Cervical Cytology - Keeping up to date
As a doctor registered with the GMC, you are required to keep up to date and maintain your skills in all clinical aspects of general practice. It is your professional obligation to make a judgement about what training you need to undertake to do this, and you should be able to defend this in Court if necessary. One could argue that if you were required to attend training for cervical cytology, you should do so for every area of clinical practice, and if this were the case, we would end up being unable to see patients because we would be spending most of our time on training updates.
The LMC's advice is as follows:
- Have a lead clinician for cervical cytology who need not be a GP but should be an individual who performed a significant number of cervical smears and was involved in the practice based organisations.
- The identified lead should attend regular updates and cascade this information to all relevant clinicians and administrators within the practice.
- Training should be appropriate and be of high quality.
- All clinicians who performed cervical cytology should ensure they are up to date and maintain their skills and this was for the individual to evaluate using the inadequate rate as a guide but should not be simply decided by the total number of smears taking in any given period of time.
Previously many commissioners and the national screening committee were insisting on mandatory 3 year training. In December 2011 a letter from Dame Barbara Hakin (National Managing Director of Commissioning Development) clarified this situation and in particular, the last paragraph which is reproduced below:
Commissioners are not able to stipulate mandatory training for GPs eg. smears.
The GMS arrangements do not allow commisioners to set mandatory requirements for training. As part of their clinical governance processes, GP practices should ensure that GPs, and others who take cervical smear samples, have the competences necessary to undertake them. Commissioners should monitor the quality of services provided, and take action if there is evidence of problems. These are principles that apply to the range of training issues relating to GPs and GP practices, and are in line with an outcomes based approach to commissioning, contracting and monitoring.
You can download the full letter here: Cervical cytology training for GPs, letter from Dame Barbara Hakin 15/12/11
The BMA's view was that this also applied to nurses, and the DH has now confirmed that they agree with our interpretation, as the letter is about the principles which apply to services provided as part of the contract, whether these services are provided by GPs or others employed by practices such as practice nurses.