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Cervical screening uptake: how practices can manage falling rates

by Beth Gault
17 March 2023

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GP practices have spoken to MiP about how they are overcoming barriers to women attending cervical smear appointments, amid declining uptake

The proportion of women who have never had cervical screening or are not up to date with their tests is at the highest it’s been in 10 years, NHS England warned earlier this year.

Approximately 4.6 million women in England between 25 and 64, or nearly a third of the eligible group, have never been screened or are not up to date with their smear tests.

This is out of almost 16 million women eligible for cervical screening in 2021/22, according to latest annual NHS figures.

Coverage has been on a downward trajectory over the past 10 years, with coverage at over 75% in 2010/11, but only 69.9% in 2021/22.

Sarah Forster, PCN Strategic Business and Transformation Manager at Medics PCN in Luton, which has around 56,000 patients, says her network has been very aware of this decrease. 

‘It’s a national problem,’ says Ms Forster. ‘Since the pandemic there’s been a huge drop in screening uptake. I think something has changed. It just seems that people don’t want to come forward.’

Medics PCN began taking steps to boost uptake back in 2020. It undertook a review of cancer screening, which found that rates varied among the five practices in the PCN – with three practices underperforming and two doing well.

To increase uptake, the PCN switched from paper invitations to text messaging via Accurx, which allows patients to immediately book in for their appointment and not put it off. For one of the practices, Ms Forster says, this change in method of communication alone helped increase uptake by 8%.

But, in line with the national trend, the PCN’s screening figures continue to be below where they’d like them to be. In response, it is taking some targeted measures to tackle dwindling screening uptake among its patient population.

These include holding an awareness event in May at a Sikh temple, which hopes to get people to come forward for multiple types of cancer screening, including cervical, breast and prostate.

‘We’re in an area with a large BAME community and there can be a lot of stigma and myths attached to such tests among this population group,’ says Ms Forster.

At the event, GPs who can speak multiple languages and female staff will be on hand to help tackle those concerns, she explains.

The PCN is also considering going into schools to instil the message about the importance of screening at an early age, early on and help promote that understanding to the whole family. 

‘We’ve been told that if you can catch someone for their first screening appointment, that they tend to repeat and come again,’ says Ms Forster.

Engaging with younger patients

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Screening uptake also tends to be lower among the younger age groups of the eligible group – NHS figures show 67.6% uptake among the 25 to 49 age group compared with 74.6% uptake among the 50 to 64 age group in 2021/22.

Ms Forster says this is definitely a trend experienced at their PCN, with four of their practices seeing around a 10% difference in uptake between the younger and older groups. She suggests this could be because smear tests appointments are often only available in the middle of the working day.

To tackle this, the PCN is introducing an enhanced service from April which will make weekend and evening screening appointments available.

‘We need to ensure patients can easily receive information we send them and respond to it. And, of course that they can then book an appointment at times that are more convenient for them,’ Ms Forster explains.

Tracy Dell, practice business manager at Cleckheaton Group Practice and primary care consultant in West Yorkshire, says being flexible with appointment times has also really helped at her practice.

‘Cytology figures are bad in most practices,’ she says. ‘Ours is doing better than others in our locality. We have a super practice nurse and a cancer champion admin staff member who supports cytology, bowel and breast screening. She follows up any DNAs with a call. This, as well as being flexible with appointment times has worked for us as well.’

She adds: ‘Some practices are also doing great things such as organising Saturday clinics and using social media to reach out to patients. Others we know have had the idea of decorating the surgery with pink banners, balloons and decorations to raise awareness about screening and make clinics feel like more of an event,’ she adds. 

Stephanie Bouckley, who is the practice nurse at Cleckheaton Group Practice, says their surgery has aimed to improve the patient experience for those coming in for screening tests, including giving them an opportunity to express worries and ask questions before the test. She says it’s important to be ‘truthful, knowledgeable and confident’.

‘Any women who are referred on for colposcopy or treatment are also scheduled for a welfare call (by using the scheduled task feature in our clinical system),’ says Ms Bouckley. ‘This makes them feel cared for and encourages continuing attendance.’

Managing QOF impact

If attendance remains low then it’s important for practices to manage the impact on QOF and practice finances.

Ms Bouckley says they have put in place various measures to do this, including maintaining a list of non-attenders, which helps to accurately exception report.

QOF rules state that the patient should have been sent a minimum of three invitations. However, care should continue to be offered on an opportunistic basis where appropriate.

Ms Bouckley says: ‘A patient is marked as ‘smear not wanted’ after three unanswered invitations. However, I keep them on a rolling scheduled task then try to contact them myself every three months to discuss the importance of attendance.’

Ms Forster adds that there is only so much practices and PCNs can do to boost cervical screening uptake, and has called for a larger scale national campaign to raise awareness.

‘There needs to be much more visibility about the issue,’ says Ms Forster. ‘What we do at practice level is just scratching the surface.’


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