Guidance

Latest news (June 2024) – Closure of Jo’s Cervical Cancer Charity

Unfortunately, Jo’s Cervical Cancer Charity have made the announcement that they are closing with immediate effect.

For more than two decades, the organisation has been at the forefront of cervical cancer awareness, education, and support for individuals and families impacted by this devastating disease.

Further information can be found here: Jo’s Cervical Cancer Charity

Should you require support and information about Cervical Cancer our website will remain online for a few weeks. If you need more information or support, we recommend that you contact:

MacMillan Cancer Support; Support Line: 0808 808 00 00

Eve Appeal; Ask Eve Helpline 0808 802 0019


Key guidance-

NHS Cervical Screening Programme – Good practice guidance for sample takers

This guidance is designed to:

  • describe the sample taker’s responsibilities in the NHS Cervical Screening Programme (NHSCSP)
  • promote good practice that is consistent with national policy and guidance
  • outline the training requirements for sample takers in the NHSCSP
  • set out the existing roles and responsibilities of GP practices involved in the NHSCSP
  • outline the audit and documentation requirements for sample takers in the NHSCSP
  • advise on some of the issues that may arise during a consultation.

Published 31 July 2023


 

Cervical Screening Campaign

The NHS Cervical Screening Programme (NHSCSP) aims to reduce the number of people who develop invasive cervical cancer and the number of people who die from it. It does this by regularly screening all people at risk so that conditions which might otherwise develop into invasive cancer can be identified and treated.

The cervical screening population is women or people with a cervix aged 24.5 to 64, who are registered on the NHS call/recall IT system for cervical screening. The eligible population is everyone in the screening population excluding those without a cervix, usually due to total hysterectomy.

Although cervical screening cannot be 100% effective in detecting cancer, cervical screening programmes have been shown to reduce the incidence of cervical cancer. The NHS Cervical Screening Programme was established in 1988; over the next decade the incidence of cervical cancer across England and Wales fell by more than 40 per cent, reflecting screening’s impact on a generation of previously unscreened people. In England cervical screening currently prevents 70% of cervical cancer deaths. If everyone attended screening regularly, 83% could be prevented.  Source- GOV.UK

High-risk human papillomavirus testing

High-risk human papillomavirus (HPV) DNA is found in over 99% of all cervical cancers. Cervical screening now primarily tests for the presence of this high-risk HPV infection, which is a common virus that most people will get at some point. HPV primary screening is a more sensitive and accurate test than the previous method (cytology alone) and is the best way to find out who is at higher risk of developing the cervical cell changes that over time could potentially lead to cervical cancer.

While the risk for people with high-risk HPV of getting cervical cancer is low, any abnormal changes can be identified early. If HPV is detected, the sample is then checked for any changes in the cells of the cervix. Cell changes are easily treated if caught early, so they don’t get a chance to turn into cervical cancer. Source- GOV.UK

Our page aims to give additional information on a variety of topics related to cervical cytology including: –

  • Eligibility of Health care Professionals to train as sample takers
  • The Education pathway
  • Cervical screening administration
  • Wessex LMCs’ recommendations
  • Third party training
  • Useful Information and resources

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Eligibility of Health Professionals to Train as Sample Takers

Taken from PHE Education Pathway (section 3.1)

The following UK registered healthcare professionals are eligible to train to undertake the role of cervical sample taker:

  • registered nurses
  • registered nursing associates*
  • registered midwives
  • physician associates who are registered on the Physician Associate Managed Voluntary Register (PAMVR)
  • registered healthcare professionals working in integrated sexual health (ISH) clinics
  • General Medical Council (GMC) registered medical doctors

*Taking cervical samples is a delegated activity and the nursing associate works within the remits of their professional code. The screening provider must consider safety, quality, competency and the treatment of disease, disorder or injury (TDDI) legislation when deploying a nursing associate. When a nursing associate has registered with the Nursing and Midwifery Council (NMC), a registered professional listed under the legislation (registered nurse or GP) will need to supervise their practice. The individual who provides this professional support must be present at the GP practice in order to undertake indirect supervision of the nursing associate when carrying out the procedure.

Registered nurses, nursing associates, midwives and physician associates must complete a recognised theoretical course followed by a period of supervised training as described in this guidance.”

For additional guidance and information, you can refer to the standards and guidance for healthcare professionals and managers working in the NHS CSP. You can also keep up to date with information on new publications and guidance via the PHE Screening blog and subscribe for new content alerts.

