Guidance

NHS Cervical Screening Programme: Call and Recall policy and operational guidance

Updated 25 August 2026

This document is a revision of the NHS Cervical Screening Programme (NHS CSP) guidance, ‘Cervical screening: guidance for call and recall administration best practice’ and replaces the version dated June 2021.

All documents relating to the management of the NHS cervical screening programme in England are on the GOV.UK website.

This document is intended for those involved in the commissioning, management, governance, delivery and quality assurance of cervical screening call and recall administration services.

Programme policy

1. Legal and commissioning basis

The Secretary of State for Health and Social Care has a responsibility to protect the health of the public by providing population screening programmes. The Secretary of State delegates the responsibility for the coordination and oversight of the programmes to NHS England through the annual NHS Public Health Functions Agreement.

The Secretary of State also delegates the responsibility to commission the population screening services to NHS England through Section 7 of the NHS Act 2006 using a set of standard service specifications.

The Department of Health and Social Care (DHSC) holds NHS England to account for commissioning and operational delivery under the NHS Public Health Functions Agreement as set out further in Chapter 3 of the 2006 act.

NHS England commissions a national cervical screening administration service to deliver the call and recall function in the NHS Cervical Screening Programme. Regional commissioning arrangements are in place for sample takers, screening laboratories, colposcopy, and histology services. Adherence to contractual agreements is monitored through robust governance processes, with regular operational and commercial, as well as quality and risk meetings.

2.   Information governance and data protection (principles)

Records management and retention

Records management must comply with the latest version of the NHS England Records management policy.

This policy sets out NHS England’s overarching records management policy and includes a set of key policy statements which govern the management of records throughout their lifecycle.

The electronic records in the Cervical Screening Management System (CSMS) constitute the master electronic record for the NHS Cervical Screening Programme (NHS CSP) call and recall administrative function. They are fundamental to the efficient operation of the service, to the assurance of quality and safety, and for the longer-term evaluation and development of the programme. CSMS processes demographic data from the Personal Demographic Service (PDS) which is updated from a number of sources.

The national cervical screening administration service uses a customer relations management tool (CRM) for recording enquiries, colposcopy discharge lists and ceasing requests.

The citizen engagement manager (CEM) manages the invitations for individuals who become eligible for human papillomavirus (HPV) self-testing.

This does not rule out a separation of data for operational use from that retained for audit, quality assurance and evaluation purposes.

Where the NHS CSP has requirements to retain specific types of documents, these are set out in the record retention schedule accompanying this guidance. The schedule includes the business reasons for the period of retention.

Processing data for call and recall (Section 251)

Data held in CSMS and associated systems underpins the operational work of the programme including:

• initial invitations for screening and HPV self-testing
• managing and updating recall periods and adding/ceasing people.
• recall invitations at set periods.
• sending results.
• invitations for follow up investigations where necessary.
• quality assuring the safety and effectiveness of the programme.
• long-term evaluation of the safety and effectiveness of the programme.

The programme uses data held in PDS to identify people who are eligible for screening. As with all medical records, this information is held in confidence. For the call and recall administration service to access this data the duty of confidentiality does not apply in these circumstances. This is permitted by using a specific law commonly referred to as Section 251. This law allows the health service to process information without the express consent of the patient, to deliver appropriate medical services.

Section 251 (S251) of the National Health Service Act 2006 allows the Secretary of State to permit the processing of personal data without consent where there is an overriding public interest to do so, and where gaining explicit consent is not practical.

The S251 approval process is overseen by the Health Research Authority’s (HRA) Confidentiality Advisory Group (CAG) which carries out an annual review of the agreement to ensure it is being applied fairly and lawfully.

Maintenance of the Section 251 agreement

NHS England complies with the CAG’s required controls through its adherence to the Data Security and Protection Toolkit (DSPT) standards. Any organisations providing elements of the screening programme must also adhere to the DSPT standards to ensure they are practising good data security and that personal information is handled correctly.

This is achieved in screening by ensuring that all staff who access screening data:

• have documented information governance training
• have access to established policies to keep data secure
• can identify and report breaches when they occur

3.   Consent, eligibility and inclusion policy

Approach to consent and informed choice

The NHS Cervical Screening Programme aims to maximise coverage and uptake among the eligible population. Individuals are supported to make an informed choice about whether to participate. Comprehensive information material is issued with (or signposted in) every screening invitation and for any follow-up procedure.

