Guidance

Education pathway

Updated 2 September 2026

Applies to England

1. Introduction

The NHS England Cervical Screening Education and Training Network (CSET) have updated earlier guidance in response to learning from cervical incident themes and issues specifically related to sample taker training.

It includes an outline of: 

• training provider responsibilities 

• employer responsibilities 

• the cervical screening mentor role 

• the cervical screening assessor role 

The guidance is designed solely to provide an overview of the training requirements for trainee cervical sample takers. It must not be used for self-directed learning or independent clinical preparation. It does not replace, reduce, or exempt the requirement for full attendance at an initial sample taker training course as described in this guidance. 

2. Aims of this guidance

The guidance aims to:

• promote high quality, specialist training that aligns with national policy, programme standards, and evidence-based recommendations
• define the training requirements for cervical sample takers working within the NHS CSP 
• clarify the responsibilities of training providers to ensure consistent delivery, oversight, and quality assurance 
• clarify employer responsibilities in supporting learners, maintaining competence, and enabling safe practice 
• set out the roles of cervical screening mentors and assessors to promote consistency in supervision, training, and assessment 
• establish a common core of learning that all cervical sample takers must meet as a minimum standard 
• align training with the national occupational standard SFHCHS37 ‘Obtaining cervical cytology samples from individuals’ (pdf) 
• support effective multidisciplinary working across the cervical screening pathway 
• emphasise the importance of good record keeping, self-reflection, and audit as a routine component of quality improvement and safe clinical practice 

This guidance also describes the requirement for update training to support cervical sample takers in meeting their clinical and professional responsibilities for continuing professional development and revalidation.

3. Education pathway

3.1 Eligibility of health professionals to train as sample takers

Cervical sample taking is one element of a complex screening pathway. A cervical screening test is a consultation and clinical examination. A cervical sample taker must have the required level of knowledge and understanding of the cervical screening programme, and clinical skill, to safeguard the individual. They must complete the full training programme as described in this guidance. 

The following UK registered healthcare professionals are eligible to train to undertake the role of cervical sample taker:

• Nursing and Midwifery Council (NMC) registered nurses
• (NMC) registered nursing associates †
• NMC registered midwives
• General Medical Council (GMC) registered physician associates ‡
• registered healthcare professionals working in integrated sexual health (ISH) clinics§
• registered paramedics working in primary care ‖
• GMC registered medical doctors licenced to practice in the UK¶

† Taking cervical samples is a delegated activity and the nursing associate works within the remits of their professional code. The screening provider must consider safety, quality, competency and the treatment of disease, disorder or injury (TDDI) legislation when deploying a nursing associate.

When a nursing associate has registered with the Nursing and Midwifery Council (NMC), a registered professional listed under the legislation (registered nurse or GP) will need to supervise their practice. The individual who provides this professional support must be a qualified cervical sample taker and be present at the GP practice to undertake indirect supervision of the nursing associate when carrying out the procedure.

Note that nursing associates cannot undertake a mentoring role. Read the NMC blog which explains the differences between activities undertaken by registered nurses and registered nursing associates. 

‡ The service provider must ensure that arrangements for delegation and supervision are in place, in line with GMC guidance, for physician associates permitted to provide cervical screening within an extended access environment. The service provider must also apply these considerations to mentoring arrangements, ensuring that any mentoring activity aligns with GMC expectations regarding scope of practice, supervision, and professional accountability. 

§  Many registered healthcare professionals working in ISH clinics already have the necessary clinical skill for taking cervical samples. The NHS Public Health Functions Agreement (Service specification no. 25 Cervical Screening) requires healthcare professionals working in ISH services to complete the programme of training described in this guidance and maintain their competencies in the sample taker role.

‖ Applies to registered paramedics working in primary care where cervical sample taking is relevant to their clinical practice.

¶ The NHS CSP recommends as best practice that qualified medical doctors undertake the cervical screening training as described in this guidance to enhance their specialist training.

GMC revalidation requires satisfactory annual appraisal, and CPD activities should reflect routine work. An element of cervical screening is essential to fulfil professional obligations for CPD. The NHS CSP provides eLearning modules to support clinicians who take cervical samples.

All UK registered health professionals who take cervical samples and those who are involved in cervical screening training must keep up to date with developments in the programme and their own clinical practice to fulfil their professional obligations for continuing professional development.