Role of the Registered Nursing Associates in Cervical Cytology Screening

Summary-

  • This activity would need to be undertaken under supervision of a registered HCP on the TDDI list
  • The supervisor must be present at the GP practice when the NA is carrying out the procedure.
  • The supervisor can undertake indirect supervision of the NA when carrying out this procedure. This is a delegated activity, and the NA would be expected to work within the remits of their professional code. PHE Screening June 2019.

Also see the NMC publication  – Standards of proficiency for nursing associates

RCN Position Statement on Registered Nursing Associates (RNAs) training in cervical sample taking (England only)

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Educational Pathway

New cervical sample takers-

More information on the following points can be found on PHE Education Pathway.

  • The training period for trainee sample takers is a maximum of 9 months from enrolment through to completion. (Section 3.6)
  • a minimum of 12 hours for the initial training (theory) course, this to include at least 3 hours practical (classroom) training where the sample taker can practise their technique on a pelvic model (Section 3.8 and 3.9) Skills for Health Competency Framework
  • a visit to a colposcopy clinic (Section 3.7)
  • a visit to a cervical screening laboratory (where logistics permit) or a virtual tour and laboratory presentation (a laboratory presentation must be included in the theoretical course)
  • the trainee observes and documents at least 2 samples taken by their mentor. (Section 3.12)
  • the mentor must directly supervise the trainee taking a minimum of 5 samples (Section 3.13)
  • interim assessment (conducted by the cervical screening mentor) which the trainee must complete satisfactorily before starting their unsupervised clinical practice (Section 3.14)
  • practical in-house assessment undertaken by a senior competent mentor
  • the trainee must undertake an interim assessment  (Section 3.14)
  • the trainee sample taker must take 20 acceptable samples (as determined by national guidance) without direct supervision and no more than 25, before undertaking a final clinical assessment (Section 3.16)
  • a final clinical assessment of a minimum of 3 samples (observed by the assessor)
  • submission of the completed training record (verified by the trainee, mentor, assessor, and training provider)
  • code allocated by the lab when signed off as competent (Section 3.10)
  • attend an update every 3 years (Section 3.22)
Role of cervical cytology mentor and assessor

 Taken from PHE Education Pathway (sections 3.5 and 3.22)

Cervical Cytology Mentor Cervical Cytology Assessor
The cervical screening mentor (‘mentor’ from this point) supports the trainee through their practical sample taker training and confirms their achievement for progression to the final evaluation and clinical assessment.

The trainee identifies to the training provider an individual who will take on the mentor role in their place of work.

The trainee must notify the training provider of any change in local circumstances that affects or is likely to affect their mentor support.

Mentors must be one of the following, a:

·        registered nurse

·        registered midwife

·        registered physician associate

·        GMC registered medical doctor

Mentors must be practising sample takers with at least 12 months continuous experience, having taken at least 50 cervical samples following completion of their own initial training. Mentors must have effective communication skills and ideally hold a relevant mentoring and or teaching qualification.

The training provider makes sure the mentor understands the role, is sufficiently prepared to carry it out and supported for the duration of the training programme.

The cervical screening assessor (‘assessor’ from this point) provides an element of externality which is crucial to quality assuring the training and verifying the assessment process. The assessor is responsible for conducting the trainee’s final clinical assessment.

The training provider is responsible for recruiting and inducting individuals to the role of assessor making sure they understand the role, are sufficiently prepared to carry it out and are consistent in their practice.

The assessor is external to the trainee’s place of work. A mentor can take on the role of assessor for a trainee outside their own practice. The assessor must meet the same criteria as described for mentors.

Mentors and assessors must undertake a formal cervical screening update at least every 3 years as a practising sample taker.

Trained sample takers

More information on the following points can be found on the PHE Education Pathway (Section 3.22). 

Sample takers must fulfil the competency requirements in accordance with their professional codes of conduct. They should:

  • undertake continuous self-evaluation
  • review and reflect on any rejected samples, including those inadequate for cytology, and abnormal test result

Sample takers must undertake a minimum of 3 hours update training every 3 years. The national eLearning resource for sample takers meets the programme requirements for update training.

Where face to face update training takes place, it must equate to a minimum of 3 hours of learning and fulfil the requirements of this guidance in addition to any local training requests. Training providers should link to their local screening and immunisation teams for the purposes of local update training. 

Returners to Sample taking after an extended period of absence

More information on the following points can be found on the PHE Education Pathway (Section 3.23).

Upon returning to practice, the healthcare professional trained in cervical screening (sample taker) should contact the cervical screening laboratory to check the status of their pin or code number and if there has been any subsequent change to the liquid based cytology (LBC) system previously employed. They should then follow the relevant course of action detailed in the table below.