Individuals who choose to attend for screening are considered to have provided consent to be screened and to have consented to the data processing necessary to provide a safe and effective service. This includes people with a cervix who are not registered as female who have been added to the screening cohort after receipt of completed forms.

Consent to receive further screening invitations is assumed unless an individual makes an informed choice not to participate in the screening programme and either tells the programme through their GP practice or submits a written request to the call and recall administration service. A clear and unambiguous written request signed by the individual is acceptable.

The call and recall administration service must include the national information leaflet for the programme with all initial invitations to participate to enable individuals to make an informed choice about attending. Reminder communications include a link to the online version of the leaflet. An information leaflet is provided to all people who are referred to colposcopy.

Individuals invited to complete an HPV self-test receive the national HPV self-testing leaflet with their invitation.

Opting out of screening

Most individuals who choose not to participate in the programme will do so by not making an appointment rather than by making a request to be ceased. Where individuals do not respond to a screening invitation, they are designated as ‘non-responders’ 32 weeks after their invitation date (see section 8). The individual’s next test due date (NTDD) will be recalculated in a further 8 weeks (40 weeks after invitation). Individuals who do not respond remain eligible for screening and are recalled at intervals according to current protocols.

An individual can make an informed choice to be permanently ceased from call and recall. The request for withdrawal from cervical screening should be submitted in writing where possible. Individuals who have made an informed choice to be ceased from call and recall remain eligible for screening and can attend for a test, which would restart their routine call and recall. For further information on ceasing individuals from routine cervical screening invitation see Cervical screening: removing women from routine invitations - GOV.UK

Objecting to data processing

Though under article 17 of the General Data Protection Regulations (GDPR) people have the right of erasure of their personal data from systems, not all personal data can be erased. Processing personal information is necessary to deliver a safe and effective screening service and is required even if a person has opted out of screening. Historical data held by NHS organisations may need to be retained (for example in case there is an incident and an affected individual needs to be told). This is separate from the request to opt out of screening.

Eligibility and inclusion criteria

Individuals must be eligible for NHS care to also be eligible for cervical screening. Inclusion criteria for the programme are based on demographic and primary care registration data held by the Personal Demographics Service (PDS).

To be eligible for the NHS cervical screening programme in England, individuals must have their primary residence in England.

Screening target population

Cervical screening is for women and people with a cervix. The programme sends cervical screening invitations to eligible individuals at the following ages and intervals:

• age 24.5: first invitation (invitations to first screen are issued at 24.5 years)
• ages 25 to 64: 5-yearly routine screening

For individuals aged 25 to 49 who have not had a HPV primary screening test, recall will be 3 yearly until they attend for a screening test. Further information on how the extended 5 year interval is implemented can be found in the appendix, 18.2 Extended Screening Interval Clinical Pathway protocol.

Automatic routine recall stops when the individual’s next test due date (NTDD) is on or after their 65th birthday, subject to clinical circumstances and follow-up. An invitation for HPV self-testing will be sent to individuals who have not attended for their final routine cervical screening.

Screening of individuals aged 65 plus is for those who have not been screened since age 60, or those who have not yet met the criteria to be ceased from the programme.

Transgender and non-binary individuals

Every person who has a cervix and is within the screening age range is eligible for NHS cervical screening regardless of their gender marker on PDS. Anyone registered as female will automatically be included in the screening programme. Someone not registered as female with a cervix will not automatically be included, but they can request to be added to the screening cohort (opt-in) and so receive automatic invitations. A trans woman is ineligible for screening as they do not have a cervix and should be ceased from the screening programme for this reason.

Detained estates and Defence Medical Service (DMS)

People in secure and detained settings in England are eligible for screening if they meet the criteria described in this guidance. Individuals registered under the Defence Medical Service (DMS) are also eligible if they meet the criteria described elsewhere within this guidance, including individuals registered with DMS in England and those on an overseas posting.

Private and non-NHS tests

Non-NHS tests are those taken outside the NHS cervical screening programme, including private services, workplace schemes, overseas or charitable organisations, and purchased hrHPV home testing kits. Results of non-NHS tests are not recorded in an individual’s NHS screening record. Individuals who have a non-NHS test remain eligible for NHS cervical screening at the appropriate screening intervals.

Operational guidance

4. Provider responsibilities

Providers of all operational aspects of call and recall administration should have a comprehensive quality management system (QMS):

• including standard operating procedures and detailed work instructions in line with national guidance
• containing clear instructions on the operational processes in place to enable the safe delivery of the service in line with the agreed standards as set out within the contract with NHS England
• including a programme of audit and non-conformance monitoring

Call and recall administration functions must take part in structured governance activities that include both internal and external stakeholders. There must be a clearly documented escalation process for the recording, management and escalation of risks and issues. Call and recall administrative functions must adhere to the guidance and processes relating to the management of screening safety incidents (see section 6 below).

