NHS Calderdale and Kirklees

1. NHS Calderdale and Kirklees Cervical Screening GP Registrars Training Information

2. 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

3. 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

4. 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

5. Update training • 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

6. 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

7. 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

8. Responsibilities of Sample Takers, Employers and Sample Taking Co-ordinators http://www.neyhqarc.nhs.uk/LinkClick.aspx?fileticket=jLc8oXXJ1o8%3d&tabid=93&portalid=0&mid=923

9. 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

10. 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

11. 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

12. 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

15. Local pathway Overview

16. Pathway & players WYCSA 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 Sample sent to laboratory Cytology Colposcopy Colposcopy clinic Laboratory / WYCSA Result sent to woman & sample taker Woman invited for colposcopy

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

20. 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

21. How to get a new sample taker code

22. CSTD Links 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

23. Sample Taker Performance

24. 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)

25. Sample Taker Performance cont

26. 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

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

28. 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

29. Finally... Any Questions?