The NHS Cervical Screening Programme Kath Bainbridge North West QA Primary Care Development Nurse.
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Transcript of The NHS Cervical Screening Programme Kath Bainbridge North West QA Primary Care Development Nurse.
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The NHS Cervical Screening Programme
Kath Bainbridge North West QA Primary Care Development Nurse
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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
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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
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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
• 2003 -Liquid based cytology introduced• Lower age increased to 25
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The Cervical Screening Programme
• 2008 - National HPV vaccination programme introduced for 13 year old girls
• HPV triage piloted• 2010 - Cytology laboratory services move
to cover larger areas• 2013 - HPV Primary testing pilots
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Elements of the Cervical Screening programme
• Sample Taking
• Transportation to Laboratory
• Laboratory Screening Service
• Call and Recall
• Colposcopy
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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
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Cervical CancerTrends in incidence and mortality, England 1989 to 2010
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Map of mortality by Cancer Network, 2006-2010
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Age-specific incidence rates and number of cases diagnosed by five year age group, England 2009
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Age-specific relative survival, England 2007-2009 (one-year) and 2003-2005 (five-year)
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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.
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78.0
78.5
79.0
79.5
80.0
80.5
81.0
81.5
82.0
2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013
COVERAGE (%
)
Coverage (less than 5 years since last adequate test) for the period 2001-2013. Target 80%
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25-29 30-34 35-39 40-44 45-49 50-64 50-54 55-59 60-6465
67
69
71
73
75
77
79
81
83
85
NHS Cervical Screening Programme: % coverage (25-64- less than five years since last adequate test ) by age. England 2002-2003 to
2012-2013. Source HSCIC
2002-2003 2012-2013
Age Group
% c
ove
rag
e
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CUMBRIA CWW GREATER MAN-CHESTER
LANCASHIRE MERSEYSIDE
< 80% coverage 59 145 450 204 220
>=80% coverage 23 28 56 27 14
5%
15%
25%
35%
45%
55%
65%
75%
85%
95%
25-64 Coverage (3.5/5.5) by Area Team for June 2014.Source: Open Exeter Practice Report (July 2014).Number in
Table = No of Practices
Area Team
Pra
ctic
es (
% o
f to
tal
nu
mb
er w
ith
in A
rea
Tea
m)
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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
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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
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The cardinal symptom of cervical cancer in this age group is postcoital bleeding, but persistent intermenstrual bleeding, which is more common also requires attention.
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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: [email protected] or 01772 221344
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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
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FailsafesCONSIDER 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?
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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
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Cervical screening QOF pointsIndicator Points Achievement thresholds
CS001. The contractor has a protocol that is in line with national guidance agreed with NHS CB for themanagement of cervical screening, which includes stafftraining, management of patient call/recall, exceptionreporting and the regular monitoring of inadequatesample 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
11 45-80%
CS004. The contractor has a policy for auditing itscervical screening service and performs an audit ofinadequate cervical screening tests in relation toindividual sample-takers at least every 2 years
2
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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
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The Future……• HPV Immunisation
• HPV Primary Screening pilots
• Evaluations in other countries for HPV Primary Testing are looking positive
www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62218-7/abstract
• Women who have had a HPV vaccination?
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Useful Websites
• www.cancerscreening.nhs.uk
• www.cancerresearchuk.org
• www.nice.org.uk
• www.gov.uk/government/organisations/public-health-england
• http://www.nwcsquarc.org.uk
• http://www.jotrust.org.uk
28 Presentation title - edit in Header and Footer
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Thank you.