Sample Taker Training Review Update

1. Sample Taker Training Review Update Caroline Burnley QA Co-ordinator (Cervical) Quality Assurance Reference Centre Caroline.burnley@nhs.net

2. The history of the review • Between 2005 – 2008 there were three incidents relating to quality of sample taking where training and governance were highlight as root causes or contributory factor • In November 2008 the SHAs requested a review of the sample taker training • The process included review of NHSCSP publication 23, interviews with professionals, review of current processes and documentation. • A number of recommendations were identified • A project board, action plan and clinical lead were appointed • A complete risk assessment of the project was undertaken and referenced within SHA, PCT’s and collaborative commissioning risk registers

3. Is it still a problem? We are still having incidents: • Trainees who failed the training but continue to take samples • Sample takers with TZ rates less than 30% • Sample takers trained moving into the NEYH and taking samples in the ThinPrep method • Sample takers regularly not visualising the cervix for a variety of reasons • Samples incorrectly labelled These all lead to women being recalled and happened in the last 12 months

4. What progress has there been?

5. Training Guidance The Purpose of the Group and Why is it an issue? • To develop the new training programme to implement from April 2011 • There is variation in how the training is provided across the NEYH Update progress: • There are two new guidance documents • Learning outcomes for each aspect have been agreed • A Grandfather clause training event has been developed • E-learning package for updates developed • Requirement of basic training courses to strengthen the accountability and governance aspects of their training • Factsheets for training courses to use FOC • Guidance for visits to care pathway

6. Assessing sample taker performance • TZ pilot has progressed to ‘Sample Taker performance pilot’ • Uses the web-based system to calculate the TZ, inadequate and abnormal rates • The percentages are then entered into the funnel plot spread sheets and the RAG (red-amber-green) analysis undertaken by laboratory • Sample taker performance/feedback will be accessed via the database • This identifies sample takers where there are concerns with their data • The PCT/mentor would then visit the sample taker and discuss the data • A supervised assessment form has been developed, trialled and in use which consists of two sections; knowledge of the programme and equipment availability and the supervised assessment of 5 samples • The next stage of the pilot is to assess when it is appropriate to only undertake the first section of the supervised assessment

7. Sample Taker Database The Purpose of the Group and Why is it an issue? • To establish a database to allow all sample takers, practice managers and PCTs to access the data to evaluate their services. • Many sample takers are not aware of their own performance • There currently is no QA of primary care therefore the largest and most diverse part of the system is open to errors. Update on progress: www.mezzobeta.co.uk/cstd

8. Commissioning of the NHSCSP work stream The Purpose of the Group and Why is it an issue? • There is a lack of clarity and clear service specifications in the Region • Departments are often not clearly contracted to undertake the NHSCSP to expected standards • Lack of performance management across the majority of the NEYH • To bring clarity to the commissioning of the NHSCSP • To establish a number of best practice documents to be rolled out across the region Update on Progress: • Accountabilities grid has been developed • Recommendations on the role of the ‘Sample Taking Coordinator’ • Template service specification • Roles and responsibilities guidance

9. Commissioning of Training The Purpose of the Group and Why is it an issue? • To ensure the improved training programme has clear governance and commissioning arrangements • Currently there is a lack of clarity with regards to the roles of the training providers, GPs and the PCT Update: • The two SHAs will be progressing training in different ways. • NE will continue with Newcastle PCT and the University of Northumbria • YH will be delivering Basic through their Universities (or university accredited courses) • YH update training will be part via e-learning package and part local events

10. Mentors Services The Purpose of the Group and Why is it an issue? • To develop the role of the mentor and ensure the governance around these is clear. • Mentors currently undertake different roles dependant on which PCT they work in. Update on progress: • The NE mentors will continue to be hosted by Newcastle PCT whilst a new host is currently being sort for the YH mentors. • YH have three new mentor providers. • Training days for mentors will be held in June/July • The mentors and their hosts will work together to develop the role

11. What still needs to be done? • Deliver the grandfather training • Address basic training for medical staff • Develop ‘templates’ for visits to the care pathway (if the support is requested) • Implement the database across NEYH • Develop centralised evaluation process

12. Summary • A lot of work has been undertaken in the last year • There is a trend to more local arrangements whilst maintaining a regional approach to standard delivery • In the future quality assurance of primary care and a sample taker Professional Advisory Group will be developed • But there is still work to be done

13. Any questions?