For additional guidance and information you can refer to the standards and guidance for healthcare professionals and managers working in the NHS CSP.

3.2 Regulation of training theory

Course accreditation  

Course accreditation is the process where an independent, recognised organisation reviews a training programme or course to confirm it meets established standards of quality, safety, governance and educational rigour. 

Accreditation provides assurance that: 

• essential content is covered and appropriate for the intended audience  

• teaching and assessment methods (including tutor qualifications, learning environment, and equipment) are valid, reliable, and aligned with required learning outcomes 

Training providers must obtain accreditation for their cervical screening initial training theory course as described in this guidance. The requirement for accreditation also applies to update training.  

Training must only be delivered while the course holds active, valid accreditation. 

Accrediting organisations can include:  

• national awarding organisations and institutes offering accreditation services 

• professional bodies  

• higher education institutes (HEIs) must obtain external professional accreditation for NHSCSP-related training) 

Accrediting organisations review the structure, governance, and quality assurance processes of a course. They do not independently verify the clinical accuracy of course content or its applicability to specific audiences.  

Training providers must be aware that not all accrediting organisations appoint reviewers with occupational or clinical competence and to consider this when seeking course accreditation.  

Training providers are solely responsible for ensuring that all educational content is accurate, current, aligned with national guidance and relevant for the intended audience. This responsibility does not transfer to the accreditation service.  

Training providers must ensure that teaching, assessment and evaluation methods meet the programme quality standards.    

Universities and accreditation 

As autonomous organisations, universities can accredit and deliver courses provided they meet The Quality Assurance Agency for Higher Education (QAA) standards and benchmarks.  

Universities offering initial cervical sample taker training (standalone or within a broader nursing qualification) must cover all elements as described in this guidance. They must obtain external professional accreditation from a relevant body. For example, the Royal College of Nursing is one option. Their accreditation service is designed specifically for the nursing community and suitable for courses delivered by HEIs or NHS providers. 

3.3 Training providers and their responsibilities

Training providers are responsible for making sure trainee cervical sample takers have access to specialist training. Appropriately qualified and experienced staff must provide the training to the standard described in this guidance.

A training provider can be:

• a training organisation in the public or private sector
• a training department within the public sector
• a private trainer or federation that operates independently

Training providers must:

• be registered under the Data Protection Act (DPA) with the Information Commissioner’s Office if operating independently
• have employee and public liability insurance (includes vicarious liability)
• have a clear governance structure and quality systems which meet local commissioning, and Screening Quality Assurance Service (SQAS) requirements
• work with local commissioners to make sure there is sufficient training course provision to the required standard as described in this guidance
• check that cervical sample taker trainees are UK registered healthcare professionals and eligible to train to undertake the role of cervical sample taker
• provide the mechanism to make sure trainee sample takers are registered on the local cervical screening laboratory database
• check that cervical screening mentors and assessors meet the eligibility criteria described in this guidance and are sufficiently prepared to carry out their respective roles

• take full responsibility for the content of their training programmes (including accuracy and relevance of theoretical content and its provision)

• provide a forum in which mentors and assessors can discuss any training issues with their peers and participate in standardisation activity to verify their compliance with the national guidance and remain competent in their respective roles

Training providers must operate within a comprehensive quality framework. This framework ensures that all aspects of course delivery, governance, and assurance meet the standards required for cervical screening training programmes.

The main elements of a quality framework are:

• management systems (organisational governance, policies, procedures, record keeping, risk management, and oversight arrangements)
• physical resources (training environment, facilities, equipment, and access to learning materials)
• staff resources (tutor qualifications, occupational competence, clinical credibility, and sufficient staffing to deliver and assess training safely)
• training and assessment (course design, delivery and assessment methods, feedback mechanisms, and evaluation activity)

Section 4 of this guidance provides structured checklists to support training providers to use when developing, reviewing, and maintaining their quality frameworks. These checklists help providers ensure that each element of their framework is complete, consistent, and aligned with programme standards.

3.4 Employer responsibilities 

Employers are responsible for ensuring that cervical screening within the organisation is delivered safely, consistently, and in full compliance with national training, quality, governance, and failsafe requirements. 

