Guidance

Breast screening: screening office management

Published 30 July 2021

Applies to England

This guidance is to support breast screening services in the management of, and best practice for, screening office administration.

1. Commissioning arrangements

All breast screening services (BSSs) in England are commissioned to provide the service by a regional commissioning team against a national service specification (number 24).

Relevant staff in each breast screening service (BSS) should familiarise themselves with their local commissioning team arrangements, identifying their area’s:

• screening and immunisation team (SIT), including the screening and immunisation lead (SIL), screening and immunisation manager (SIM) and co-ordinator
• regional commissioning team, including the head of public health commissioning and commissioning manager

The national service specification requires that regular screening programme board meetings are held between the breast screening management team, commissioning team and SIT, and with screening quality assurance service (SQAS) input. The frequency of these meetings is given in the service specification. The senior leadership team of the BSS must attend, including the:

• director of breast screening
• programme manager (or equivalent)
• screening office manager (SOM)
• lead radiographer

1.1 Monitoring and performance: targets and standards

Evaluation of the NHS Breast Screening Programme (NHS BSP) is essential to make sure there is continual development of the service. Services are monitored against the NHS BSP consolidated standards which specify acceptable and achievable thresholds of performance. Data is typically collected from 1 April to 31 March.

SQAS uses the data to review and measure service performance. BSSs should regularly review the data within service and at screening programme board meetings. BSSs should be able to report the reasons for any of the standards not being achieved.

Contract monitoring data

BSSs are required to submit monthly, quarterly, biannual and annual data to SQAS in accordance with their annual key performance indicator (KPI) schedule. SQAS then shares this data with NHS England and NHS Improvement (NHSEI) commissioning teams under a memorandum of understanding (MOU). As part of the service contract, BSSs may also need to provide data to NHSEI directly via their trust. The data provides regional teams with a means of monitoring the performance and activity of BSSs against the service specification.

Significant data is derived from the following national statutory data returns.

KC62

All BSSs in England are required to complete a KC62 return on an annual basis (submit data in October, covering the previous period 1 April to 31 March). The KC62 is uploaded to the breast screening information system (BSIS) and then submitted to NHS Digital (NHSD) for analysis.

The KC62 is a record of all breast screening activity undertaken by the BSS in a given timeframe. The return is a record of the progress of each screening episode from invitation to either return to screening or final diagnosis.

The return is generated within the national breast screening system (NBSS). It is usually the screening office managers’ (SOMs) responsibility to make sure screening data, including clinical information, is inputted correctly, completely and uploaded annually. The KC62 return is the main way that the BSS is evaluated against NHS BSP standards. Training slides for completing KC62 returns are available.

KC63

The KC63 return is run annually by NHS Digital (NHSD) from BS Select. The KC63 records breast screening activity for all women within a BSS or health area, particularly relating to coverage information and episodes with an open status at the time of data extraction.

2. Patient confidentiality

Guidance is available on the use of information in NHS population screening programmes. It explains how and why the programmes collect and process data, covering:

• the information used by the NHS to invite people to be screened
• the screening programme’s and client’s rights
• how long personally identifiable information is kept
• how client information is protected and kept confidential
• population screening programmes and the law
• how members of the public can find out more or raise a concern

2.1 Information governance

BSSs should work locally with their clinical governance and IT teams to make sure the NHS information security policy is referenced for use within their service. All staff have a contractual responsibility to safeguard patient information and should be familiar with national and local policies.

The BSS host trust has a responsibility to ensure that:

• physical and electronic patient identifiable information is secure
• adequate risk assessment relating to data handling and use is carried out
• appropriate equipment and system security policies are in place

Detailed work instructions or a trust policy should be in place to this effect.

SQAS has an electronic view-only link to each services’ National Breast Screening System (NBSS) to assist data verification and audit. The NBSS superuser at a breast screening service grants the appropriate level of access to SQAS, and should comply with the information security management: NHS code of practice.

2.2 General Data Protection Regulation (GDPR) guidance

Guidance on GDPR explains any changes organisations may need to make in order to comply with EU general data protection regulations (which are applicable even though the UK is not an EU member state).

2.3 Transferring records

All data transfers must follow the guidance provided in Information security management: NHS code of practice.

Transfer of information between sites

When screening is undertaken at various sites there must clear trust agreement for the secure transfer of patient identifiable paperwork and electronic media between locations. For example, this may include for someone who is screened on a mobile unit, or someone who chooses to be screened at a different screening service to the one they are invited to attend. All portable electronic media and the NBSS Daybook facility must be encrypted in line with NHS Digital guidance on data and information. For paperwork there needs to be a clear local policy based on the right results pathway to ensure direct transfer securely from site to site.

Email, electronic transfer and NHS mail accounts

Encrypt all patient identifiable information for electronic transfer, including via email. Use an NHSmail account (nhs.net) for emails of this type. You can set up an email account via NHSmail.