The provider must take part in quality assurance activities and respond to requests from screening quality assurance functions, addressing any recommendations in a timely manner.

5. Communication and engagement

The call and recall administrative function is a main component of the NHS CSP pathway. Local governance meetings held by the commissioner and/or stakeholders e.g. local screening programme boards, should ensure all parties are aware of both national and local developments. Attendance at these governance meetings is a requirement of the service. A further requirement is linking with education providers for sample taker training. The call and recall administrative service should provide resources such as presentation slides or staff to deliver call and recall aspects of sample-taker training and engage with training providers to deliver this training as required.

All stakeholders must be notified in advance of planned changes to the call and recall administrative service operated by the provider and appropriate impact assessments considered. All changes to the operation of the call and recall administrative function must be managed through documented change management processes and, as appropriate, approved in advance at a suitable governance meeting.

6. Managing screening incidents

All providers contributing to a screening pathway have joint accountability to ensure safe and coherent screening for the population screened in accordance with national service specifications.

Each provider is accountable for the safe and coherent delivery of their part of the screening pathway and has joint accountability when working with another provider. Both the NHS England Patient Safety Incident Response Framework and managing safety incidents in screening programmes apply to the NHS cervical screening programme. Providers of services have a responsibility to operate in accordance with this guidance. Provider incident policies should reference both sets of guidance.

7. CSMS Access control

CSMS contains call and recall administrative data and medical records for England in a single application.

A user’s access is controlled so that only data and features appropriate to their role are accessible. A user should always have a legitimate relationship with an individual participant when accessing their record. Help to access and use CSMS can be found here.

User access is managed using:

• NHS approved methods of authentication
• role-based access control (RBAC)
• workgroups

All users of CSMS must have an NHS approved method of authentication issued by their local Registration Authority (RA). Users will need to be connected to the Health and Social Care Network (HSCN). NHS Identity Agent and NHS Credential Management must be installed on the user’s computer.

Role-based access control (RBAC) controls the functionality that a user has in accordance with their role and organisation. Roles include clerical posts, nurse or biomedical scientist in a laboratory. For example, certain roles can produce an HMR101 form or cease an individual participant.

As well as RBAC, workgroups are used to determine access. Users must be assigned to the cervical screening workgroup by their local RA team when an appropriate sponsor from the organisation confirms that they have a legitimate reason to access cervical screening data.

Additional workgroups may be used to limit access further, for example for Defence Medical Service (DMS) results.

Further information is available in the CSMS IT prerequisites guidance on  Cervical Screening Management System (CSMS) - NHS England Digital (system prerequisites for local IT teams).

8. Call and recall administrative process

The call and recall administrative process uses demographic information from the Personal Demographics Service (PDS). The address used for GP registration is the correspondence address used for invitations. For individuals not currently registered with a GP practice, the last address known to call and recall administration must be used.

PDS sends revised cervical screening cohort information to CSMS in a daily feed – see section 3 for inclusion details.

If an individual is added who does not currently exist in the CSMS system, then a new screening participant record will be created. An initial next test due date (NTDD) is then calculated for an individual so they can be invited for screening.

The NTDD is a target date for the individual to have a cervical sample taken. For first invitations this is 20 weeks before the individuals 25th birthday or if they are over 25 when they join the cohort then this will be 10 weeks + 1 day after joining. For subsequent invitations then this will be a defined interval after their previous test, for example, 5 years after a previous negative test for ages 25 to 64.

When individuals move into the NHS Cervical Screening Programme from a devolved nation the NTDD will be calculated at 13 weeks and 1 day as a failsafe to provide sufficient time for an individual’s screening history to be received and added to CSMS. The NTDD will be reset if the screening history requires this.

Individuals who are within 10 weeks of NTDD are included in prior notification lists or PNLs (see section 9).  The PNL is a list of individuals from the GP practice who are due to be called or recalled for screening. This provides an opportunity for practice staff to consider deferral or ceasing of individuals if appropriate. Unless the individual has been deferred or ceased on the PNL by the GP practice then the invitation will be issued, 6 weeks before NTDD an invitation communication is generated.