This includes: 

• training compliance (ensure all cervical sample takers are trained, competent, and maintain a valid sample taker PIN or code number) 

• training support (ensure mechanisms are in place to monitor training progress and manage any concerns) 

• performance monitoring (review sample taker performance, quality indicators, and error trends regularly) 

• failsafe systems (maintain rigorous systems to track every sample from collection to result and ensure timely follow‑up) 

• accurate sample submission (ensure correct use of ordering systems and complete, accurate clinical information) 

• governance and incident reporting (comply with national governance requirements and report screening incidents promptly) 

• sample taker register (keep sample taker details up to date with laboratories and commissioners) 

• communication and escalation (follow defined processes for escalating concerns and implementing corrective actions) 

• support for patients with additional needs (ensure staff can provide equitable, person centred care for individuals requiring additional support) 

Employers are also responsible for undertaking due diligence when procuring cervical screening education.  

As a minimum this includes:  

• verifying that the training provider holds current, valid accreditation for their theoretical course 

• seeking assurance that the course content aligns with that described in national guidance 

• confirming that trainers are appropriately qualified and experienced 

Effective due diligence: 

• supports workforce competence 

• ensures investment in high‑quality training 

• protects people with a cervix 

• upholds the integrity of the NHS CSP

3.5 Clinical and professional support for trainees

Trainees must have easy access to an experienced sample taker who is on site at the time they are taking cervical samples during unsupervised practice. This applies to all trainees whether they work on one site or within a federation. Note that nursing associates must have their mentor present within the building when taking cervical samples. 

3.6 Cervical screening mentors and assessors

Cervical screening mentors and assessors however termed (sometimes called trainers, supervisors, or external assessors) and who are responsible for supporting novices to complete their practical training must themselves be active cervical sample takers.

NHS cervical screening mentor

The cervical screening mentor (‘mentor’ from this point) supports the trainee through their practical sample taker training and confirms their achievement for progression to the final evaluation and clinical assessment.

The trainee identifies to the training provider an individual who will take on the mentor role in their place of work.

The trainee must notify the training provider of any change in local circumstances that affects or is likely to affect their mentor support.

Mentors must be one of the following:

• registered nurse
• registered midwife
• registered physician associate
• GMC registered medical doctor

Mentors must:

• be practising sample takers with at least 12 months continuous experience
• have taken at least 50 cervical samples following completion of their own initial training
• have effective communication skills
• ideally hold a relevant mentoring and, or teaching qualification
• support any identified learning needs
• maintain accurate records of professional discussion with their trainees
• support the trainee by checking their documentation is complete prior to submission

The training provider is responsible for ensuring the mentor: 

• understands the role 

• meets the criteria in full prior to supporting the trainee 

• is sufficiently prepared to carry out the role and provide support to the trainee for the duration of the training programme 

Cervical screening assessor

The cervical screening assessor (‘assessor’ from this point) provides an element of externality which is crucial to quality assuring the training and verifying the assessment process. The assessor is responsible for conducting the trainee’s final clinical assessment.

The training provider is responsible for recruiting and inducting individuals to the role of assessor. Note that that the assessor induction is provider specific.

They are responsible for making sure the assessor: 

• understands the role
• is sufficiently prepared to carry out the role
• are consistent in their practice

The assessor must be external to the trainee’s place of work. A mentor can take on the role of assessor for a trainee outside their own practice. The assessor must meet the same criteria as described for mentors.

Note that the cervical screening mentor role and the cervical screening assessor roles are completely separate from the NMC ‘academic assessor’, ‘practice supervisor’ and ‘practice assessor’ educational roles.

Maintaining competence in the mentor and or assessor roles

Mentors and assessors must:

• undertake a formal cervical screening update at least every 3 years as a practising sample taker

• regularly attend and participate in the training provider’s forum(s) to update and maintain competence in their respective roles
• stay updated with any local and, or national changes to the cervical screening programme (including equipment and sample preparation)
• show continuing competence in taking cervical samples in accordance to their professional codes of conduct
• meet their professional obligations for continuing professional development (CPD)
• undertake continuous self-evaluation
• audit and reflect on their own rates of inadequate tests and abnormal test results compared with the rates reported by the local NHS cervical screening laboratory - see NHS CSP guidance on sample acceptance

3.7 The training period

The training period for trainee sample takers is a maximum of 9 months from enrolment with the provider through to completion.

