Cervical screening

Unfortunately, cervical screening uptake and coverage has been declining as a result of COVID-19, but together we can change this and help prevent cervical cancer. This page contains suggestions on increasing cervical screening uptake for your practice as supported and reinforced by local Macmillan GP leads across mid and south Essex.

Ideas to increase awareness and uptake of cervical screening in your practice

1) Non-clinical staff could wear teal and white during Cervical Screening Awareness Week (15th to 21st June 2020), this could also act as a reminder to mention cervical screening to eligible patients who are due or have missed their screening to book appointments.

2) Book patients for their screening when their reminder is given.

3) Consider offering weekend or evening appointments for patients who are unable to attend during working hours.

4) Consider using systems such as AccuRx to send a free text to patients who have missed their screening following the initial letter from the screening programme.

5) Have a named contact in your practice whom patients can ask for if they have questions/anxieties around their smears. 

6) Put a bulletin on your website and posters around the surgery about Cervical Screening and the awareness week. (There are many free resources available online that can be downloaded, jostrust.org.uk is just one of the many websites with posters available).

7) Consider targeted calls to patients who miss their screening or who may be in an at risk group, for example mental health patients, learning disability patients and those whose first language is not English. Public Health England have published ‘Cervical Screening - helping you decide’ booklets in a number of languages which can be accessed at: https://www.gov.uk/government/publications/cervical-screening-description-in-brief). There is also Easy Read information available online at: https://phescreening.blog.gov.uk/2019/04/15/weve-updated-our-easy-read-guide-to-cervical-screening/​.

9) If a patient books in for a health check and their cervical screening is due, offer to have this taken on the same day and provide a longer appointment.

10) Follow up any non-responders by texts or practice reminder letters.

Resources

Below are several resources that you can adapt to suit your practice and increase your cervical screening uptake. These include:

(Above) Dr Andrea Oustayiannis and nurse Liza Benson talk about the importance of attending your cervical screening appointment and what you can expect. Please feel free to use this video as a resource across GP practice channels to help raise awareness of cervical screening.

If you have any queries or would like any assistance in increasing your cervical screening uptake. Please do not hesitate to contact your local Macmillan GP.

Impact of COVID-19 on cervical screening

To further their work in understanding the impact of COVID-19 on cervical screening, Jo’s Cervical Cancer Trust recently (September, 2020) conducted an online survey of 2,000 women aged 25-64 living in England and spoke to an additional 22 through one to one interviews and focus groups.

While the majority of participants felt less anxious about the virus than at the start of the pandemic, one in 10 (9%) said they definitely wouldn’t attend cervical screening now and 22% felt less likely to attend.

Higher levels of fear or concern was found among those who have been shielding or living with someone shielding, women from Black, Asian and minority ethnic backgrounds and those overdue screening.

BAME women less likely to attend screening due to COVID-19

This survey highlighted the fact that BAME women are less likely to attend cervical screening right now, with a third reporting that they are more likely to feel unsafe visiting their GP surgery than white women due to COVID-19.

In addition, the survey of almost 2,000 women (1,752 white ans 225 BAME) found that:

• BAME women are more than twice (17.3%) as likely as white women (8.1%) to believe that delaying cervical cancer screening is the safest thing to do at the moment.
• White women are twice as likely (51.1%) as BAME women (25.3%) to say that the virus has not affected how they would feel about attending a screening.
• 14.6% of white women strongly agree with needing more information about safety measures which would be put in place at a screening appointment, compared with 26.7% of BAME women.
• BAME women are almost twice as likely (30.2%) as white women (17.2%) to say that knowing other people who have been screened and felt safe would make them more likely to have a smear test if it was due.

How can staff in primary care help?

1. Alert women to the availability of screening – do they know they can book a test?
2. Consider the information and support that patients, especially those in higher risk groups, might need to feel more comfortable with attending
3. Provide upfront information on what to expect, being clear that the NHS and your surgery are following guidelines to keep people safe. This could be through a phone call when contacting those who are overdue, when patients book in, or using websites and social media to communicate what you are doing
4. Explain what patients can do themselves ahead of an appointment to feel safe, such as wearing a mask and keeping a safe distance when travelling
5. Consider how to engage those who may be less likely to attend as a result of the pandemic, or who may have increased barriers. The pandemic means outreach work, educational events or awareness sessions, literature that may be displayed in community settings or workplaces, and other initiatives may have paused or stopped
6. Remain mindful of the barriers to screening that existed before the pandemic – psychological, physical, literary and cultural. These have not gone away and instead patients are likely to be feeling more anxious than before
7. Try to work with patients to find alternatives to things no longer available due to the pandemic, for example for those who would want to bring someone with them

Please visit Jo’s Cervical Cancer Trust website for more information and support.