Individuals who accept their invitation arrange an appointment to have a sample taken, usually at their GP practice, but sometimes via other routes such as a sexual health clinic. The sample taker sends the sample to a cervical screening laboratory (see section 11) for analysis and reporting (see section 12).

The result of the laboratory analysis is returned to the call and recall administration service. The call and recall administration service then notifies the individual of the test result (see section 13). The GP also receives a copy of the results from the laboratory. The recording of the result on CSMS also triggers the calculation of a new NTDD.

Abnormal screening results may prompt a direct referral from the screening laboratory to colposcopy for further diagnosis and possible treatment. Patients who complete their treatment may have their NTDD changed, and this should be notified to the call and recall administration service by the treating colposcopy service.

Any invited individual who does not have a test taken and the result is not recorded on CSMS within 40 weeks of their initial invitation is classified as a non-responder and a new NTDD is set.

The diagram below illustrates the timeline of the call and recall administration pathway.

Pathway from invitation to non-responder status and resetting of NTDD

A more detailed summary of the call and recall administration timetable for a standard screening round accompanies this guidance.

9. Prior notification lists (PNL)

GP practices have a responsibility to provide assurance that the right individuals are being offered screening. This is managed through the prior notification list (PNL) process in CSMS. The PNL is a list of individuals from the GP practice who are due to be invited (called or recalled) for screening. This provides an opportunity for practice staff to consider deferral or ceasing of individuals if appropriate.

Individuals will be included in the GP practices PNL lists in CSMS 70 days (10 weeks) prior to their NTDD.  The practice has 28 days (4 weeks) to defer or cease any individuals before the invitation communication is generated 42 days (6 weeks) before the NTDD.

The GP practice must specify how long any deferral is for (this is dependent on the reason for deferral – see below). GP practices are responsible for making sure that requests to defer are appropriate. The ceasing and deferral guidance specifies appropriate deferral periods.

When a deferral ends, the individual is returned to the PNL. It is acceptable for subsequent deferrals to be created if required. Multiple consecutive deferrals must not be used and all GP practices should use PNLs. These practices must be subject to audit.

Deferring screening

GPs may defer an individual’s screening invitation for a limited number of reasons through the PNL process. Any deferral must specify a reason. The identified reason is used to recalculate the NTDD based on the length of the deferral.

An individual or GP may also make an ad hoc request for deferral.

Section 5 of the guidance Ceasing and deferring women from the NHS Cervical Screening Programme describes the valid reasons for deferral in detail.

10. Invitations, reminders, and non-responders

Invitation and reminder communications

All eligible individuals must receive an invitation to attend for screening together with the national information leaflet (or a link to the information online) to enable them to make an informed choice about attending. The call and recall administration service issues screening invitations up to 6 weeks before a person’s NTDD.

Invitations are issued initially via the NHS App as shown in the diagram below. If the App invitation is not opened in 72 hours an SMS invitation is sent, then if this is not accessed within a further 72 hours a letter invitation is printed and posted to the individual.

A delay of several months may occur between a person receiving their invitation and booking their screening test. Sending invitations well before a NTDD reduces the chance that someone will go beyond their NTDD before being screened.

Where the call and recall administration service has not received a test result from the relevant screening laboratory within 126 days (18 weeks) of an invitation communication being created, the individual becomes ‘overdue’ for screening and a reminder communication is created and sent. Reminder communications are issued initially via the NHS App. If an individual has notifications disabled on their NHS App an SMS message will be sent prompting the individual to check the App. If they do not check the App in the next 72 hours the reminder is printed and sent via second class mail. Reminder communications include a link in the text to the leaflet online.

All invitation and reminder communications must use the national communication templates.

Automatic reports by CSMS will monitor that communication files have been successfully transferred to the centralised print provider. The call and recall administration function must, with all relevant parties, resolve any communication transmission failures as a matter of urgency.

Communication preferences expressed by individuals to GPs or hospitals are not automatically transferred to CSMS and may not be able to be accommodated in all circumstances. It is also not possible for individuals to opt out of specific parts of the communication pathway, for example, requesting to only receive paper correspondence.

Failsafe process for newly registered individuals

If the individual’s screening history has not been received by the call and recall administration service within 21 days of registering with a GP surgery in England, a ‘failsafe’ NTDD is set. This is calculated within the current systems to be 91 days (13 weeks) from the date of registration.

If the screening history is received after this failsafe the NTDD is updated accordingly.

If the individual’s screening history is received after the invitation communication has been sent, any sample taken should be processed. The NTDD calculated from their full screening history must be recorded in their screening history record.

