FSRH statement: FSRH, RCOG, BSCCP and Jo’s Cervical Cancer Trust Joint Response Review of Adult Screening Programmes

The FSRH, the Royal College of Obstetricians and Gynaecologists (RCOG), Jo’s Cervical Cancer Trust and the British Society for Colposcopy and Cervical Pathology (BSCCP) welcome the release of Professor Mike Richard’s review of adult screening programmes in England. We are encouraged to see that our main concerns about the current cervical screening programme have been recognised.

In our joint submission to the review, we highlighted the worrying decline in cervical screening uptake and called for greater availability and flexibility of screening times and locations. We therefore support the recommendation that financial incentives should be offered to providers to promote out-of-hours and weekend appointments.

We are pleased to see that the review acknowledges that sexual and reproductive health services have a role to play in increasing uptake. Many women choose to access cervical screening at sexual and reproductive healthcare services, and women tested through this route have an above average HPV positivity rate. However, the number of screenings in sexual and reproductive healthcare services has halved since 2014/15. Cervical screening is not a mandated requirement for local authority commissioning of sexual and reproductive healthcare services and is not included in many service specifications. Therefore, we strongly support the review’s call for consideration to be given as to how best to incentivise “alternative” providers such as sexual and reproductive health services. We urge commissioners and providers to include consideration of walk-in appointments at sexual and reproductive healthcare services and community clinics as part of this, to make cervical screening as accessible as possible.

The current fragmented approach to the commissioning and delivery of cervical screening has created confusion for women and risks for patient safety. It is encouraging that this has been recognised by Professor Richards. We fully support the call for an integrated approach to commissioning between primary care and sexual and reproductive health. We also welcome the recommendation for a simpler governance and advisory structure, with sole responsibility for the delivery of screening programmes residing with one organisation, and the appointment of a named director for screening which will provide clearer lines of accountability. It will be vital that the director for screening works closely with the national clinical director for maternity and women’s health to ensure a joined-up approach to women’s health.

We are pleased to see that our concerns about outdated and inadequate IT systems have been highlighted and that the IT system for cervical screening is identified as one of those most in need of renewal. It is encouraging that NHSX is already working on developing a new IT system for the cervical screening programme – this work must be given the highest priority.

Our submission identified concerns about the decline in the NHS cytologist workforce and subsequent problems providing sufficient cytology service capacity, in light of the move to primary HPV testing. Given the current backlog of cytology samples awaiting analysis, we support the recommendation to revisit, in the short term at least, the requirement that all samples should be assessed on one of the eight sites designated for cervical screening. We also support the recommendation for commissioners to work with organisations at a local level to identify and manage demand. The director for screening should work with HEE to ensure a system-wide response to workforce demand issues within screening services.

We urge the future director of screening to prioritise securing extra funding for screening programmes. It is clear that the screening service needs greater investment to ensure it can manage any welcome increase in demand, provide results within agreed timescales and utilise the best possible technology to provide the best service for patients.

As Prof Richards himself notes, many of the report’s recommendations are high level, so we look forward to working with system leaders to add greater detail to these plans.

For further information please contact:
Camila Azevedo
FSRH External Affairs & Standards Manager
Email: externalaffairsmanager@fsrh.org
Telephone: 02037945309