Absence of 12 months and less than 5 years Absence of 5 years or more
The sample taker must:

The sample taker must:

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Cervical Screening Administration Service

The Cervical Screening Administration Service (CSAS) supports the National Cervical Screening Programme by;

  • Providing Prior Notification Lists (PNLs) of patients eligible for screening to GP practices
  • Sending out call and recall letters to patients eligible for cervical screening tests
  • Notifying patients of test results once we receive these from laboratories

Find out more about out screening administration support services provided to: GP Practices/Practice Nurses

NHS England is stepping up preparations for switchover to the new NHS Cervical Screening Management System (CSMS) . We are now in the final stages of testing CSMS, and we will provide an update on when the system is expected to go live once this testing is completed.

letter to the system was issued on 18 September 2023, which outlines the actions which need to be taken before CSMS goes live.

With the new system, accuracy and security of patient information will be improved, making sure every person eligible for a screening appointment continues to be invited on time and followed up if required. CSMS will be much easier to navigate, freeing up more time for frontline staff.

As Open Exeter will no longer be accessible for NHS Cervical Screening Programme purposes after the transition to the new NHS CSMS it is vital that local IT teams, Registration Authorities and system users take action now to enable a seamless switchover to the new system.

NHS Digital – Last updated 7th March 2024

Training (Part 1 – Introduction to CSMS)

The first part of the training for CSMS is now available to users via the NHS Learning Hub (Learning Hub – home and search for CSMS). If users have a current e-LfH login, these credentials can be used to access the Learning Hub. Part 2 of the training (more role specific training) will become available in the coming weeks prior to go live.

NHSE SW Vaccine & screening bulletin, issue 176, March 2024

Cervical Screening Management System (CSMS) Update

Taken from-  NHSE SW Vaccine & screening bulletin, issue 176, March 2024

The CSMS holding page is now available via https://cervicalscreening.nhs.uk . The dashboard shows that many colleagues have been testing and checking the configuration of their devices (PC / laptop) and their smartcards using this link already. If you have not already done so, please check your access via the link so any access issues can be resolved promptly.

  • If there are issues with smartcards not being recognised or authentication, then it is likely to be a software issue (the device will need the correct version of Identity Agent and Credential Management installed on the machine. The link Guidance for IT support – NHS Digital can be passed on to the IT team to check and install the software if required).
  • If the error states there is no or an incorrect workgroup on the card then RAs (Registration Authority) and Smartcard Sponsors can resolve the problem – please use the Guidance for registration authorities – NHS Digital if the following prompts on screen do not help.
  • It is vitally important that the workgroup attached to a smartcard is spelt correctly (cervical screening). In some instances, the workgroup has been spelt incorrectly and gone unnoticed, or the workgroup name has been changed at some point. Simply renaming the workgroup will not work; the workgroup needs to be removed from the users’ card, and the user then readded to the correctly named workgroup.

Contact Information

For any questions on the new CSMS please contact the new CSMS implementation team at screening.implementation@nhs.net. This is a mailbox to help organisations get ready to be able to access the new NHS Cervical Screening Management System.

For support to access the current open Exeter cervical screening call/recall system, please contact the National Helpdesk Exeter.

Email: exeter.helpdesk@nhs.net or phone: 0300 303 4034

We are unable to accept any emails which contain patient identifiable data (PID) and any emails received with PID will be deleted.

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Wessex LMCs’ Recommendations

  • Nominate a lead clinician in the practice for cervical cytology ­ who need not be a GP but should be an individual who has performed a significant number of cervical smears and up to date with training.
  • The identified lead should cascade relevant information to all relevant clinicians and administrators within the practice.
  • All clinicians who perform cervical cytology should ensure they are up to date, maintain their skills, reflect on their inadequate rate and make changes as necessary.
  • Training for all HCP professionals undertaking cervical screening should be appropriate and of high quality and meet with the national recommendations.

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Training Guidance and Support

Local training hub contact details-

HIOW- primarycareschooltvw.se@hee.nhs.uk

Dorsettraininghub@ourdorset.nhs.uk

BSW- bswicb.traininghub@nhs.net

Frimley- frimley.traininghub@nhs.net

Wessex LMCs– For training and education queries only lead@wessexlmcs.org.uk

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Third Party Training Providers

Wessex LMCs do not provide cervical training specifically, but a full list of third party training providers can be found here – Wessex LMCs: Third Party Training & Events – The Nursing Team .

Please do not contact Wessex LMCs about these training events & programmes. These are just being advertised here for your information.

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