The training period must cover:

• theoretical course 

• initial assessment 

• supervised and unsupervised clinical practice 

• final clinical assessment  

• portfolio validation 

The training provider can make reasonable adjustments to the training period in the event of planned or unplanned absence.  

3.8 Duration of theoretical course

There is a minimum requirement of 12 hours contact time for the initial sample taker training theoretical course (excludes pre-course preparation). This must include at least 3 hours practical (classroom) training for practical skills training including working on the pelvic models. 

The theoretical component provides the essential foundation for safe, consistent practice. It cannot be shortened, condensed, or replaced with self‑directed learning.  

Completing the full theoretical programme at the outset:

• ensures trainees enter the clinical environment with the required baseline knowledge 

• supports effective supervision 

• maintains the overall quality and safety of the sample‑taking pathway

3.9 The training model

The training programme requirements are:

• directed pre-course reading (approximately 3 hours)
• initial screening (theory) learning
• a visit to a colposcopy clinic
• a visit to a cervical screening laboratory or a virtual tour
• a laboratory presentation
• to observe the mentor taking at least 2 cervical samples
• practical training (supervised and unsupervised clinical practice)
• to take a minimum of 5 cervical samples directly supervised by the mentor
• satisfactory completion of the initial assessment before starting unsupervised practice (conducted by the mentor)
• to take 20 acceptable cervical samples without direct supervision (no more than 25 up to the point of final assessment)
• a final clinical assessment of a minimum of 3 samples (observed by the assessor)
• submission of the completed training record (verified by the trainee, mentor, assessor and training provider)

Training providers must make sure:

• the trainee is eligible to undertake training
• the mentor and their employer are fully aware of the time commitment for the training (do not underestimate the amount of work and involvement needed to support the trainee)
• a learning plan is agreed with the trainee, their mentor and employer within 2 weeks of the theory course
• the trainee visits a colposcopy unit to attend a clinic for its duration and follow the patient journey (ideally within 3 months of the initial training course)

3.10 Initial training course (theory)

The initial theoretical training course is intensive, and we expect trainees to undertake some directed pre-course reading (allow approximately 3 hours for this).

• Theoretical training must cover all the competencies outlined in the national occupational standard CHS37 ‘Obtaining cervical cytology samples from individuals’(pdf) and all topic areas set out below and described in this guidance.

The initial training must take place in a classroom setting and include an element of practical sample taking using a teaching pelvic model and range of specula. The training provider must make sure the equipment is available for the duration of the course.

3.11 Cervical screening theory: topic areas, learning objectives and teaching checklists

There are 9 topic areas. Please see the guidance on minimum course content accompanying this document.

Topic 1: the NHS CSP

Topic 2: background to cervical screening

Topic 3: organisation of the NHS CSP

Topic 4: equality of access to cervical screening

Topic 5: cervical screening sample requests

Topic 6: understanding the test results

Topic 7: anatomy and physiology of the pelvic organs

Topic 8: practical aspects of taking cervical samples

Topic 9: hrHPV self testing

Trainers must provide sufficient detailed information for each topic area.

Each topic area outlines (where applicable):

• what the trainee should know (minimum theory)
• what the trainee should understand (implies a greater level of learning)
• what trainees are expected to be able to do as a result of a learning process
• teaching checklists (the minimum expected content)
• guidance for trainers (including suggested reading and resources for trainees)
• guidance for mentors on planned learning activity (including suggested topics for professional discussion with the trainee)

3.12 The trainee sample taker pin code or code number

The NHS screening laboratory has oversight of the sample taker database for its locality. The training provider advises the trainee how to obtain a pin or code number.

The trainee’s pin or code number is unique to them, and they are wholly accountable for its use. The trainee must use only their own pin code during clinical practice.

They must not:

• use someone else’s sample taker pin or code number
• share their own sample taker pin or code number
• allow other sample takers in the practice to use it (including locum staff for example)

Commissioners and providers of cervical sample taking services must ensure that a robust process is in place for identifying, reporting, reviewing, and learning from all incidents involving incorrect use or misuse of sample taker pin or code numbers.

3.13 Practical training

The trainee should be familiar with the consultation and screening process before starting their supervised practice.

