Welcome to the Sussex-wide Cervical Screening Webinar - PowerPoint Presentation

1. Welcome to the Sussex-wide Cervical Screening WebinarHost – Mandeep Singh AhluwaliaSpeakers – Mandeep Ahluwalia, Karen Burgess, Bikram Raychaudhuri, Jane Lodge and Amy Dissanayake The webinar will commence at 1pmPlease remember to turn off your mics and camerasThe session will be recorded

2. 2Mandeep Singh AhluwaliaMacmillan GP / Clinical Cancer Lead - West Sussex (North)West Sussex CCGmahluwalia@nhs.netScreening in General Practice and PCNs

3. 3PCN Cancer DES and Cancer QOF QICervical screening has been prioritised and resourced nationally: Additional servicesQOF – Doubling of cervical screening QOF pointsQOF QI – Who are your non-responders?PCN Cancer DES What support is in place for you?PCN Intranet Page:https://www.sussexccgs.nhs.uk/clinical_documents/pcn-and-general-practice-cancer-support/Screening quick wins for PCNs and practicesSSCA Data Dashboard ToolkitsWebinars (including the DES/QOF QI from September)ResourcesScreening in General Practice and PCNs

4. 4Restoring/improving cervical screening uptakeActions to engage with hard to reach and seldom heard groups where there are inequalities in cervical screening uptakeParticular groups of patients: Deprived, People with Learning Disabilities and Serious Mental Illness, where English is not 1st language (however NOT ALWAYS, so don’t assume!)Prevent health inequalities gap from widening/worseningAppointments made vs AttendeesLook at Non responders/exception reported patient listsWork with PPGsOpportunistic promotion/endorsement and staff training to improve knowledge and awareness Practice/PCN Cancer champions (clinical and non-clinical)Screening in General Practice and PCNs

5. 5ICS Cancer Team:Place Based Cancer Action GroupsClinical Lead in each areaCancer Managers and commissionersPCN Delivery ManagersMacmillan and CRUKSurrey and Sussex Cancer AllianceScreening in General Practice and PCNs

6. Cervical Screening Call/Recall& General Practice Practical Guidance17th December 2020Presented by Karen BurgessScreening and Immunisation Manager – Surrey & Sussex SIT

7. UK17713 09/14UK National Screening Committee: makes independent, evidence based recommendations to ministers

8. What is screening? UK17713 09/14Screening is the process of identifying healthy people who may have anincreased chance of having a disease or condition, so they can be offeredinformation, support, further tests and/or treatment.The NHS offers 11 national screening programmes, covering 36 healthconditions. Screening is offered to the different sections of the population mostlikely to benefit from it.

9. The condition sought should be an important health problem.There should be an accepted treatment for patients with recognised disease.Facilities for diagnosis and treatment should be available.There should be a recognisable latent or early symptomatic stage.There should be a suitable test or examination.The test should be acceptable to the population.The natural history of the condition, including development from latent to declared disease, should be adequately understood.There should be an agreed policy on whom to treat as patients.The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.Case-finding should be a continuing process and not a 'once and for all' project.Wilson JMG, Jungner G. Principles and practice of screening for disease. Geneva: WHO; 1968. Available from: http://apps.who.int/iris/bitstream/10665/37650/17/WHO_PHP_34.pdfUK17713 09/14Principles of ScreeningWilson and Jungner classic screening criteria, WHO 1968

10. Quality in screening “Screening is a pathway – it’s not just a test”“ Screening is not diagnosis”-UK17713 09/14

11. UK17713 09/14UK National Screening Committee: makes independent, evidence based recommendations to ministers SECTION 7A Exists to protect and improve the nations health and wellbeing and reduce health inequalities. Develops standards, implements and supports screening policy in collaboration with NHSE. Quality assures Screening [Screening Quality Assurance Service]NHSE commissions, implements and runs screening services across England PHE Screening and Imms Team

12. Section 7a: National screening and immunisation programmesImmunisations: Non-cancer screening:Childhood programme Diabetic Eye screeningSchool-based programme Abdominal Aortic AneurysmAdult Antenatal & Newborn Immunisations for those at risk Cancer screening:Bowel Cancer ScreeningBreast Cancer ScreeningCervical Cancer Screening

13. SIT - What do we do? meet the needs of our eligible population Improving equality Improving access provide the highest levels of quality, safety and efficiency Investigating safety incidents Quality assurance meet minimum standards and strive for excellence Programme board meetings / review performance

