FAILSAFE

1. FAILSAFE Maggie Luck Screening Commissioning Lead London QARC

2. Responsible for failsafe Primary Care Trusts - Call & Recall teams - Primary Care - Screening Leads Primary Care - GPs - Practice nurses - Administration staff Community Clinics - Clinicians - Administration staff Screening Commissioners Laboratories - Screeners - Pathologists - Administration staffColopsocopy clinics - Consultant Colposcopists - Nurse Colposcopists - Colspocopy nurse - Administration staff Hospital Based Programme Co-ordinators

3. Patients Invitation letter issued Appointment made at either the surgery or community clinic for a smear test Smear sample is sent to the laboratory for reporting Smear is reported and returned to the smear taker and the Call & Recall team Patient informed of her full test result by either; call & Recall, laboratory or GP Normal Early repeat Referral Patient referred to colposcopy clinic Called again in line with national policy Called as per laboratory recommendation Following attendance and or treatment the woman will be discharged back to her GP or responsible clinician

4. Call & Recall Responsibilities • Issuing invitation letters to women - letters should adhere to national policy and include the national leaflet • Additional failsafe for women with previous abnormal results - If the system rejects the current result as it has failed validation they must notify the laboratory in writing and ask for the test to be reviewed. • Entering result details onto the Exeter database- confirm the number of results with the laboratory- all results where possible should be recorded using the national laboratory code and national action codes • Issuing result letters if within local policy - letters must include the full result and must be sent at the beginning of the week • - If letters are not issued by the PCT there should be adequate failsafe arrangements in place to ensure results are sent out • Issuing non-responder cards to GPs- Teams should ensure that non-responder cards for non negative smears are identifiable as GPs receive many cards.

5. Prior Notification PNLs are sent to the surgery monthly and provide vital information on the number of women due for a smear test. They allow practices to make advanced assessment of their future Cervical Screening workload PNLs should be updated and returned to the screening team Invitation and reminder letters issued to the woman

6. Smear Taker Responsibilities • If General Practice check and return PNLs • Woman attends for a smear test either at her surgery or clinicwhere she will be seen by: - Administration staff - Practice Nurse - GP Must remember I’ve changed my address Women have a responsibility for ensuring their records are correct when attending either the surgery, clinic or hospital Can I just check your details Staff at the surgery, clinics and hospital need to ensure that they check the woman’s details against their records

7. Smear TakersResponsibilities • Maintain a register of smears taken and check that they receive a result for each one. • Act on non responder notification regarding women with previous abnormal results • Ensure that all women who attend for a smear test are aware of how they will receive the result of their smear. - this also applies to women who request no correspondence or who who are not registered with a permanent GP - Inform women and treat infections as appropriate • Deal personally with women who require urgent referral • Refer women to the Colposcopy clinic for further investigation and where necessary act upon notification from the clinic if women have failed to attend. • Ensure that appropriate follow-up take place • Cooperate with failsafe enquiries

8. Laboratoryresponsibility to…. Failsafe system for urgent referrals Hospital Based Programme Coordinator Call & Recall Screening Commissioner GP/PrimaryCare Transfer results Set up a failsafe system for monitoring the referral Notify both the Commissioner and the Hospital Based Programme that the woman has failed to respond to follow-up Amend action codes if necessary 4 weeks 1st enquiry Notify test results and make management recommendation 6 weeks 2nd enquiry Failsafe enquires should remain open for at least six months

9. 6wks Confirm woman has been seen 4mths Enquiry to GP if no colposcopy outcome 6mths Close F/S, inform Colp and GP 24mths Call/Recall invites woman for screening Audit F/S procedures annually 3mths 1st letter to GP 6mths Contact GP 9mths Check PAS, Contact GP 10mths Letter to Commissioner 16-20mths Urgent letter to GP/Commissioner National v London

10. Urgent Referral • Severe Dyskaryosis ?Invasive and ?Glandular Lesions (5S and 6S) • 2 week cancer wait applies to these patients • Duty to phone GP and follow this up with a letter • No letter sent through centralised systems • Inform GP that he/she must personally inform the woman and make referral

11. Colposcopy Clinic Responsibility Following the referral of the woman by either her GP or clinician unless local arrangements differ and the laboratory has made a direct referral • The colposcopy clinic will be responsible for the woman’s treatment and for arranging further follow-up in either the clinic or in the community • For informing the laboratory and the GP or responsible clinician of the outcome • Colposcopy clinics must have a system for notifying laboratories of both the woman's attendance and the histology results • Issue reminder letters • ? Inform PCTs of discharge from colposcopy for women who fail to attend

12. All of these have their part to play in Failsafe PCT CONSULTANTS GPs SCREENERS NURSES ADMIN STAFF FPC COLPOSCOPIST GUM HISTOLOGY STAFF