automatically informed.
- Inadequate result: The lead practice nurse for cytology keeps a copy of newly reported inadequate reports until they are repeated. A reminder letter is sent from the practice if not repeated after 3 months
- Borderline or Mildly Abnormal result: will be tested for HPV- result of this would then decide if direct referral to colposcopy is required.
- Any other abnormal result: will automatically generate a direct referral to colposcopy
CALL and RECALL
The practice cervical screening programme is managed by PHE, who communicate direct with patients. PHE will send the practice a Prior Notification List (PNL) which we will then check and verify that the women listed are indeed eligible for the Cervical Screening Programme. This will then be returned to PHE. The GP or PN must authorise the PNL if a woman is removed from the list for any other reason than moved away.
OUR FAIL-SAFE SYSTEM
Each smear taker is responsible for ensuring that the results are back for all the smears they have done and that relevant follow up has been initiated.
If a patient reaches the Final Non-Responder stage, a personalised invitation is sent from the Practice strongly advising the patient to attend. The practice will also check for any valid reason for not attending such as not having a cervix, being pregnant, or having a smear already done elsewhere. The FNR card (see below) will be completed by Lead PN and return to PHE cytology.
PHE issue Final Non Responder (FNR) cards to the practice approx 20 weeks after the reminder letter, and WYCSA sets the patient’s call/recall depending on her previous result:
- One year for “repeat advised” and previous abnormal results
- Three years for first calls or routine recalls (aged 25 – 49)
- Five years for first calls or routine recalls (aged 50 – 64)
The FNR cards are dealt with by the practice as soon as they are received.
- The practice checks the patient record to ensure there is no valid reason for the non- response (i.e.: hysterectomy/no cervix)
- The practice then writes to the patient strongly advising her to attend as above.
- The patients notes are flagged fro discussion on the home page
- Women may temporarily refuse a smear for valid reasons like being pregnant.
- Women who have temporarily refused smear tests will still be invited by PHE recall will be moved onto 1, 3 or 5 years recalls depending on age and previous history.
- These ladies must NOT be coded as 'exceptions'. Exception reporting is not used by the practice
Patient must be given one-to-one counselling ensuring she has sufficient, accurate information to make an informed choice before they decide upon permanently disengaging with the Cervical Screening Programme. PHE will then send them the OFFICIAL disclaimer which needs to be signed and returned.
The practice will ask PHE to stop recalling the following types of patient for the Cervical Smear Screening Programme:
- Age over 65
- No Cervix
- Radiotherapy for cervical cancer
Staff Training/Inadequate Smear Rates
- The practice will fully comply with all requested for training and mandatory updates required by the Cervical Screening Programme. All smear takers attend refresher training as routine.
- Nurse Zoe Booth is the sample co-ordinator: she receives notification from QARC (Quality Assurance Reference Centre) for cancer screening- now part of PHE - of all sample takers performance data. Each individual also receives a copy of their own. In this way we can audit our performance.