Returned mail

There are processes in place to ensure communications that are returned undelivered are notified to the appropriate organisation. For example, the call and recall administration service will raise a query directly with the individual’s GP practice for returned abnormal results to determine the reason for non-delivery e.g., addressee deceased.

If a communication has been returned indicating the addressee is no longer resident at the address, a query may be raised to check the address with the individual’s GP practice using the FP69 process. These investigations can result in a registration update, a change of address notification, or verification of the original address. Any invite or reminder communications that are produced for the individual must continue to be sent to their last known address until any address or registration update is applied.

Where a change of address including a change of postcode is notified, this will be updated on PDS which will then feed through automatically to CSMS. The system will then recreate the most recent invitations and reminders if the invitation process is still open and send to the new address.

Where the original address is verified, the FP69 process will be closed.

If the address cannot be verified through the FP69 process within a maximum of 3 months, the individual is automatically removed from the GPs practice list and won’t receive further screening communications.

Non responders

Individuals join the non-responder list (NRL) if they have been sent an invitation and a reminder but have not attended for a test within 26 weeks of their NTDD (or 32 weeks of invite).  GP practices will be prompted to check their NRL on CSMS.

Participants appear on a practices NRL until 34 weeks after their NTDD.

GP practices are required to update any demographic changes via agreed processes as necessary.

Individuals who become a non-responder have their NTDD recalculated 8 weeks after joining the NRL in line with the appropriate recall interval.

Opportunistic sampling is defined as any sample taken from an individual after they have reached non-responder status following a screening invitation. Opportunistic screening is not appropriate for individuals who present with symptoms. For such individuals, appropriate gynaecological referral pathways should be followed.

People who are invited for cervical screening but do not attend are invited by the NHS to complete an HPV self-test. Individuals who opt in receive an HPV self-test kit, which is sent to the individual’s home address registered with their GP, or an alternative address specified by the individual, which will also be used for their results if a letter is generated. Completed kits are returned directly in the post to the laboratory for testing, and results are sent electronically to CSMS so that the result can be communicated to the participant. The laboratory also sends the results electronically to the participant’s GP. The recording of the results on CSMS triggers the calculation of a NTDD or dispatch of a repeat test kit if necessary. Participants with hrHPV positive results or two occurrences of an HPV unavailable result are invited to attend for a clinician taken cervical screening test and their onward management is based on the results of this test.

Individuals who do not opt in for HPV self-testing remain eligible for cervical screening and HPV self-testing (until they attend for a clinician taken cervical screening test).

11.   Sample requests

Screening samples must be submitted to the laboratory with all essential data items necessary to support patient identification and reporting including the screening history. Full sample taker guidance is available here.

This information may be on a suitable test request form which must be completed legibly and in full. GP practices may also use electronic ordering communications or ‘order-comms’ systems where available to transmit data to laboratories to support the sample request.

The HMR101 form is the national standard request form for cervical screening, and it includes all essential data fields. Sample takers may use locally produced versions if these include all standard HMR101 form data fields as a minimum and are acceptable to the receiving screening laboratory.

The HMR101 form available from the CSMS system is populated with each person’s demographic details and screening history. This system should always be used in preference to hand-completed forms, to ensure that laboratories are provided with all relevant information already recorded on the master index.

It is essential that all demographic and screening information is checked with the individual at their screening appointment in case there are any errors or updates. An individual may also request an alternative correspondence address is used for the result of the sample being taken.

Systems must be in place to accurately link the sample to the order-comms data, such as bar-coding conforming to the relevant NHS Information Standard.

Self-test samples and the return packaging used for postage to the laboratory contain 2D barcodes and all the necessary screening and demographic data required for the laboratory to log and process the sample.  

12. Sample processing and reporting

Cervical screening laboratories are responsible for analysing samples and for assigning standard results codes that determine follow-up actions. This includes both HPV and cytology results.

The standard NHS CSP coding system, which must be used for all results, contains a table of valid combinations for cervical and self-test samples. All results files must be formatted correctly, and quality checked before electronic transmission to call and recall administration service.

Laboratories have a contractual responsibility to process and report samples promptly and send results to the call and recall administration service to support the 14-day turnaround time standard. The programme requires the use of electronic messaging systems to do this.

Receipt by call and recall administration services

Cervical screening laboratories send completed results in EDIFACT files via the MESH (Message Exchange for Social Care and Health) mailbox. CSMS regularly scans MESH for new result files. On discovery, CSMS imports and attempts to open the file. A receipt is sent to the sending laboratory.