14. Awareness and CommunicationsNHSE Commissioning National Task and Finish groupsNational Programme BoardNational Programme Team SQASSITPROVIDERS GPs PracticesCCGsLocal AuthoritiesCancer Alliance Cancer Research UK / MacmillanCancer Action Groups General Public

15. Surrey and SussexScreening and Immunisation TeamScreening and Immunisation LeadCaroline Vass Screening and Immunisation ManagersAmiira Bodheea, Karen Burgess, Jackie PearceScreening and Immunisation CoordinatorsKaren Creed, Fiona Ridpath, Kathryn Attwood, Sarah TomkinsonScreening and Immunisation AssistantClaire Ellis, Sarah PipkinScreening and Immunisation Business AssistantLise Martinez GonzalezEmail: PHE.Screening-ImmsSSAT@nhs.netUK17713 09/14

16. Cervical Screening Administration Service – Call/Recall https://www.csas.nhs.uk/contact-us/Who is invited for cervical screening? Women with a cervix, trans men, non-binary and intersex people may also have one.In the UK, you are automatically invited for cervical screening if you are:between the ages of 25 to 64 registered as female with a GP surgeryRoutine Recall in England3 years if you are age 25 to 495 years if you are age 50 to 64NotificationsPNL 10 weeks before screening due1st Invitation 5-6 weeks before screening dueReminder letter 18 weeks after 1st Non-Responder to GP Practice 14 weeks after reminder letterhttps://www.gov.uk/government/publications/cervical-screening-call-and-recall-administration-best-practice/cervical-screening-call-and-recallUK17713 09/14

17. Prior Notification Lists (PNL) Prior Notification Lists (PNL) identify women who are due to be invited for cervical screening. They are an essential part of the call/recall programme and should be completed by GP practices each week to ensure that women are invited for screening at the appropriate time. The lists can be viewed on Open Exeter 10 weeks before a woman’s next test due date. 4 weeks before invitation letters are issued. GP practices have 4 weeks to check their lists and submit a response. An email advising practices that the PNL is available for completion is sent to the nominated practice email address. It is recommended that a generic email address is used rather than a named individual’s email so that the practice is aware that PNLs are pending even when named individuals are absent or if they leave the practice. To check the email address details held on Open Exeter, visit the Organisation Maintenance Screen found on the main menu Application drop down list. https://www.csas.nhs.uk/support/pnl-guideUK17713 09/14

18. Cease and DeferGP Practices can defer screening due to the patient: Being pregnantHaving had a recent testCurrently under cytological follow-upPatient wishes to deferWomen can be removed from the screening programme for the following reason: By informed choice – a signed Disclaimer form is requiredIf they are aged over 65If they have no cervixUnder the Mental Capacity ActIf they are undergoing radiotherapyUK17713 09/14

19. How to Request a Cease or DeferralPractices should submit Cease and Deferral requests via Open Exeter to CSAS before the cut off shown on the PNL to avoid inappropriate invitations.Women can ONLY be ceased via Open Exeter for reasons of Age or No Cervix.They can be deferred for: Recent test, current pregnancy, patient wish to defer or under treatment relevant to screening.For any other reason to cease or defer, which you are unable to submit via Open Exeter, a cease or deferral form should be completed.Forms should be submitted via the online enquiry form, which can be found on our Contact Us page.UK17713 09/14

20. Non-RespondersNon Responder notifications are sent to practices if there is no record of a woman attending for a test after having been sent invitation and reminder letters. How to access the Non Responder notifications 1. The Non Responder notifications are listed in the Electronic Cards application of the Open Exeter system, together with other screening notifications. 2. Click on the main menu and select Practice Electronic Cards from the Application drop down list. You can request a cease or deferral for the same option available on a PNL.Practice should send a 3rd letter to those reaching non-responder where there is no known reason. (Women need to be sent a minimum of three invitations before the personalised care adjustment of not responding to invitations for care can be applied - QOF)Practice can set flags and reminders on their systems as a prompt should patients attend the surgery for other reasonsUK17713 09/14 e

21. Transgender & Non-Binary IndividualsEvery person who has a cervix and is within the screening age range is eligible for NHS cervical screening regardless of their gender identity. Current cervical screening IT systems do not have the facility to include individuals registered with the NHS as ‘male’, and current registration systems are unable to record the gender category of ‘non-binary’. Trans menA trans man still registered as a female (or indeterminate) who has a cervix will automatically be included in the screening programme. He will be invited for screening at appropriate intervals unless he chooses to opt out of the programme in accordance with national guidance.A trans man registered as a male who has a cervix cannot be invited for screening by the national programme. Screening invitations should be made either by his GP practice or the healthcare team managing his gender reassignment. Alternatively he can request screening every 3 or 5 years (depending on his age).UK17713 09/14

