Practice Nurse Leads LLMC Forum

1. Practice Nurse Leads LLMC Forum Cervical screening Updates and Issues Within the NHSCSP Programme Allison Ferdinand NHS England London Commissioning Manager Cervical Screening – Primary Care 21st March 2019

2. National Update Primary hr/HPV Testing • Primary high risk Human Papilloma Virus (hr/HPV) testing national roll out complete by December 2019 • Some earlier implementation of the hr/HPV primary screening differ CCG to CCG from mid April

3. Hr/HPV testing • No change to the clinical procedure • Change in the consultation/information given to women ensure informed consent, letters and information leaflets women receive • Hr/HPV 16, 18 High-risk HPV is the “driver” for pre-cancer-cancer sequence • hr/HPV positive samples – approx. 10 - 15% of samples screened will be HPV +ve necessitating cytological screening • hr/HPV is a more sensitive test than cytology, (but can still have false negatives)

4. Impact on Laboratories • Reduction of cytology labs nationally 9 for England • From 9 laboratories in London to One • Currently tendering processes are taking place • Laboratories are expected to be awarded in mid April

5. Trainee Sample Takers • It is vital that all sample takers (ST) accurately document their ST code on the request form • Trainees will need to ensure documentation of their trainee code to support their training • Trainee sample takers - to assess clinical competency, samples obtained by trainees will have a slide processed for cytological examination and reporting, this is to include the Transformation Zone (TZ) for women under 50 years

6. Colposcopy • National office stipulated that colposcopy units adhere to the national colposcopy guidelines protocols:- • Women will be referred back to general practice following treatment for their repeat hr/HPV tests • It is vital to check on open Exeter for previous tests and test due date and avoid samples being taken too early

7. National and Local Issue With TATs • National Turnaround Times (TATs) target of 98% is to ensure all women receive their result within 14 days • Turnaround times are well below this nationally London TATs vary across the CCGs/laboratories with Royal London achieving circa 1.4% with significant numbers of samples to process

8. Restricted access: Please be aware thatthe data presented here is unpublished,use for internal management purpose only

9. Reasons for National and Local Issue with TATs Significant pressures within the laboratories:- • Capita incident • iPLATO SMS Texting • Screening campaign in January – Jo’s Trust • Jade Goody 10 year anniversary • PHE National be clear on cancer campaign cervical screening • Screeners retiring or leaving as they find other jobs. • No new screeners in training. • National measures are in place to manage and improve this by introducing resilience plans

10. Local Resilience Plans/Earlier Implementation of hr/HPV Primary Testing • Resilience plans refer to the earlier implementation of Primary hr/HPV testing this will reduce the backlog of samples needing to be processed and improve the Turnaround times (TATs) • RLH/BartsLab- will be implementing hr/HPV primary screening:- • Tower Hamlets • Newham • City and Hackney in mid April 2019 • HSL NCL will implement hr/HPV primary screening :- • Camden & Islington – 15th April 2019 • Barnet, Haringey, KCW – 7th May 2019 • Enfield and Herts – June (date to be confirmed shortly) • NWP NWL will implement hr/HPV primary screening – • Brent & Harrow – May 2019

11. hr/HPV Primary Screening Training • Local face to face training is currently being delivered/planned for those CCGs who will be impacted by the earlier roll out • On line national/PHE training is available, on successful completion download certificates and upload to Loncstd profile, check all fields, name, employer/s, email address etc

12. Failsafe • Ensure failsafe processes continue/are introduced, i.e. a result must be returned for every sample taken within the TAT • Practices generally receive results by 12 day of sample being received (as delays in TATs improves with hr/HPV implementation). Check a result is received by day 14 and actioned as relevant • This is different to Sample takers auditing their results

13. Acceptance Policy Guidance for acceptance of cervical screening samples in laboratories and pathways, roles and responsibilities 2017 • RLH lab is seeing an increase in the rejection of samples due these being unlabelled Error code 3 • Identify the woman, asking for her full name, DoB and address • If T-Quest forms (GP generated labels for the vials) are used please:- - Use the label with the full patient details and history - attached label to the vial (do not leave the label on the form) • Double check the details on the form and vial are correct have 3 identifiers, Full name, DoB, NHS Number on vial • General reminder that women invited to the programme (first call) letter is sent at 24.5yrs, samples can be taken without risk of this being rejected by the laboratory

14. Total errors in samples received in London’s laboratories

15. NHS England London cervical sample taker database (Loncstd) • Registration issues – Registrants not always:- • completing the registration, e.g. initial training uploading certificates in the correct format • GP/employer details – substantive post and additional practices need to be provided • Loncstd team are receiving repeated emails with same issue automated response informing of 3-5 working day response time

16. NHS England London cervical sample taker database (Loncstd) Trainee training and registration • Trainees will be issued a ST trainee code on Loncstd team receiving confirmation/receipt of attendance to theoretical training • Trainees must clearly record this on the request form to ensure appropriate management of the sample for their competency • Once completing competency, signed off by the training provider, their certificates must be uploaded – on checking their professional registration and certificates, their profile will be updated – ‘Qualified’ and issued revised code the laboratory will be notified and will cease to process a slide for cytology against their code