Send patient identifiable information separately from other information. Issue a password separately, for example via a separate secure email message or a telephone call once the data is received.

Post

Use secure electronic transfer for information, particularly to GP practices, where possible. However, if this is not possible, use 2 sealed envelopes (one inside the other) to send all confidential external correspondence. Clearly mark each envelope with the name and address of the recipient, and mark as ‘private and confidential’. Send bulky personal identifiable information (containing 10 or more records) either by secure courier or Royal Mail’s Special Delivery Guaranteed service.

Clear arrangements should be in place for the receipt and dispatch of all materials sent out for reporting, such as pathology samples.

Telephone

Do not provide patient identifiable information over the telephone to an unverified enquirer. Where individual personal information is involved, call the requester back to verify their identity and their right to access the information. External requests for individual personal information should be submitted in writing.

For disclosure of information that is not personally identifiable (for example, an appointment date), verify the identity of a caller in accordance with local procedures ahead of disclosure of information.

Internal enquiries requesting identifiable patient information should be recorded and logged.

Digital and Picture Archiving Computerised System (PACS) data transfers

There should be secure methods for the transfer of electronic media between screening clinics where remote screening takes place. All data or PACS transfers between sites need to be secure and adhere to local trust protocols. All portable storage media must be encrypted in line with NHS Digital guidance. Use the image exchange portal (IEP) when transferring images between services, trusts and symptomatic services.

3. IT systems access and support

The NHS BSP operates via 2 IT systems:

• BS Select is the call recall function that enables breast screening offices (BSOs) to identify and select women due for breast screening
• NBSS is the national database that holds all the screening pathway information, from invitation to outcome

3.1 BS Select

The BS Select system is supported by NHS Digital (NHSD). Their contact details are:

• Helpdesk: 0300 303 4034
• Email: exeter.helpdesk@nhs.net

The BS Select support service is available from 08:00 to 17:00, Monday to Friday excluding English public and bank holidays.

Access BS Select via the Open Exeter portal.

New users must request access via a Data User Certificate (DUC), signed and emailed from their Senior Information Risk Owner (SIRO) or a nominated Information Asset Owner (IAO). The forms are held on the NHSD Systems and Services web page.

There are 2 levels of access to BS Select:

• update access – users must first attend the NHS Digital course BS01. Information regarding training is available from the NHS Digital Training Team (email nhais.training@nhs.net)
• read only access – no training required before access is granted

For further information see knowledge article (KA) ‘Access to BS Select and BSIS via Open Exeter’ on the NBSS website (within the ‘training’ section).

Requesting system changes to BS Select

Discuss suggestions for potential IT system changes at your regional admin and clerical meeting (arranged by SQAS). Raise any requests for changes to BS Select via your regional representative on the BS Select Steering Group.

3.2 NBSS intranet

Access to the NBSS website is authorised by the national breast screening team. Contact them at phe.screeninghelpdesk@nhs.net for allocation of a user name and password.

The NBSS website is aimed at current NBSS users. It provides a single point of contact for dissemination of information about NBSS. Site features include:

• contact details for screening offices, national breast team and SQAS teams
• training resources – NBSS training articles, training slide decks, videos and BS Select knowledge articles
• NBSS information such as release notes newsletters and general documents
• Crystal reports available to download to support data extraction and KPI monitoring
• national documents
• national letter templates with Crystal reports and PDF examples of the letters
• national form templates, for example the FM001 registration request form (BS Select)

NBSS support

NBSS support is provided by Hitachi. The service desk contact details are:

• Email: GlobalServiceDesk@hitachivantara.com
• Telephone: 0871 433 3040

The NBSS support service is available from 08:00 to 17:00, Monday to Friday excluding English public and bank holidays.

Report any NBSS problems to the service desk as soon as possible to enable all relevant information regarding the issue to be given to the NBSS support team.

Anyone from a screening office or their local IT can raise a support call via email or telephone. Those members of staff with an account for the Assure Service Desk (ASD) can also log calls directly via the portal.

Assure Service Desk (ASD) portal

Hitachi uses the ASD to manage support calls and changes. As a minimum, at least one person in the screening office (usually the office manager) is issued with login details to access the ASD portal. Through the portal you can log new calls, check on the status of existing calls, and provide updates.

When logging calls directly, select the most appropriate type from the list of NBSS calls, for example ‘NBSS Advice & Guidance’. Only use the option ‘‘Create a New Incident’ if you believe that something in NBSS is not working as it should.

When the NBSS team updates a call, an email from the ASD is sent to the person who raised the call if they have an account, otherwise to the nominated contact for the screening office. These emails can also go to other members of staff if they ask to be added to the watch list for that particular call.

