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Practice systems should reach trans men for cervical screening, DHSC sets out

by Jess Hacker
25 June 2021

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Cervical screening providers must have systems in place to offer appointments to trans men and non-binary people, the Department for Health and Social Care (DHSC) has outlined. 

In its pathway requirements specification, published yesterday (24 June), the DHSC said that providers responsible for taking cell samples must be able to offer screenings to eligible people not registered as ‘female’, and to those registered as ‘indeterminate’. 

It said that these systems should be put in place ‘either via the person’s GP practice or, where appropriate, a gender clinic healthcare team’.

This comes after a recent study indicated that gender markers on practices’ IT systems acted as barriers to screening, potentially excluding trans men – who may still have a cervix – from routine call and recall programmes

That same study found that only 7% of trans men preferred to be screened at their GP practice than elsewhere. By comparison nearly two-thirds (64%) preferred to attend a trans-specific clinic for a screening. 

Meanwhile, more than half (54%) who did not attend a cervical screening cited that they did not want disclose that they are transgender in order to get screened.

A DHSC spokesperson told Management in Practice: ‘Anyone with a cervix could be at risk of cervical cancer. The only way to protect against it is through regular and effective screening which saves around 5,000 lives every year.

‘If they have not already received an invitation, we urge people in LGBT communities to contact their GP to get a cervical screening appointment.’

‘Inflexible’ practice IT systems 

These findings were supported by a separate study, published last week (15 June) in the British Journal of General Practice (BJGP), which suggested that practices’ ‘inflexible’ IT systems can lead to exclusion of trans patients from necessary check-ups. 

It said that issues with not using the correct gender marker were ‘amplified’ by systems that have no option to record both a patient’s gender identity and their sex assigned at birth. 

Similarly, display systems in waiting rooms and reception booking systems were identified as a barrier as they can often display a patient’s birth name, it said. 

The study was based on interviews with 20 GPs and other healthcare professionals who work with trans people. It also found that GPs felt they were working ‘without clear guidance’ from their local CCG, or information for care pathways. 

All participants reported that trans health was ‘not sufficiently covered by their education and professional training’, with one practice nurse reporting there was ‘absolutely nothing about transgender healthcare’ during their training. 

The study authors said that while structural barriers require ‘wide-scale improvement’ in policy, GPs can act as ‘drivers of change’ at a practice level. 

It said: ‘Heightened awareness of the needs of this patient group would enable a better understanding of technical barriers that can be tackled systemically, and at the local level in individual practice.’ 

Call and recall signposting 

The new pathway requirements specification also outlined that call and recall services must signpost everyone invited to informative resources, so they can make an informed choice about whether they would be screened. 

Meanwhile, these services responsible for call and recall must ensure there is a system in place to manage people who have asked to have cervical screening invitations stopped

The specification also said services must: 

  • ensure the eligible population are offered cervical screening in line with national guidance on call and recall 
  • work with secure and detained settings to identify eligible persons for screening 
  • use the National Health Application and Infrastructure Services (NHAIS) system to manage and monitor individuals within the programme in line with programme failsafe guidance.