1. CERVICAL SCREENING AMNESTIES DO THEY CUT IT? Ms Christine Reid Health Improvement Senior Dr Jennifer Darnborough Consultant in Public Health Medicine

2. Background NHSL & many individual GP practices do not achieve the essential NHS QIS target of 80% uptake over 5 years Between 1 in 4 and 1 in 5 eligible women do not take part in cervical screening Women from the most deprived areas are least likely to attend screening & significantly more likely to be diagnosed with and die from cervical cancer

3. Source: NHSL PH/ISD NHSL Cervical screening uptake in the 5 years to Dec 2013

4. OBJECTIVE To evaluate the impact of smear amnesties in poorly performing practices. The smear amnesty is a personalised, additional service offered by the practice to all eligible women who have not attended their cervical screening appointment.

5. Detail Women receive a personalised invitation in an eye catching coloured envelope A (longer) evening smear appointment is offered to enable women to discuss fears and anxieties Women are reminded that the smear taker will be female Free massage to reduce anxiety is offered in a relaxing environment (aromatherapy oils, music) Women can bring a ‘buddy’.

6. A Practice Perspective 13 practices participated 31 smear amnesties delivered 212 women attended Previous smear could be as long ago as 30 years! Smear amnesty uptake ranged from 2.3% to 5%

7. The Womens’ Perspective Evening appointment (69%) Personalised invitation (61.5%) “The pink envelope sealed the deal”. Information on risks of cervical cancer and benefits of screening (53.8%) 98% stated they would attend next appointment in 3 years time

8. Outcomes CHIs from 127 women were supplied 12 women, (approx.10%) had an abnormal result NS different from background population rate of abnormalities Not possible to quantify whether there was a correlation between no of times a woman had defaulted and the presence of abnormalities

9. Outcomes Of the 12 non routine results, 10 women had attended one subsequent smear/ colposcopy appointment – evidence of early good on-going engagement

10. Costs ActivityCosts (approx) Practice nurse hourly rate£30 Stress therapists hourly rate£30 Mailing Costs for invitations31p – 50p each Coloured A5 envelopes19p each Cervical Screening leafletFree Health Improvement staff timeCost neutral

11. Costs From £150 to £350 per amnesty Approx. £19 - £44 per participating woman Approx. cost of an abnormality between £201-465

12. Conclusions Benefits to the practice and to women were reported The cost of detecting an abnormality varies between £201-465 Longitudinal engagement will be monitored Preliminary results will be reviewed and the process further refined