Files which cannot be read are flagged on CSMS and the laboratory is notified. CSMS will also detect and flag missing files by checking the sequence of received files.

Files successfully read are split into individual result records for processing.

The call and recall administration system is designed to ensure accurate processing of cervical screening and HPV self-test results. It checks incoming files for essential information, including valid demographics and test details. Results that pass initial checks are queued for matching; unsuccessful matches are flagged for manual review by the call and recall administration service. If no match can be found, a dummy cervical screening record is created so the result can be sent out. All validated results are then processed, with participant status and recall updated as appropriate. Any results that fail validation are flagged, and the call and recall service works with laboratories to resolve these promptly. If unresolved within two weeks, the issue is escalated to the local screening and immunisation team, ensuring timely communication with individuals.

13. Notification of test results

Notification timescales and standards

In line with the programme standard CSP-S03, individuals should expect to receive their screening results within 14 days from the date of the sample being taken.

Test results are issued initially via the NHS App as shown in the diagrams below for normal results/ceasing notifications and abnormal results. If an individual has disabled notifications on their NHS App an SMS message will be sent to prompt them to review their messages. If the results are normal and have not been read after 72 hours a printed letter will be dispatched via second class mail. If the results are abnormal and have not been reviewed after 24 hours a printed letter will be dispatched via first class mail.

Normal results/ceasing

Abnormal results

All result notifications sent to the print provider by 3pm lead to the production of a result communication for dispatch to the individual the same day, except for normal/ceasing results received after 3am on Thursday which are sent on Monday. All non-referral results should be dispatched by the print provider using second or business class postage with a presumed delivery period within 3 working days. All referral results should be dispatched by first class post with a presumed delivery period within 1 working day.

CSMS will maintain an audit trail to enable verification of processing and dispatch of communications to individuals. The audit trail should be available to NHSE if required and the performance (key performance indicators (KPIs)) of the service reported each month to the relevant boards. The call and recall function must, with all relevant parties, resolve any communication transmission failures as a matter of urgency.

Result communications will only be produced by CSMS for samples received within 4 months of the test being taken to ensure that communications are not sent for historic tests. A report in CSMS will identify samples received after 4 months and these will be checked for possible anomalies.

Suppression of result letters

In some circumstances, usually while patients are under the care of a colposcopy clinic, results for cervical screening can be suppressed. This is where it has been agreed that the service will inform the individuals of the results from samples taken. This is actioned by setting the sender code as a source type 7 on CSMS. If source type 7 is set, annual verification with the local service must be undertaken by laboratories to confirm that all parties are aware of their responsibilities in the notification of results to the individual. The outcome of the verification process should be submitted to regional NHS commissioning teams and SQAS.

Test result communications

The NHS CSP determines the wording and content of national result communications. As a minimum, result communications contain the details of the result and provide information on what follow-up actions are recommended.

Notification to GP practices

Cervical screening laboratories notify GP practices of the results of all screening tests for individuals on their practice list who have participated in the programme. The programme requires electronic messaging to GP systems where possible. This includes the results of primary HPV screening and the results of any further tests.

Amendments to results

Occasionally, amendments may need to be made shortly after results have been sent to the GP, call and recall and the individual. After results have been sent to the GP, history may have been identified which warrants a review of the original result. Under these circumstances, discussion should happen between the laboratory and the GP/sender who is best placed to inform the individual. The laboratory should contact the individual’s GP practice to pass on the information regarding the change in recall. Any changes to the previously reported codes must be sent from the laboratory to the call and recall service to update the screening history.

The call and recall service will only send an amended result communication within 4 months of the original communication.

Any changes due to an error should follow the incident reporting process. Where possible the organisation where the error occurred should raise the incident.

Addresses for results communications

When a result letter is sent it must be sent to the address on the sample request form as confirmed by the participant at the point of screening.

Where an individual chooses not to register with a GP, the address details provided by the sample taker must be used for any letter communications including future call and recall. However, all efforts must be made to ensure the individual’s details are identified in the NHS Spine Personal Demographics Service (PDS). If mail is returned the sample-taking organisation must be informed and provided with their results.

When an individual relocates to another home nation prior to a result communication being issued then the original nation is responsible for sending out the result communication.

