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Welcome
to the Primary Care section of the NWCSQARC. Latest news HPV Triage Sentinel Site Implementation Liverpool and Manchester has recently been invited by the National Office of Cancer Screening Programmes to participate as an early implementer or 'Sentinel Site' in the use of HPV testing. Human Papillomavirus (HPV) is present in virtually all cases of cervical cancer. It has been proposed that testing for the virus could be incorporated into the NHS Cervical Screening Programme to stratify women with minor cytological abnormalities who test positive for HR-HPV (high-risk HPV) to immediate colposcopy. Women who test negative for HR-HPV are known to be at negligible risk for cervical cancer and would be returned to routine recall. At present women who are referred
for colposcopy for low grade disease are typically managed conservatively
with repeat colposcopy and smear/biopsy. Frequently such women remain
within the colposcopy setting for years with persistent cellular
changes as cytology cannot determine whether these relate to low
or high-risk HPV subtypes or the relative risk of progressive disease.
This poses a risk of missing abnormalities that could be treated
earlier; risks losing women with HR-HPV infection if they fail to
attend for repeat smears; and is a substantial cost burden to the
service. The Sentinel Sites also provide an opportunity to broaden the use of HPV testing to determine the need for cytology post treatment. It is well recognised that a negative HR-HPV test carries are very high predictive value that there is no residual disease. Women who are cytologically normal and who are HR-HPV negative at 6 months post-treatment will therefore be returned to 3/5 yearly recall, rather than having annual repeat smears.
Documents to download HPV Sentinel Sites - Implementation Project (.pdf file) HPV Triage and Test of Cure Protocol (.doc file) HPV testing for women following treatment for CIN - Information for Women (.pdf) HPV - Frequently Asked Questions (.pdf) The NHS Cervical Screening Programme (.pdf) Introducing HPV Triage (Powerpoint presentation) HPV Triage Training - Flyer (.pdf) HPV Triage Training - Reply Slip (.doc) Sample Taker Mentor Update Events 3 events took place throughout the region during September. Feedback from the events and copies of the presentations are now available
The North West Cervical Screening Quality Assurance Guidance
This guidance has been produced by the Primary Care Collaborative group of the North Quality Assurance and aims to provide standard guidance across the North West region. The publication has been distributed to GP practices and sample takers across the North West. The document encompasses all aspects of the cervical screening programme that is relevant to Primary Care and is intended to support existing local documentation and the requirements of the GMS contract. The document can be downloaded in PDF format.od Practice The Taking Samples for Cervical Screening - A Resource Pack for Trainers has been published by the NHS Cancer Screening Programme. This is available on the NHS CSP website and can be downloaded in PDF format. The resource pack is intended to be used by experienced trainers to enable them to offer a common core of learning to all sample takers to ensure consistency and to provide learning to a minimum recognised level across the NHSCSP. It is not intended to be used by practice staff for unsupervised training. A Power Point presentation is also available on CD that accompanies the publication; this includes slides and speakers notes and is arranged in sessions corresponding to the resource pack
The pack is designed to train doctors and nurses who are already qualified healthcare professionals. It is not suitable in its current format for training Health Care Assistants as sample takers. Draft competency skills are currently being developed by Skills for Health relating to Cervical Cytology Sampling CHS237 www.sfhcancerservices.org.uk/cervical.html Sample Taker Training Issues for Primary Care Quality Assurance has been working with PCT's throughout the region to ensure the standards of training for sample takers are maintained. QA are working in collaboration with the training leads in the North West region to achieve a standardised approach to the training. The publication of the Taking Samples for Cervical Screening - A Resource Pack for Trainers will provide the standard. On 7th July 2006 the first Cervical Screening Mentors update was held at the Liverpool Womens Hospital for Merseyside and Cheshire. The event was well attended and the evaluations were very positive regarding the educational content. The event was held to support the training that has been modernised in Merseyside & Cheshire. It is expected that these events will be held annually in the future. Other mentor updates have been taking place in the Greater Manchester area and have been hosted by Dr Nicky Waddell from the Palatine Centre. These events are held annually and support the mentors who provide mentorship for the Manchester Cytology Training School at the Manchester Royal Infirmary. New Guidance and Leaflet re. Physical / Learning Disabilities Comprehensive advice regarding consent and for women with disabilities is provided in the publication Equal Access to Breast and Cervical Screening for Disabled Women NHS Cancer Screening Series No 2. There is also a new leaflet to assist women with learning disabilities to make an informed choice about whether to participate in the programme or not. These are available from the website: www.cancerscreening.nhs.uk
The NWCSQARC has also helped to develop a patient leaflet Cervical Screening - Your questions answered in conjunction with Dimension Creative Ltd. giving upto date information on the changes to the screening programme with regards to LBC. A sample pack of leaflets and accompanying posters was sent out to all practices earlier this year. Please contact your PCT regarding enquiries for ordering additional supplies.
Training Courses Manchester Cytology Training Centre - Practice Nurse Courses 2008 Duration: 2 days - all training will be held at the Manchester Cytology Training Centre, Manchester Royal Infirmary, Manchester. 31st January - 1st February 13th - 14th March 23rd - 24th June 1st - 2nd October Further details: Jen Bradburn 0161 276 8804 Coverage
Update The latest figures show that coverage rates over the last few years have been dropping steadily in the North West. The current coverage rate is 79.4% (2005/06) compared to the England coverage rate of 79.5%. whilst this does not appear to be a low figure, this is an average across all PCTs for each area. Chart 1 highlights the rate of decline by PCT for the North West from 2001/02 to 2005/6. Some PCTs are experiencing more rapid decline than others.
Table 1 shows the changes in coverage by PCT based on the KC53 statistical return.
In order to address this fall in coverage, NW QARC have undertaken a region wide initiative looking at ways in which coverage rates could be improved on. This has been done by asking for bids for funding from PCTs to support work looking at ways in which key areas of the region's population could be targeted to encourage attendance for regular cervical screening. Projects have now been established in seven PCTs to support this. The project areas cover Blackpool, Wirral, Liverpool, East Lancashire, Bolton, Rochdale and Manchester. The
main focus of these projects is to raise awareness of the cervical
screening programme amongst women who fall in to the' hard to reach'
groups.
Coverage
data will be collated from each of the projects over a specified
time period looking at data from a 'before and after' perspective
and this data will then be used against a comparative set of practices
for each area who have similar demographics and coverage rates but
for whom no interventional work has been instigated. To contact the QA Primary Care Team
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