NHS Calderdale and Kirklees Cervical Screening GP Registrars Training Information.

NHS Calderdale and Kirklees

Cervical Screening GP Registrars Training Information

Topics to be covered:• Cervical screening programme basics• Training guidance and further resources• Responsibilities as sample takers• Responsibilities as employers• Quality/safety – Incidents• Local Pathway• Cervical Sample Taker Database (CSTD)• Monitoring Performance

Cervical Screening Programme Basics

• The programme covers women age 25-64

– 25-49 every 3 years– 50-64 every 5 years– 65+ only if not screened since 50 or had recent

abnormal tests

The majority of cervical screening samples are taken in primary care

Useful Websites

• Quality Assurance Reference Centre (QARC)http://www.neyhqarc.nhs.uk/

CervicalScreening/RegionalProtocolsandGuidance.aspx

• NHS Cervical Screening Programme:http://www.cancerscreening.nhs.uk/cervical/index.html

Update training

Components• E-learning – accredited package• Localisation training

Specific event Optional visits to the care pathway

• Annual review of audit data Inadequacy; abnormality; TZ rates

NHSCSP publication 23: Taking Samples for Cervical Screening (April 2006):Training requirements for medical and nursing professionals are equivalent. “Sample takers should undertake a minimum of one half day’s update training every three years.”

NEYH Sample Taker Training Guidance (July 2012):“All sample takers in in the NEYHQARC region irrespective of their place of work and job description are required to adhere to the requirements of this training guidance”

E - learningThis course covers theoretical information - but it doesn't guarantee clinical competence.

http://www.nwyhelearning.nhs.uk/elearning/yorksandhumber/shared/cervical_sample_taker/Preview/index.html

HPV e-learning module

• An e-learning course has been developed, which takes approximately 30-45 mins to complete:

http://www.nwyhelearning.nhs.uk/elearning/Shared/HPV/HTML/Published/WEB/COURSE/SHA-HPV.html

• Following completion of the course sample takers can take an assessment by following this link:

http://www.nwyhelearning.nhs.uk/elearning/Shared/HPV/HTML/Published/WEB/ASSESSMENT/assessment.html

Responsibilities of Sample Takers, Employers and Sample Taking Co-ordinators

http://www.neyhqarc.nhs.uk/LinkClick.aspx?fileticket=jLc8oXXJ1o8%3d&tabid=93&portalid=0&mid=923

“All screening programmes do harm: the challenge is to ensure that

programmes are implemented in such a way that they do more good than

harm at reasonable cost”

Raffle, A. & Gray, M. (2007) Screening: evidence and practice. Oxford University press

Quality/Safety and Incidents

Essentials

• High coverage of the population (80% or more) • Well trained professionals • High quality cervical sample taking • High quality cervical sample analysis • Evidence-based, high quality treatment and

clinical management • Efficient failsafe systems for all elements of the

pathway

Err on the side of caution…

• Inform / discuss with the Screening Manager / Co-ordinator

• The QARC should be notified within 24 hours of any problem which may be a suspected Serious Incident

• The responsible person in the provider/PCT should complete the template form

Incidents in primary care

• Incorrect method (e.g. not including the brush head in the pot due to being trained in a different technique)

• Incorrect use of screening e.g. sample-taking when visible cancer on the cervix

• Using out of date vials• Taking samples without training or a code• Employing an untrained sample taker• Incorrect labelling of samples / not matching with

forms• Code-sharing• Poor technique e.g. not visualising cervix

Local pathway

Overview

Pathway & players

Call/recallGeneral

practice, hospital or community

clinic

CytologyColposcopy

Treatment

WYCSA

Laboratory / WYCSA

Colposcopy clinic

Woman receives invitation

Woman registers with GP

Woman has cervical sample

taken

Sample sent to laboratory

Result sent to woman & sample takerWoman invited for

colposcopy

Woman invited for treatment

CERVICAL SAMPLE TAKER DATABASE

www.cstd.neyhqarc.nhs.uk

Cervical Sample Taker Database• Web based database - register of all the sample takers in the North East,

Yorkshire and the Humber• Performance management tool (results of samples, reports on

performance)• Cervical sample taker training record tool• Local training days and events in your area advertisement• National, regional and local cervical screening guidelines and protocols

held• All sample takers need to obtain a new cervical sample (smear) taker code

to replace their existing code• A NEW CODE WILL NOT AUTOMATICALLY BE SENT TO YOU!• The new code will begin with a letter followed by four numbers e.g. A0001• Access will be given to the Cervical Sample Taker Database

• QARC REQUIRE ALL SAMPLE TAKERS TO BE REGISTERED BY END SEPT 2012

How to get a new sample taker code

CSTD Links

For the sample taking coordinators to register and to add sample takers:

www.cstd.neyhqarc.nhs.uk/admin

For sample takers:

www.cstd.neyhqarc.nhs.uk

Sample Taker Performance

Sample Taker Performance• Audit of inadequates, TZ rate (women under 50) and

abnormals by QARC

• Monthly download

• Use lab data toProduce funnel plot

• RAG rated (how nearto lab average)

Sample Taker Performance contSample Taker Code Sample Taker Inadequate % RAG Rating

Example 1 1.25% Green

Example 2 7.50% Red

Sample Taker Code TZ % RAG Rating

Example 1 80.00% Amber

Example 2 90.00% Green

Sample Taker Performance cont• ‘A Guide for Practices and Sample Takers to UnderstandingSample Taking Performance Data’ http://www.neyhqarc.nhs.uk/LinkClick.aspx?

fileticket=FCelRX1QH3A%3d&tabid=289

• If RED – recommend looking at data in more depth. QARC/PCT can support this. They may recommend an internal WASP assessment should take place.

http://www.neyhqarc.nhs.uk/LinkClick.aspx?fileticket=sLuhQAYqREg%3d&tabid=93&mid=923

• Practice responsibility to ensure staff are competent

TZ Rates

• Good technique:

– Get a good view of the cervix– Anchor the brush in the os– 5 clockwise turns with firm pencil pressure

For further informationCalderdale & Kirklees Cervical

Screening Programme & NHS Calderdale

Dr Jill FarringtonDistrict Coordinator / Consultant in Public Health Medicine01422 [email protected]

Sharron McMahonPublic Health Screening Manager01422 [email protected]

Sarah JanuszczykPublic Health Secretary01422 28 [email protected]

NHS Kirklees

Dr Mercy VergisConsultant in Public Health01484-464236 (PA)07904-194321 [email protected]

Finally...

Any Questions?