People attending the clinic for their cervical screen must consent to the presence of the trainee before the consultation starts. Notify people in advance that the individual who is observing the procedure or taking their sample (as applicable) is:

• a qualified professional
• undergoing specialist training under supervision
• being assessed

3.14 Observing samples taken by the mentor

The trainee must observe and document at least 2 samples taken by their mentor.

3.15 Directly supervised clinical practice

The mentor must directly supervise the trainee taking a minimum of 5 samples in the first practical sessions (the mentor must document this).

Both the mentor and trainee must be able to fully view and assess the cervix and full sample taking technique.

If additional training or supervision is required, address these needs before moving on to the initial assessment. Use the national occupational standard SFHCHS37 ‘Obtaining cervical cytology samples from individuals’ (pdf) to inform additional training needs. 

The trainee must take all 5 supervised samples before moving on to the initial assessment.  

3.16 The initial assessment

Before moving on to unsupervised clinical practice, the trainee must undertake an initial assessment and complete it successfully. This assures the mentor and training provider that the sample taker is confident and safe to proceed with their unsupervised clinical practice.

There is a library of numbered images of cervices for use in the initial assessment. Please refer to section 5 (guide to the initial assessment) which explains how to access and use this resource. It also provides instructions for the mentor on how to conduct and record the interim assessment.

Note that this e-learning is the only approved initial assessment tool and must be used by mentors and trainees.

3.17 Unsupervised (indirectly supervised) clinical practice

Once the trainee has satisfactorily completed the initial assessment and the mentor is confident they can proceed safely, the trainee should arrange to take and document 20 samples without direct supervision. Allow at least 30 minutes per appointment to take the sample and complete the paperwork. Easy access to an experienced cervical sample taker is essential throughout this period.

The trainee must maintain regular contact with their mentor to:

• identify and discuss any emerging training issues or problems
• discuss progress towards meeting identified training needs
• review their progress throughout their unsupervised practice
• prepare for the final evaluation session and clinical assessment

The training provider must review the trainee’s completed portfolio and final clinical assessment report. The training provider checks the portfolio for completeness and accuracy and determines whether the trainee has achieved the required standard of knowledge and understanding.

3.18 Review of the first 20 unsupervised cervical samples

The trainee must review their first 20 unsupervised cervical samples and discuss the results with their mentor. The trainee writes a reflective learning account and discusses this with the mentor.

The review may identify one or more of the following: 

• samples reported as inadequate for cytology 

• HPV unavailable 

• out of programme samples 

• mislabelled vial 

• out of date vial 

Both parties must agree an action plan and notify the training provider at the earliest opportunity. 

If the mentor is satisfied that the trainee is competent to proceed once they have taken 20 acceptable samples, the trainee can complete their final assessment. 

The trainee must not take more than 25 cervical samples prior to completing their final assessment.

Management of trainees exceeding the maximum sample limit

Screening commissioners must agree a process with regional laboratories for identifying and managing trainee sample takers who have taken a considerable number of samples beyond the maximum 25 prior to completing their final assessment. The process must set out how such trainee sample takers are monitored, how progression concerns are addressed, and how safe continuation of training is ensured.

3.19 Formal evaluation and final clinical assessment

The trainee and assessor must plan and arrange a formal evaluation session which includes a final clinical assessment.

The trainee must provide evidence of having taken and reviewed 20 acceptable cervical samples before proceeding to the final clinical assessment. We advise the trainee to book in at least 5 people for their cervical screening test.

The assessor observes and assesses the trainee taking a minimum of 3 samples.

The assessment will focus on:

• professional conduct
• knowledge and communication skills
• cervical sampling technique
• adherence to infection control measures
• accurate and timely completion of the request form
• reflection and evaluation of own practice

The assessor can engage the trainee in professional discussion on other aspects of practice not necessarily covered during the consultation (once the person being screened has left).

The assessor documents their observations and completes a report on the trainee’s clinical competence to practice.

The trainee submits their completed portfolio to the training provider after the final assessment.

Note that the assessor will stop the assessment immediately if they see the trainee engaging in unsafe or unprofessional practice.

3.20 Training records and portfolio documentation

Training records are a vital part of the learning process. Trainees must have a personal training record, and the record must show that:

• all training is complete and documented
• all records are signed and dated where appropriate prior to submission for final assessment

Trainees must retain an intact copy of their training record (paper or digital) for a minimum of 3 years from the date they complete their training.

