Welcome to the Primary Care section of the NWCSQARC.
This section is aimed at providing concise information and guidance for primary care within the cervical screening programme.

Latest news

DFSHR Cytology (pdf document)

Sample Taker Mentor Update Events

The last of the three Sample Taker Mentor Update Events took place on 30th April at the Windrush Millenium Centre, Manchester.

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.

Information packs giving a wide range of information in respect both to the project and general information regarding HPV infection are available for downloading in PDF Format below. Primary care staff affected by the Sentinel site implementation will need to be aware of the role of HPV infection in cervical disease; the different implications of low- and high-risk HPV subtypes; the altered management protocols for women with low-grade cytological abnormalities; and the altered management protocols for women after treatment for CIN.

Documents to download

HPV Sentinel Sites - Implementation Project (.pdf file)

HPV Triage of borderline & mild dyskaryosis & HPV test of cure - Information for Sample Takers (.pdf file)

HPV Triage and Test of Cure Protocol (.doc file)

HPV testing for women with a cervical screening result of borderline or mild dyskaryosis - Information for Women (.pdf)

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)

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

Liverpool Cytology Training Centre - Courses 2009

LBC Update

26th-28th May

3rd - 5th November

24th - 26th November

Pre-COC

2nd - 5th June

MRCPath Mock Exam

11th - 14th August

Advanced Practitioner

7th - 11th September

IBMS Non-Gynae Pre-Exam

21st - 25th September

4-week Introductory

5th - 30th September

Further details: Angela Curran, Manager, 0151 706 4447 (angela.curran@rlbuht.nhs.uk)

Coverage Update
In England the percentage of eligible women who have been screened at least once in the previous 5 years (coverage) has fallen from 80.6% (2003-2004) to 78.6% (2007-2008). In the North West the percentage of eligible women who have been screened at least once in the previous 5 years (coverage) has fallen from 80.6% (2003-2004) to 78.2% (2007-2008).

Sources: Cervical Screening Programme, England: 2003-2004 © Crown Copyright 2004, Cervical Screening Programme, England 2007-08 © The Information Centre.

This decline in coverage across the North West can be further broken down to individual Primary Care Organisation (PCO) level. Note: due to PCO re-organisation, this is only available for the last 2 years. Pre-reorganisation data is available from the Information Centre website (www.ic.nhs.uk)

Coverage (percentage of eligible population screened at least once in last 5 years) by PCO

Source: Cervical Screening Programme, England 2007-08 © The Information Centre

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.
Targeted work is underway amongst local community groups and practices identified as having low coverage rates and higher levels of deprivation.
The project work is slightly different for each project. Some are using community workers to go out to local community groups to raise awareness about cervical screening or by organising local health awareness events. Others are targeting women directly through their GP practices to raise awareness and encourage women to go for screening.
Awareness raising materials have been developed by some of the project workers to target women within specific cultural groups and based in their own languages.
Here are two examples of the materials produced for the East Lancashire project work and the Wirral project.

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.
Professor Paola Dey from the University of Central Lancashire will analyse this data and produce an evaluative study report on the outcomes of the project work.
A final study report will be published on completion.
Many of the projects are drawing to a close so evaluative data will be looked at in the interim time periods and will be published here.
Further work on looking at coverage is in the pipeline and details of this will be posted as soon as it is available.
If you want more detail about looking into coverage in your area or would like to share ideas on how to improve coverage, please contact Yvonne Browne, on the number shown below or email .

To contact the QA Primary Care Team

Yvonne Browne QA Special Project Manager Tel - 0151 702 4308 Email: yvonne.browne@lwh.nhs.uk

Ruth Stubbs QA Primary Care Coordinator Tel - 0151 702 4279 Email: ruth.stubbs@lwh.nhs.uk