Hitachi contact with breast screening offices (BSOs)

There must be a nominated person within the BSO as a primary screening office contact for Hitachi. Usually this contact is the SOM or programme manager, or it can be anyone the SOM chooses to nominate. This nominated individual must make sure that all of the messages from Hitachi are circulated as necessary across the breast screening service. This will include liaising with local IT when communications state that input is required.

The nominated person (or people) are included on the distribution list for NBSS email communications. These are sent by Hitachi to notify the BSO about any new issues and actions to be taken, to provide release notes prior to NBSS upgrades, and when the bi-annual NBSS newsletter is issued. The newsletter gives updates on changes made to NBSS and details actions that the BSO and their IT departments need to take. These newsletters are a source of information and SOMs should familiarise themselves with the information they contain. It is essential that any required actions specified in newsletters or release notes are taken in a timely manner.

Inform Hitachi if any nominated contacts within the BSO change, or there are any email address changes.

NBSS System Management menu (SYSMGR)

There is a separate desktop icon for NBSS System Management (Thin SYSMGR Live). There must be a nominated person within the screening service who acts as a system manager. This is usually the SOM or PM. Those with access to NBSS System Management must make sure that their deputy or another member of staff also has access in case they are absent.

Seek advice from the NBSS Support team to understand the potential impact before making any type of change within this application.

NBSS user logins

The system manager provides each user with an individual user name. Advise the user that their password is confidential and must not be given to anyone. Users must use their own accounts – if that account does not give them access to the functions they require, the system manager should modify the account using the options in NBSS System Management.

Do not use generic user accounts accessed by multiple people. All NBSS accounts must be for an individual named user. The user names are recorded against changes made in NBSS and this informs the audit trail.

If a user is unable to log on to NBSS because they have forgotten their password, it is the responsibility of the system manager to confirm that this user is permitted to access the system, and to reset their password. Refer to training article TA021 – ‘How to reset the password’ on an NBSS user account (in the training section of the NBSS website).

Only in exceptional circumstances and subject to express permission from the national breast screening team, may the NBSS support team provide assistance with password resets.

NBSS film-reading superusers

There must be at least one nominated person within the BSO who is a superuser. This can be a film-reader or a senior member of the admin team.

To become a superuser the person needs to have the ‘superuser’ box ticked on their user account screen. This needs to be done by a system manager. The user’s account details are found in ‘System Management’, under the ‘MA Maintenance’ menu and then the ‘Users’ option.

In exceptional circumstances a superuser can amend film-reading results entered on NBSS by another member of staff, if the film-reader is not available to do so themselves. Make the correction using the superuser’s own login details. The change is logged in the audit trail on NBSS, accessed via ‘System Management’.

SQAS has an electronic link to each service’s NBSS system to enable data verification and audit. The NBSS superuser at a breast screening service grants the appropriate level of access to SQAS and should comply with the information security management: NHS code of practice.

NBSS request for change (RFC) process

The NBSS support team can apply fixes to NBSS but are unable to implement any functional changes. For functional change requests:

• present the change to your regional admin and clerical group for consideration before submitting
• fill out a request for change (RFC) form and send it to the service desk

The RFC form is available from GlobalServiceDesk@hitachivantara.com

Once the RFC is received by Hitachi, it will be presented at the next available Change Advisory Board (CAB) and/or the national group for administration and IT (GAIT).

Additional NBSS licences

The NBSS Caché licence is based on concurrent users. When the maximum is reached, the next person trying to access the system is blocked. SOMs should determine how many licences are needed based on the maximum number of users at any one time. Take into account all users of NBSS, including:

• screening office staff
• mammographers – including advanced and consultant practitioners
• breast clinicians and radiologists
• NBSS Job Queue (to enable batch transfers and overnight processing)
• SQAS
• the NBSS support team

If you need additional Caché licences for NBSS, raise a new service request under ‘NBSS license request’. If the business case for extra licences is justified, the cost is covered by the annual NBSS IT Service Charge which is invoiced by the national breast screening team direct to your trust.

Crystal reports

‘Crystal’ is a report-writing tool used to extract data from NBSS into a variety of formats. All breast screening services were initially supplied with one Crystal licence by the national breast screening team. The licences are computer-specific and need to be uninstalled from an old PC and installed on any new replacement PC. Failing to transfer the licence means the service has to purchase a new one. Replacement licenses must be sourced and paid for by the service’s local IT department.

An additional Crystal licence is required if a service uses more than one PC for writing crystal reports. NBSS users do not need a Crystal licence to be able to run Crystal reports.

Crystal report writing access is required for the management of the NBSS Crystal national templated letters for screening call and recall (including results).

Individual Crystal reports can be downloaded from the NBSS website. Save reports within the local NBSS reports folder. Follow the steps below to find the file path location for the NBSS folder.