The training provider must hold a copy of the record for audit purposes for minimum of 3 years from the date the trainee completes their training.

Example recording forms

We have provided some examples of recording forms as a guide to what should be included in the portfolio of evidence (or when designing a personal workbook). These forms are to record:

• a summary of training
• completion of training
• interim assessment (performance evidence)
• practical training
• the review of the initial 20 consecutive samples
• the continuous self-evaluation audit of 20 consecutive samples
• the final clinical assessment (performance evidence)
• update training

You can download the suite of example recording forms accompanying this guidance and adapt them for local use.

3.21 The sign off process

The training provider reviews the trainee’s completed portfolio and final clinical assessment report. The training provider checks the portfolio for completeness and accuracy and determines whether or not the trainee has achieved the required standard of knowledge and understanding.

The training provider raises any record keeping issues with the trainee if their portfolio is incomplete. The trainee must address these issues before the training provider can validate their training record. The trainee must not take any more cervical samples before their training provider validates their submitted training record.  

Assessment decisions must be valid and reliable. Following a successful final clinical assessment:

• the assessor confirms the trainee as being competent and proficient in cervical screening clinical practice
• the training provider confirms the trainee has achieved the required level of knowledge and understanding of cervical screening theory
• the training provider confirms that the trainee is eligible to request their PIN, or code number be updated to remove trainee status

The training provider should make sure the entire sign off process is documented. Sign off confirms that the trainee is proficient in the competencies outlined in the  national occupational standard SFHCHS37 ‘Obtaining cervical cytology samples from individuals’ (pdf)  and is capable of safe and effective practice. 

If the trainee has not passed the final clinical assessment, the training provider must notify the local cervical screening laboratory of the training outcome at the earliest opportunity.

Assessment and ratification of trainee portfolios

Student assessment and ratification of the submitted portfolio must be carried out by registered practitioners who are actively involved in the screening programme. This ensures that the scientific, theoretical, and practical aspects of the cervical sample taker role are evaluated accurately and in accordance with national standards. The training provider must validate the final outcome in a timely manner.

3.22 Certification

Certificate of attendance

If they wish to, the training provider can issue a certificate of attendance or a certificate of learning after a trainee has completed the theoretical course. The certificate must clearly state:

• trainee status (the recipient is a trainee)
• theory only completion (the certificate relates solely to completion of the theory component)
• no competency implied (the certificate does not indicate competency to practise)
• not full pathway (the certificate does not confirm completion of the full training pathway)

System generated certificate upon completing the initial assessment

The trainee can print off an (elfH) system-generated certificate after completing the exercise (this applies to single or multiple attempts). The certificate is a record for the trainee’s portfolio and does not imply completion of the full training pathway.

Certificate of completed training

The training provider issues a certificate of completed training and competency to practise once the trainee has successfully completed the full training pathway.

3.23 Managing trainee performance

Trainee fails to complete training

The training period is a maximum of 9 months. Trainees who are unable to complete within this time must seek advice from the training provider and request an extension of up to 3 months.

The training provider, mentor, trainee and their employer must agree an action plan to support completion within the extended timeframe.

If the trainee has not completed the pathway by 12 months, they must stop taking cervical samples. The training provider must notify the trainee’s mentor, employer and the local cervical screening laboratory.

The training provider should:

• discuss the reasons for non-completion with the trainee
• establish what support the individual needs to complete their training
• agree an action plan with the trainee, mentor and their employer and timeframe for completion

Reasonable adjustments for training interruptions

If the trainee has an extended period of planned or unplanned absence during their training, the training provider and employer must make reasonable adjustments to support them to complete their training on return to work.

Managing training resumption after absence

It may not be necessary for the trainee to repeat the entire training process on their return. Decisions should be made on a case‑by‑case basis, using professional judgement. In many situations, the trainee may not need to repeat the full theoretical course, although they may benefit from revisiting elements with their mentor through focused discussion.

Trainee fails to gain competency

If a trainee does not meet the required competency standards at the final clinical assessment, they must stop taking cervical samples. The training provider must notify the trainee’s mentor, employer and the local cervical screening laboratory service.