17. Review and update to Loncstd Work is underway to update the Loncstd database Maintenance of the database:- Trainees on the database ≥ 9 months (day one = first day of attendance to theoretical training day) • NHSE Loncstd team are contacting these trainee sample takers ensure they upload their training certificates and evidence of competence. Those who do not will be removed from the database, their employer and laboratory will be informed • Hr/HPV testing, still requires labs to undertake cervical cytology for trainee sample takers and report on TZ for the under 50 year old women. Errors, inadequate and pick up rates monitored for training purposes • Performance data – on update of database to be available

18. Review and update to Loncstd The update of the database will assist in a more robust database It is vital for sample takers to keep their profiles up to date, e.g. notify changes to:- ST name to NHSEL though must be using the name as per professional registration employer details • Locums - agency details • NHS to be informed should a ST: ceases to work within London retires takes extended leave ≥ 12 months, sabbatical sick etc professional registration has bee suspended or is under review, has caution/restriction etc against their code – managed case by case • Trainees experiencing difficulty completing training within 9 months from the first day of attendance to theoretical training must notify NHS England London

19. Health Professionals and Cervical Sample Taking Clinicians who may undertake cervical sample taking/training those professionally registered:- • Nurses • Midwives • Doctors • Physician Associates Note overseas trained cervical sample takers (non-medical professionals) are required to undertake the full NHSCSP sample taker training (UK training to full competency)

20. Nursing Associates • Nursing Associates (NAs) are a newly emerging professional group –NMC registered on qualifying • However, Nursing Associates (NAs) – are not permitted to undertake cervical sample taking training/procedure

21. Cervical Screening Coverage National cervical screening coverage target is 80% Nationally this is declining and locally Interactive data is available on CCG Practice and Local Authority level at NHS Digital via the link:- https://www.digitalhealth.net/2017/06/nhs-digital-releases-cervical-screening-data-tool/ https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-programme/cervical-screening-programme-coverage-statistics-management-information

23. Coverage and Uptake Initiatives • Jo’s Cervical Cancer Trust:- • January cancer prevention week campaign • June Cancer awareness campaign • PHE March 2019 starts the ‘be clear on cancer’ focus on cervical screening overcoming barriers, high level media awareness • NHS England London – SMS texting with iPLATO • Currently iPLATO project has 89% practice sign-up (as of 7th January 19) • iPLATO successfully extracted on average 91% of mobile phone numbers from GP clinical systems across London of those identified for a cervical message. Of these, 83% were successfully delivered

24. Transgender Population and Cervical Screening • Call recall are not able to invite trans man if he is registered as a man on the general practice records. Practices will have to keep a record and invite the patient in. The individual should maintain their own record of screens to also ensure they appoint for 3 or 5 yearly and takes this information with them should the change practices. • Below are some resources to support practices with transgender populations:- • 1. Good practice cancer screening guide for primary care in London https://www.healthylondon.org/wp-content/uploads/2016/09/Screening-Good-Practice-Guide-2018-1.pdf • 2. Information for trans people https://www.gov.uk/government/publications/nhs-population-screening-information-for-transgender-people • 3. RCGP (NI) guidelines for Care of Trans Patients in Primary Care http://www.rcgp.org.uk/-/media/Files/RCGP-Faculties-and-Devolved-Nations/Northern-Ireland/2017/RCGPNI-Trans-Patient-Guidelines-for-GPs-2017.ashx?la=en

25. Federation/Hub delivery of Cervical Screening • NHS England London in the process of finalising guidance for practices working across federations, this opens access to cervical screening • Very essential areas for consideration:- • HMR101 request form document details of sender/where the sample was obtained in addition to the woman’s practice details • Failsafe processes, woman’s practice responsibility • Direct referral to colposcopy responsibilities

26. Management of Screening Incidents • Incidents occurring in the cervical screening programme must be reported in line with the national Managing safety incidents in NHS screening programmes • using the screening incident assessment form (SIAF) accessed at:- • https://www.gov.uk/government/publications/managing-safety-incidents-in-nhs-screening-programmes send the completed SIAF to • PHE.LondonQA@nhs.net & • england.londonscreening-incidents@nhs.net

27. Key NHSCSP documents NHS Cervical Screening Programme Guidance for the training of cervical sample takers Published November 2016 • https://www.gov.uk/government/publications/cervical-screening-cervical-sample-taker-training NHS Cervical Screening Programme Guidance for acceptance of cervical screening samples in laboratories and pathways, roles and responsibilities Published April 2017 • https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/669132/Guidance-for-acceptance-of-cervical-screening-samples.pdf NHS population screening: improving access for people with severe mental illness Published 15 March 2019 • new national guidance for screening providers and commissioners to help improve access to screening for people with severe mental illness

28. Thank you for listening Any questions?