1. Log into the NBSS System Management application.
2. Select ‘System parameters’.
3. Select the ‘SPRPT reports’ folder server.
4. The file path will now be visible so you can save your report.

As soon as a report has been saved into this folder, it can be used by the ‘NBSS SPRPT Ad Hoc Reports’ function. There are 3 types of reports available for download. These are:

• standard – reports agreed and tested for national use
• personal – reports created by individuals in screening services that others may find useful; these have not been tested for national use so when using them, test the reports on your system before you assume that the results are correct for you
• letters – accessed via the letters template section of the NBSS website

Crystal reports support

Support for the functionality of Crystal reports is provided by the national breast screening team. If you need to write a Crystal report to extract certain information from NBSS, email the national breast screening team (phe.screeninghelpdesk@nhs.net) with ‘Crystal reports’ in the subject field, and attach the completed Crystal report request form located in the ‘form template’ section of the NBSS website.

If an issue relates to connecting to the NBSS database, or problems with access to reports via function ‘SPRPT’, contact GlobalServiceDesk@hitachivantara.com

NBSS menu codes

The menu codes used on NBSS (for instance ‘SPRPT’) are not abbreviations or acronyms related to the task, just short codes to refer to the function names.

Backups

Local IT departments must make sure that the NBSS server has successfully backed up after the NBSS backup overnight job has completed. They must not back up the NBSS server again until at least 30 minutes after the finish time of the last backup.

The time of the NBSS backup job can be found by looking in ‘System Management’, and ‘Job Overview’. The job description is ‘Create cache backup and restart cache’. The job will have a scheduled start time, shown in the ‘Date Time’ column. Look at the list for the previous day – the time the process finishes is in the ‘Status’ column.

If the NBSS backup job needs to be run at a different time due to local IT requirements, consult with the NBSS support team who will reschedule the job. There are other NBSS overnight jobs which should not be running at the same time as the IT server backup, so they may also need rescheduling. The SOM should not attempt to reschedule the jobs themselves.

In the unlikely event that databases need to be restored from the IT server backup, the local IT department should consult with the NBSS support team before carrying out the procedure. It is important to make sure certain files (for instance journal files in the folder ‘C:\cachesys\mgr\journal’) are not overwritten. Journal files are used to store transactions that have been updated in NBSS. Retrieval of updates from a journal file can be used to bring a restored database up to date. The NBSS newsletter has a standard item with guidelines for local IT departments.

3.3 Service disaster recovery plan

All services must make sure their IT department has a disaster recovery plan in the event of a major incident. The SOM must be familiar with the disaster recovery plan to be able to assess if screening can continue if a major incident occurs.

Additionally, all services must have a document within their Quality Management System (QMS) identifying what action needs to be implemented or taken in the event of a major IT incident.

4. Communications with GP practices

When planning communications with GP practices (GPPs), BSSs will need to consider their invitation method. Services that invite purely by next test due date (NTDD) across their geography may have to consider how they structure their GP engagement and the best time for this to take place. Services that invite different groups of eligible women from a GPP each year will need to do the same. It may be that the timing of communication is staggered to each GPP and is sent out periodically, for instance every 18 months. Additionally, services also need to consider which GPPs are part of bigger practice groups and any implications this may have on how and when the women from these practices are invited for screening. BS Select holds details of each service’s responsible GPPs.

4.1 Pre-invitation stage

The BSS should:

• have a contact email address for each GPP they are responsible for
• use the GP pre-screening pack and tailor this to their service as appropriate; email it to the GPP approximately 6 weeks before invitations are due to be sent out – this allows time for GPPs to advise eligible patients they are shortly due for screening (if they wish to)
• consider printing off breast screening information posters to provide with the GP pre-screening pack
• offer to undertake a GPP visit if there is resource within the BSS to carry one out

The GPP visit can be used to explain the process of invitation, screening and results to the practice team and answer any questions they may have. It may be possible to deliver a practice or practice care network (PCN) educational session. Clinical commissioning groups (CCGs) may also be able to support the arrangements for educational sessions; screening and immunisation teams may also be involved.

4.2 During the invitation process

The BSS should:

• update GPPs of all women invited for screening using the NBSS GP reports (accessed via the SIL – ‘print lists’ function) at least weekly; export the reports to PDF and email securely to the GPP (the reports include details of women who attended for screening, women recalled for assessment and women who did not attend)
• copy GPPs into all letters sent to women following assessment
• advise GPPs of any women who do not attend an assessment appointment
• copy GPPs into all letters sent to women discharged from assessment or diagnosed with cancer

4.3 After the invitation process

Send the NBSS breast screening feedback report (STA02A BSF) to GPPs 6 months after the completion of each round of screening for the practice cohort. You can save the report electronically and email it securely to the GPP. The report provides the outcomes for all screening invitations as defined by the NBSS user.