22. Transgender & Non-Binary Individuals cont’dTrans womenA trans woman is ineligible for screening as she has no cervix.Ineligible peoplePeople registered as female (or indeterminate) but who do not have a cervix should be ceased from screening call and recall as soon as possible, stating the reason ‘absence of cervix’.In all cases where a trans man is no longer eligible for cervical screening, the GP practice must ensure that any outstanding treatment or follow up is continued in accordance with national colposcopy guidance.An information leaflet on screening for trans and non-binary people is available.PHE has produced a blog on reducing cervical screening inequalities for trans people which may be helpful.UK17713 09/14

23. Transgender / Non-Binary GP Practice ResponsibilitiesAs the screening programme cannot automatically include people registered as male or non-binary, the GP practice must:communicate with their screening laboratory to ensure that samples are processed appropriately and that results are returned to the practice rather than the call and recall servicemake arrangements with the individual concerned regarding providing test results and make referrals for colposcopy where requiredensure that local failsafe systems include all individuals who require further investigations, treatment or follow-up, regardless of genderAll GP practice staff need to understand the screening eligibility criteria and ensure that they offer appointments to eligible trans men and treat all trans individuals with respect and sensitivity.UK17713 09/14

24. UK17713 09/14Open ExeterOpen Exeter enables GP admin and sample takers to:Process PNLs and Electronic CardsView a woman’s cervical screening historyView when the next screening test is due (This all prevents samples being taken too early and rejected)Defer or cease women from the screening programmeGenerate a pre-populated HMR101 Cervical Cytology request form if the ICE system is unavailable.

25. UK17713 09/14Open ExeterIf you require further information regarding Open Exeter please contact:Primary Care Support England For general Open Exeter enquiries, for example access to applications or password resets, please email us at:PCSE.openexeter@nhs.net .

26. Screening Coverage v QOFWhy are the figures for coverage different?Cervical Screening National ProgrammeWomen can be removed from the screening programme for the following reason: By informed choice – a signed Disclaimer form is requiredIf they are aged over 65If they have no cervixUnder the Mental Capacity ActIf they are undergoing radiotherapyQOF - Criteria for the personalised care adjustment 1. The investigative service or secondary care service is unavailable (where relevant to the indicator) 2. Intervention described in the indicator is clinically unsuitable 3. The patient has chosen not to receive the intervention described in the indicator 4. The patient has not responded to invitations for the intervention described in the indicator (a minimum of two invitations for the intervention in the preceding 12 months, except for the cervical screening indicators where women should receive a total of three invitations for screening) 5. The patient has registered with the practice or has been newly diagnosed with the condition of interest in the preceding 3 months and has not received the defined clinical measurements e.g. blood pressure measurement 6. The patient has registered with the practice or has been newly diagnosed with the condition of interest in the preceding 9 months and has not achieved the defined clinical standards e.g. blood pressure control within target levels. UK17713 09/14

27. Recent incidents originating in Primary CareUK17713 09/14No sample taker number or sharing sample taker numberSample Taker training issuesMislabelled or unlabelled sample pots /request formsEmpty sample pots arriving at the labTransport incidents Samples taken out of scope / out of protocol / wrong NTDDOut of date vialsSamples stored in a fridge over a weekend

28. ResourcesJo’s Trust www.jostrust.org.uk Cancer Research UK www.cancerresearchuk.org NHS Digital www.digital.nhs.uk PHE Screening Blogswww.phescreening.blog.gov.ukPHE Fingertips – practice level data:https://fingertips.phe.org.uk/profile/general-practiceEasy Health [range of easy read resources]http://easyhealth.org.uk/UK17713 09/14

29. UK17713 09/14

30. 30Engagement OpportunitiesJane Lodge Associate Director of Public Involvement  jane.lodge1@nhs.net

31. 3131Reaching your “non attenders”Who are your non attenders ?Why aren’t they attending ? Fear/embarrassmentLack of knowledge – why, how, what happens?Myths Cultural issues TransportChildcare/caring issues Don’t understand the information sent My sister had it and said it really hurts My friend said it was really embarrassing In my culture, women should not let others see their private parts As a transitioning trans man, I am worried about misunderstanding and discrimination I haven’t got anyone to look after my toddler

32. 3232Understand barriersengage with communities – through community groups, leaders, existing forumsask patients – at appointments for other reasonsProvide information have easy to understand information readily available – including how to access further information Use the existing assets in your population- patients / community groups advise you on how to reach people/reach people, explain, cascade information, increase knowledge and confidence So, what can you do?

