1. Explain how the patient will be informed of her result and give a written results information sheet.
2. Take the cervical sample as per national guidance 
3. Complete an ICE request form with accurate name, demographic and clinical details, visualisation of cervix sampler used, adequate sampling, previous abnormalities & treatment.
4. Record sampler ID on request form.
5. Document consultation on SystmOne template.
6. Verify the sample labelling and request form and send the sample to the laboratory.
7. Write patients name and date of birth in the blue sample book. 

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:   a recall date will be added for three/five years.  The patient will be automatically informed.
• Borderline or Mildly Abnormal result:   all samples are tested for HPV, if positive then cytology will be performed – result of this would then decide if direct referral to colposcopy is required or whether a repeat sample in 12 months is needed.
• Any other abnormal result: will automatically generate a direct referral to colposcopy

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 fully comply with all requested for training and mandatory updates required by the Cervical Screening Programme.  All smear takers attend refresher training as routine.
• The lead nurse mentioned at the top of this webpage is the sample co-ordinator.  This lead nurse 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.