Addresses for result communications if no GP registration

Occasionally results are received from the laboratory where, after searches by the call and recall service, a cervical screening record cannot be identified to enable the result to be recorded. To ensure these individuals can receive their result a dummy cervical screening record is created to record the test result, it must be retained until the individual is next invited or it is linked to a live record. If the individual becomes a non-responder and the last test was reported as negative routine recall, the screening record must be set to ‘Inactive’. If the last test was not negative, further checks should be made to trace the person and their record must remain active. This will ensure none of these individuals are lost to follow up. These individuals should be retained on the dummy record and recalled in line with their NTDD.

Regular reconciliation should be undertaken to identify live records for any individuals with a dummy GP record. If a live record is found, then the screening record should be recorded on the live record and the dummy record removed.

The use of dummy records should be subject to routine audit, annually as a minimum.

Notification on changing GP practice

Where an individual who has had an abnormal result or is under care or surveillance changes GP practice, their registration information should be updated on PDS and then will be received by CSMS.

GP practices are expected to review the individual’s details and take appropriate action.

14. Colposcopy referral and discharge

14.1 Comprehensive failsafe processes are in place to manage the follow up of patients in colposcopy and their discharge to primary care.  This ensures that patients are invited for their next screening test at the appropriate interval in the appropriate care setting.  Details can be found in the cervical screening failsafe guidance.

Colposcopy departments must use the colposcopy discharge notification template form (or an equivalent electronic output) to notify the call and recall service of individuals discharged, and to specify their NTDD.

Individual patient management should be agreed before entering an individual on the discharge list (cervical screening care pathway). The request to discharge a patient must be approved by an appropriate clinician on behalf of the colposcopy service.

Responsibilities of the call and recall administration service in the discharge process include:

• promptly confirming receipt of colposcopy discharge lists from clinics, ensuring that the colposcopy discharge lists are either in sequential order or concurrent date order. If any data is suspected of being missed, the call and recall service will contact the colposcopy service
• processing the colposcopy discharge data within 5 working days of receipt.
• querying with colposcopy clinics where information is unclear or appears to be outside national guidance
• providing clear explanations (using agreed, standardised content) in cases where a specific request has been rejected
• implementing NTDD for individual patients as advised by colposcopy, as colposcopy takes responsibility for determining the next test due date
• actioning requests from colposcopy to cease an individual for age where the patients next test would be due after their 65th birthday and is a routine test
• contacting clinics when discharge lists have not been received for a 3-month period as an additional failsafe to reduce the risk of incidents arising. Keep regional commissioners and SQAS informed

The call and recall service must manage all colposcopy discharge related processes through the use of SOPs. The use of SOPs must be subject to routine audit.

15. Operational data quality and system controls

CSMS contains features designed to protect the integrity and accuracy of the information held on the database. These features require user action to review, validate and update systems at the intervals described below. Data that is processed and input manually should be quality checked to further assure database accuracy. The call and recall service should have detailed standard operating procedures that describe actions to be taken relating to each of the following subheadings.

Manual entry

To minimise risk of error, all data needing manual input requires validation by a second member of the call and recall administration service to confirm accuracy. This process should take place in a timely manner to ensure that correct information is provided to external stakeholders. All manual processes should be defined in a comprehensive SOP or work instruction and subject to routine audit.

Data transfer

Daily checks should be in place to monitor network transfers to ensure files are not missed or repeated and that transferred files are complete and uncorrupted. Where issues are identified a record must be maintained to describe any remedial actions and confirmation that all issues have been resolved or escalated as appropriate.

Processing information from other NHS services

Providers of NHS services may receive information relevant for call and recall services. This information (for example emails and paper letters) must be redirected to the call and recall service for processing in line with agreed standards and KPIs. Governance of these arrangements should be managed in line with agreed contracts.

Data Quality

CSMS includes reports that must be run (and entries resolved) at required intervals in line with KPIs. These reports highlight anomalies within the screening system that may prevent individuals proceeding through the screening pathway.

System changes

CSMS must operate in line with programme policy and guidance. Developments in national programme protocols or policies may necessitate updates to CSMS, for example changes to recall intervals.  Any updates to CSMS must be subject to formal approval and change control procedures.

16. Invasive cervical cancer audit

National guidance describes the process for auditing cases of invasive cervical cancer. The purpose of the cervical cancer audit is to monitor the effectiveness of the screening programme and to identify areas of good practice and where improvements can be made.

Screening histories for cases and controls are extracted from CSMS by SQAS.

The call and recall administrative service may be required to provide additional information, such as the dates of invitations sent, if requested by SQAS.

