NHS Calderdale and Kirklees Cervical Screening GP Registrars Training Information

Topics to be covered: Cervical screening programme basics Training guidance and further resources Responsibilities as sample takers Responsibilities as employers Quality/safety – Incidents Local Pathway Cervical Sample Taker Database (CSTD) Monitoring Performance

Cervical Screening Programme Basics The programme covers women age 25-64 25-49 every 3 years 50-64 every 5 years 65+ only if not screened since 50 or had recent abnormal tests The majority of cervical screening samples are taken in primary care

Useful Websites Quality Assurance Reference Centre (QARC) http://www.neyhqarc.nhs.uk/CervicalScreening/RegionalProtocolsandGuidance.aspx NHS Cervical Screening Programme: http://www.cancerscreening.nhs.uk/cervical/index.html

Update training Components E-learning – accredited package NHSCSP publication 23: Taking Samples for Cervical Screening (April 2006): Training requirements for medical and nursing professionals are equivalent. “Sample takers should undertake a minimum of one half day’s update training every three years.” NEYH Sample Taker Training Guidance (July 2012): “All sample takers in in the NEYHQARC region irrespective of their place of work and job description are required to adhere to the requirements of this training guidance” Components E-learning – accredited package Localisation training Specific event Optional visits to the care pathway Annual review of audit data Inadequacy; abnormality; TZ rates Direct towards update training part – not mandatory but recommended practice – even attending local sessions useful as an update of local issues.

E - learning This course covers theoretical information - but it doesn't guarantee clinical competence. http://www.nwyhelearning.nhs.uk/elearning/yorksandhumber/shared/cervical_sample_taker/Preview/index.html

HPV e-learning module  An e-learning course has been developed, which takes approximately 30-45 mins to complete: http://www.nwyhelearning.nhs.uk/elearning/Shared/HPV/HTML/Published/WEB/COURSE/SHA-HPV.html Following completion of the course sample takers can take an assessment by following this link: http://www.nwyhelearning.nhs.uk/elearning/Shared/HPV/HTML/Published/WEB/ASSESSMENT/assessment.html

Responsibilities of Sample Takers, Employers and Sample Taking Co-ordinators Handout of this document Applies to all sample takers, not just nurses and in all sample taking settings Colp follow up – DNA failsafe responsibilities too http://www.neyhqarc.nhs.uk/LinkClick.aspx?fileticket=jLc8oXXJ1o8%3d&tabid=93&portalid=0&mid=923

Quality/Safety and Incidents “All screening programmes do harm: the challenge is to ensure that programmes are implemented in such a way that they do more good than harm at reasonable cost” Raffle, A. & Gray, M. (2007) Screening: evidence and practice. Oxford University press

Essentials High coverage of the population (80% or more) Well trained professionals High quality cervical sample taking High quality cervical sample analysis Evidence-based, high quality treatment and clinical management Efficient failsafe systems for all elements of the pathway

Err on the side of caution… Inform / discuss with the Screening Manager / Co-ordinator The QARC should be notified within 24 hours of any problem which may be a suspected Serious Incident The responsible person in the provider/PCT should complete the template form

Incidents in primary care Incorrect method (e.g. not including the brush head in the pot due to being trained in a different technique) Incorrect use of screening e.g. sample-taking when visible cancer on the cervix Using out of date vials Taking samples without training or a code Employing an untrained sample taker Incorrect labelling of samples / not matching with forms Code-sharing Poor technique e.g. not visualising cervix

Local pathway Overview

Pathway & players WYCSA Call/recall General practice, hospital Woman registers with GP Woman receives invitation Call/recall Woman has cervical sample taken General practice, hospital or community clinic Treatment Woman invited for treatment GP Input into: Call/Recall - PNL/FNR and exception reporting Sample Taking – sending to lab quickly – 14 day TaT Labs – ensuring results returned for each sample Colp Referral – Failsafe actions if not attended = GP gets notified for each refusal then a final letter Sample sent to laboratory Cytology Colposcopy Colposcopy clinic Laboratory / WYCSA Result sent to woman & sample taker Woman invited for colposcopy

- Mention younger age groups rates declining

CERVICAL SAMPLE TAKER DATABASE www.cstd.neyhqarc.nhs.uk

Cervical Sample Taker Database Web based database - register of all the sample takers in the North East, Yorkshire and the Humber Performance management tool (results of samples, reports on performance) Cervical sample taker training record tool Local training days and events in your area advertisement National, regional and local cervical screening guidelines and protocols held All sample takers need to obtain a new cervical sample (smear) taker code to replace their existing code A NEW CODE WILL NOT AUTOMATICALLY BE SENT TO YOU! The new code will begin with a letter followed by four numbers e.g. A0001 Access will be given to the Cervical Sample Taker Database QARC REQUIRE ALL SAMPLE TAKERS TO BE REGISTERED BY END SEPT 2012 - GP - must get a code– contact practice manager/sample taking co-ordinator – change location on personal details if changing location

How to get a new sample taker code Sample Taking Coordinator & General Practice Manager to apply for access to database QARC approves access and Sample Taking Coordinator receives an email confirming that their access has been granted Sample Taking Coordinator logs into the database and completes a form to add new sample taker New Sample Taker Code request approved by QARC and Sample Taker receives an email with their new sample taker code and log in details for sample taker database. Laboratory informed of new sample taker code

CSTD Links www.cstd.neyhqarc.nhs.uk/admin www.cstd.neyhqarc.nhs.uk For the sample taking coordinators to register and to add sample takers: www.cstd.neyhqarc.nhs.uk/admin For sample takers: www.cstd.neyhqarc.nhs.uk

Sample Taker Performance

Sample Taker Performance Audit of inadequates, TZ rate (women under 50) and abnormals by QARC Monthly download Use lab data to Produce funnel plot RAG rated (how near to lab average)

Sample Taker Performance cont Sample Taker Code Sample Taker Inadequate % RAG Rating Example 1 1.25% Green Example 2 7.50% Red Sample Taker Code TZ % RAG Rating Example 1 80.00% Amber Example 2 90.00% Green

Sample Taker Performance cont ‘A Guide for Practices and Sample Takers to Understanding Sample Taking Performance Data’ http://www.neyhqarc.nhs.uk/LinkClick.aspx?fileticket=FCelRX1QH3A%3d&tabid=289 If RED – recommend looking at data in more depth. QARC/PCT can support this. They may recommend an internal WASP assessment should take place. http://www.neyhqarc.nhs.uk/LinkClick.aspx?fileticket=sLuhQAYqREg%3d&tabid=93&mid=923 Practice responsibility to ensure staff are competent

TZ Rates Good technique: Get a good view of the cervix Anchor the brush in the os 5 clockwise turns with firm pencil pressure

For further information Calderdale & Kirklees Cervical Screening Programme & NHS Calderdale Dr Jill Farrington District Coordinator / Consultant in Public Health Medicine 01422 281470 jill.farrington@calderdale.nhs.uk Sharron McMahon Public Health Screening Manager 01422 281513 Sharron.McMahon@calderdale.nhs.uk Sarah Januszczyk Public Health Secretary 01422 28 1516 sarah.januszczyk@calderdale.nhs.uk NHS Kirklees Dr Mercy Vergis Consultant in Public Health 01484-464236 (PA) 07904-194321  mercy.vergis@kirklees.nhs.uk

Finally... Any Questions?