Screening programmes

1. Screening programmes Practice nurse forum 13th January 2009

2. Screening – an overview 12:45 • Helen Knowles • Cervical screening 13.00 • Helen Knowles / Elizabeth Stephens • Breast screening 13.15 • Jane Sarify-Nafis/ Amanda Dixon • Bowel cancer 14.00 • Helen Knowles/ Alison Ball • Chlamydia 14.10 • Cass Golumbina • Retinal screening 14.20 • Helen Knowles

3. National screening programmes

4. Biological onset of disease Screening Early diagnosis possible Usual clinical diagnosis Recovery/ disability/death Longer pre-disease state = ↑ chance of being detected Detected earlier so less severe disease

5. Inviting and Informing eligible population Systematic call / recall A screening programme Screening test Results and communication about results Decision making Assessment

6. May benefit from early detection. But outcome may not change for everybody. Further unnecessary investigations and anxiety Falsely reassured. No difference to their disease outcome Reassured. But may not lead to desirable behaviour

7. Where’s the harm in screening?

8. Lab BHT PCT Clinical Community Provider PSU call/recall Clinical L&D Lab GP practices (58) PCT Clinical Stoke M Lab Child health Records out of area Clinical Lister Child health records PCT HVs Lab Clinical MK Lab Clinical SCG spec consortium Lab Adden PSU Out of area Specialist labs Clinical

9. Cervical screening Lab BHT PCT Clinical Community Provider PSU call/recall Clinical L&D Lab GP practices (58) PCT Clinical Stoke M Lab Clinical Lister Lab Clinical MK Lab Clinical Lab Adden PSU Out of area Clinical

10. Newborn bloodspot BHT PCT Clinical L&D GP practices (58) PCT Clinical Stoke M Child health Records out of area Clinical Lister Child health records HVs Clinical MK Clinical SCG spec consortium Adden Specialist lab 1 Specialist lab 2 Specialist lab 3 Clinical

11. Screening programmes – key actions • Develop clarity about service specification and description • Improved monitoring of performance • Development of programme boards • Development of programme guides/ policies for primary care: • How the programme works • Flow chart diagrams • Roles and responsibilities within the programme • Local contact information • Failsafe processes • Information material for patients – leaflets, posters etc • Letters etc that are used within the programme

12. Cervical screening • Aims to detect abnormalities that could develop into cancer • National programme 1988; death rate now 50% of what it was then • Screening programme (changed in 2003) • 25 – 49 year olds 3 yearly screening • 50 -64 year olds 5 yearly screening • Not for under 25s

13. Under 25 screening • Incidence of cervical cancer very low in under 25s (less than 40 cases per year) • Low grade cervical changes relatively common • Risk of doing more harm than good

16. Coverage in cervical screening • BPCT : • 81.2% in 5yrs for 25 -64yr in 07/08 • 71.0% in 3.5 yrs in 25-49 in 07/08 • Coverage declining nationally especially in younger age (25 – 34 ) groups

19. TAT - Turnaround time • Target for women to receive results within 14 days of sample from April 09 • LBC introduction to reduce inadequate rate (from 9% to less than 3% and decreasing) • Implications • Reduce out of programme samples (<25, screening intervals as per programme ie 3 yearly and 5 yearly) – i.e. implement good practice in line with national standards • Sample to lab time • Lab turnaround time (processing and reading of samples, results to PSU). Bigger labs- more automation of processing and reading. Regional review of cervical screening lab and call / recall provision • Planning for PSU to send out all results letters (but those with abnormal results will still need to be contacted by practice)

20. Inadequate audit • Local lab providers not yet able to log unique code within IT system to track sample. • Continue with in-practice codes as now so that each sample can be matched with sample taker • Working on obtaining practice and PCT level data to be communicated on regular basis.

21. Questions • Discussion