The number of times a trainee can repeat the training programme is determined locally. However, following any unsuccessful attempt to achieve satisfactory competence, the training provider, trainee, mentor, assessor and their employer must consider whether or not continued support is appropriate. The trainee’s employer is responsible for making the final decision.

If supported to continue, the trainee must repeat both the initial and practical training in full. This is necessary to ensure safe practice. The training provider, trainee, mentor and employer must agree and document an action plan to address the issues and achieve the required competencies.

3.24 Transfer of trainee progression between providers

If a trainee moves to a new employer within the region or transfers to another region, the new mentor must (subject to the trainee’s consent) contact the previous training provider to verify the trainee’s progress to date.

The mentor is responsible for identifying a training provider for training to support safe ongoing progression. The previous training provider must supply all training records, including prior attempts and outcomes, to enable continuity of training and maintain safe progression. 

3.25 Returning to cervical sample taker training

For trainees resuming their training after an absence of 3 months or more, the training provider should ensure the following actions are completed: 

• recalculate submission deadlines (adjust timelines to reflect the trainee’s period of absence and ensure new deadlines are formally communicated) 

• arrange a return to training meeting (hold a structured meeting between the trainee and training provider to identify support needs and agree expectations for re-engagement) 

• reinstate system access (restore the trainee’s pin or code number, CSMS access, ICE permissions, and any other required digital or clinical systems) 

• provide mentor checks and support (ensure the trainee is reconnected with their mentor, with additional check-ins scheduled as needed to support reintegration) 

• resume supervised practice (the trainee returns to observation and supervised activities with a nominated mentor until competency and confidence are re-established) 

3.26 Post certification competence and ongoing practice requirements

Maintaining competence

Competence is an ongoing professional obligation. Sample takers must meet the competency requirements set out in their professional codes of conduct. To maintain safe, effective, and high-quality practice, cervical sample takers are expected to demonstrate: 

• continuous self-evaluation (ensures practice remains aligned with current evidence and professional standards) 

• continuous self-reflection (supports accountability and encourages a culture of learning) 

• good record keeping (provides clear audit trails essential for patient safety, continuity of care, and legal protection) 

• regular participation in audit (an integral part of everyday practice for quality improvement) 

• a 3-yearly update 

Sample takers must review and reflect on any rejected samples, including those inadequate for cytology, HPV unavailable, and abnormal test results. 

Training requirements and competency verification for locum qualified cervical sample takers

Employers must verify that any locum qualified sample taker is safe to practise within the NHSCSP. This includes confirming that they have:

• completed all required training
• obtained a valid pin or code number from the local laboratory
• met their professional obligations for CPD as described in line with national guidance

Employers must not permit locum sample takers to practise until these checks have been completed and verified.

Training requirements for overseas-trained cervical sample takers

Employers must ensure that any cervical sample taker who is new to England completes the full initial sample taker training pathway described in this guidance before they can obtain a pin or code number from the local laboratory.

Employers are responsible for verifying that overseas‑trained practitioners meet all national competency requirements and are safe to practise within the NHS Cervical Screening Programme.

3.27 Update training requirements for cervical sample takers

Eligibility for update training

To be eligible for the update training, sample takers must have completed their initial training. They must then complete an update every 3 years as outlined in this guidance.

Frequency and minimum requirement

Sample takers must undertake a minimum of 3 hours update training every 3 years.

National e-Learning resource

The national eLearning resource for sample takers meets the programme requirements for update training (this module equates to approximately 3 hours of learning.

Note that the eLearning resource does not meet the requirements for initial sample taker training which are described in this guidance. 

Face-to-face update training

Where face to face update training takes place, it must:

• be accredited
• equate to a minimum of 3 hours of learning
• fulfil the requirements of this guidance
• incorporate any local training needs (training providers should work with their local screening and immunisation teams when planning and delivering local updates)

Minimum content

Update training must cover:

• current developments in the NHS CSP (national and local)
• recent guidance updates relevant to cervical sample taking
• changes to screening policies and procedures (national and local)
• identification of personal learning needs to meet professional obligations for CPD and revalidation
• learning from incidents in the programme (common national and local themes)

Evidence of update

Sample takers can download a system-generated certificate on completion of the national eLearning module.

The training provider will issue a certificate on completion of face-to-face update training.