33. 33

34. 34Cervical Screening in People with Learning DisabilitiesDr Amy DissanayakeClinical Lead for Learning Disabilities for Sussex CCGsamy.dissanayake@nhs.net

35. 35Uptake of Cervical Screening - PwLD19% of females with an LD v 73% General populationWhy?

36. 36Uptake of Cervical Screening - PwLDProfessional fear & anxiety around capacityCommunication & comprehension difficulties around importance of screeningAssumptions made by professionals, families and carersTime pressuresScreening letters not accessibleStaff unaware of available resourcesPWLD feeling embarrassed, scared or anxiousMobility difficulties and lack of equipmentEnvironment not suitable

37. 37Reasonable AdjustmentsEasy Read Invites & guidesLogisticsCommunication Pre-visit Alternative venueChaperone or carer/friendHelp her to feel more relaxedMusicdistraction

38. 38Mental Capacity ActIs specific decision basedAssumes capacityThe professional must take reasonable steps for effective communicationAny treatment should be with least restrictive meansUnwise decision doesn’t mean they don’t have capacityhttps://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/

39. 39Capacity to Consent or declineConsider if the patient (with reasonable adjustments)Has a basic understanding of what cervical screening is, its purpose and why she has been invited?Understands that the test does not always find that something is wrong? Understands that a positive test result will mean having more tests? Is able to retain the information for long enough to make an effective decision?Is able to make a free choice (i.e. free from pressure from supporters or health professionals)?No-one else can consent/decline on her behalf – including family/carers

40. 40Best Interest DecisionDiscussion - LPA, family, friends, carers, health professionalsPast screening Beliefs and wishesCan collate informationReasonable BeliefIndependent advocate PohWER https://www.pohwer.net/Pages/Category/in-your-areaPerceived lack of Sexual activity is not a reason to not have cervical screening

41. 41If decision is not to have screening Consider other ways of keeping her safe from cervical cancerEducating the woman, her family and carers about the signs and symptoms of cervical cancerReview the decision on a regular basis The patient can NOT be removed from the list

42. 42Contact and Resources for LDBrighton & Hove CCG Jane Viner Learning Disability Health Facilitator, 01273 296507/07517131341 Jane.Viner@brighton-hove.gov.uk West SussexLearning Disabilities Health Facilitation Team 01403 227000 Extension 7341 SC.TR.LDHF-Horsham@nhs.netEast Sussex CCG’s Hastings & Rother Hastings and Rother Community Learning Disability Team 01424 726600 LDAdminEast@sussexpartnership.nhs.uk Eastbourne, Downs and Weald Eastbourne Downs and Weald Community Learning Disability Team 01273 336555 LDAdminWest@sussexpartnership.nhs.uk Public Health England https://www.gov.uk/government/publications/cervical-screening-easy-read-guideJo’s Trusthttps://www.jostrust.org.uk/sites/default/files/isl116_18_er_smear_tests_final_low_res.pdfMCAhttps://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/

43. 43Serious mental illness (SMI) + cervical cancer screening Dr Bikram RaychaudhuriGP Clinical Lead, West Sussex CCGDementia & Adult Mental Health bikram.raychaudhuri@nhs.net

44. 44Serious Mental Illness (SMI) Face a shorter life expectancy by an average of 15–20 years.Are three times more likely to smoke.Are three-and-a-half times more likely to lose all teeth.Are at double the risk of obesity and diabetes, three times the risk of hypertension and metabolic syndrome, and five times the risk of dyslipidaemiaAre 5 times more likely to have > 3 physical health conditions, between ages 15 – 34 (schizophrenia, bipolar affective disorder and other psychoses)

45. 45People with SMI in the STP (Sussex + East Surrey) – 18,673Eligible for Cervical Cancer screening – 3,537Recommended checks – Alcohol screeningBlood glucoseBlood lipidBlood pressureBMISmoking Diet Substance misuse Medicine's reviewCervical cancer screening Breast cancer screening Bowel cancer screening Cervical Cancer Screening (received)England average – 68.7%South East – 65.9%Sussex and East Surrey STP – 68.3% of eligible population Target – 60% SMI population receive all the checksSTP achievement (Q2 – 20/21) – 21.7%Serious mental illness (SMI) + cervical cancer screening DON’T JUST SCREEN INTERVENE

46. Thank you for AttendingQ&ACervical Screening WebinarWe will capture all the questions and the answersif you have any additional questions please email:Mark.Hannigan@nhs.net