17. Migration in and out of England

Migration from England

Where individuals move from England to become a resident in Scotland, Wales or Northern Ireland, they are no longer eligible for call and/or recall in England.

Their screening history must be copied to the relevant NHS body for the home nation to inform their call and recall services. This process will be initiated by the individual registering with primary care in their new nation. The transfer of screening history will happen either automatically (for Wales) or by a call and recall service action for Scotland and Northern Ireland.

The records of individuals who relocate outside England will be retained as inactive in CSMS. This allows access to historic data for programme evaluation and supports reactivation in case they return to England and re-join the screening programme.

Migration into England

Where an individual relocates from Scotland, Wales or Northern Ireland to become a resident in England, the programme expects the relevant NHS body to make the individual’s screening history available.

This process will be initiated by the individual registering with primary care services in England. The transfer of screening history will happen either automatically (for Wales) or by a call and recall service action for Scotland and Northern Ireland

Where possible, provision of screening history includes details of individuals who have been ceased, to ensure appropriate management.

When an individual moves to England from a country outside of the UK their previous screening history is not recorded.

Acknowledging receipt of screening history

When a screening history is provided to the call and recall services in England, an acknowledgement of receipt must be provided by the call and recall service to the sending site electronically. The screening history provided must be entered into the individual’s English screening record and used to calculate their NTDD if appropriate.

18. Appendix

18.1 Process for creation and management for NHS CSP non-GP sender codes

NHS Cervical screening programme test results are submitted with 3 data items relating to their source. This information is provided in the following format: 

Cipher + Sender Code + Source Type 

As this information is validated in the new cervical screening management system (CSMS) it is necessary to establish a controlled process through which non-GP sender codes will be created and subsequently managed. This process was developed through a Task & Finish Group comprising representatives from laboratories, commissioners, cervical screening administration service (CSAS) and screening quality assurance (NHSE SQAS). 

The use of non-GP sender codes is, following the implementation of the CSMS, subject to specific rules. Table 1 (below) describes the mandatory fields in the system that relate to non-GP sender codes. Table 2 describes the assignments for specific ‘source types’. Deviations from these assignments are not permitted. 

Table 1: Mandatory Information for non-GP Sender Codes 

Field	Description
Cipher	NHAIS Cipher (maximum of 3 characters)
Sender Code	Name to be used (non-GP Sender Code) (maximum 8 characters)
Source Type	Code from 1-8 (see table 2 below – note not all applicable)
Sender Name	Full name of sender (Service Name)
Sender Address	Address
Sender Telephone Number	Phone number

Only alphanumeric characters are permitted. No special characters will be accepted* 

Table 2: Source Type Settings 

Source Type	Reserved for (Service)
1	GP
2	NHS Community Clinic
3	GUM Clinic (and other sexual health services)
4	NHS Hospital
5	DMS Sender
6	Other (including ‘self-sampling’)
7	Consultant (commonly ‘colposcopy’)
8	Self-testing

Creation of non-GP Sender Codes 

Figure 1 (overleaf) describes the process for the creation of new non-GP sender codes.

Figure 1: Request and Creation of non-GP Sender Codes

Figure 2 (below) describes the process through which non-GP sender codes in CSMS will be periodically reviewed and reconciled by CSAS and laboratories. 

Figure 2: non-GP sender code reconciliation

Principles for the creation, administration, and management of non-GP sender codes 

The process will be supported by the following principles: 

1. New codes may only be created where approval has been provided by the appropriate commissioner and all fields of the request template have been completed correctly
2. Use of source types for unapproved ‘assignments’ (for example using source type 6 for DMS sender codes) is prohibited and requests of this type will be rejected
3. New requests will be processed by the call and recall service within 5 working days
4. laboratories and the call and recall service to conduct an annual reconciliation of all non-GP sender codes confirming (as a minimum)
5. all codes to remain ‘active’
6. all codes should be marked as ‘inactive’
7. Existing codes will NOT be marked ‘inactive’ without prior agreement from the corresponding laboratory

New non-GP sender code request template 

Table 3: New non-GP sender code request template 

Request date:
Requested by:
Required date:
Cipher (NHAIS):
Sender Code:
Source Type:
Sender Name:
Sender Address:
Sender Phone:
Sender Description:
Additional Information (optional):
Commissioner Approval (name)
Commissioner Approval (date)
Confirmation sent to laboratory (call and recall service):

18.2 Extended Screening Interval Clinical Pathway

Add to this document and delete standalone version.

Extended Screening Interval Clinical Pathway protocol - GOV.UK