Cervical sample takers must provide evidence of their completed update training to the cervical screening laboratory that holds the sample taker register for their locality. 

3.28 Returning to cervical sample taking practice

After an extended period of absence

Upon returning to practice, the cervical sample taker should:

• arrange a return to work meeting with their line manager
• contact the cervical screening laboratory to check the status of their pin or code number
• check the status of CSMS access, ICE permissions
• check if there has been any subsequent change to the liquid based cytology (LBC) system previously employed.

They should then follow the relevant course of action detailed below.

For an absence of 12 months and less than 5 years

The cervical sample taker must:

• complete the cervical screening update eLearning which provides information on the entire programme pathway including failsafe responsibilities and pathway changes
• complete eLearning for health primary HPV screening for sample takers
• take 2 samples and have the consultation and sample taking process peer-reviewed to confirm their competency

For an absence of 5 years or more

The cervical sample taker must:

• complete the cervical screening update eLearning which provides information on the entire programme pathway including failsafe responsibilities and pathway changes
• complete eLearning for health primary HPV screening for sample takers
• take 5 samples and have the consultation and sample taking process peer-reviewed to confirm their competency

An experienced cervical sample taker who meets national standards and fulfils their professional obligations for CPD can undertake peer review. The cervical sample taker’s employer should manage any concerns raised in connection with meeting competency requirements. Cervical sample takers may have to repeat the training if their employer has concerns about their competency to take cervical samples.

3.29 Governance, escalation of risks, issues and incidents

Strong governance, supported by effective escalation processes, maintains the quality, safety, and integrity of the training programme. 

Governance arrangements must set out clear lines of accountability and defined escalation routes between employers and training providers. These routes must ensure that concerns, risks, or instances of non‑compliance are raised, reviewed, and acted on promptly at the correct level of authority.  

Internal escalation pathways must specify: 

• a trigger point (the point at which an issue can no longer be managed routinely and must be raised to a higher level of oversight [SIAF]) 

• a reporting route (that is explicit about who needs to be informed, in what order, and through which communication channels) 

• a description of how events are assessed (the process used to understand the seriousness of an issue, determine its impact, and decide what action is required) 

• the expected time frames for action (describe how quickly each stage of an escalation must happen once a concern has been raised) 

The national guidance for managing safety concerns, safety incidents and serious incidents in NHS screening programmes and associated flowchart provides clarity for staff providing and commissioning NHS funded services who may be involved in identifying or managing a screening incident.

4. Checklists for training providers

We have included these checklists to help training providers identify any gaps in their existing processes and supporting documentation, and to develop their quality framework.

4.1 Management systems checklist

Training providers should have a:

• document identifying training activity and describing how it is resourced (training activity plan)
• procedure describing the training administration process
• procedure describing how to maintain IT system(s) in accordance to local and national regulations
• procedure to describe how you support trainees from enrolment through to the completion of their training (sign up to sign-off)
• procedure describing how to manage and report trainee performance in line with local protocol
• procedure describing how to respond to any training issues (action taken and or escalation) as necessary
• procedure describing how to provide feedback to trainees, teaching staff and employers
• procedure describing how to review, approve and update training documents (paper and electronic)
• procedure describing how to store and maintain training records within the management system
• procedure describing how to monitor training content and quality
• procedure describing how to identify and induct cervical screening mentors and assessors to their respective roles
• procedure describing how to collect, evaluate and use feedback from trainees, mentors, assessors (and others) to inform subsequent training courses and future programmes (management review)
• procedure describing how to communicate training outcomes to all relevant stakeholders (for example periodic activity reports, annual reports)

4.2 Physical resources (facilities and equipment) checklist

Training providers should ensure that:

• the training (classroom) facility is appropriate in terms of lighting, heating, ventilation, seating and so on
• the teaching facility is suitable for accommodating the number of course attendees, course format, frequency, and duration
• there are sufficient training resources (pelvic models, cervical sampling equipment and laboratory consumables) available for the trainee cohort (and that they are available for the duration of the course)
• course equipment is functional, safe, checked and maintained to provide training to the standard described in this guidance
• steps are in place to keep the training area free of all distractions for the course duration (including interruptions by people and or electronic devices)
• there is a document displayed in the training room which provides relevant health and safety information
• there is an appropriate confidentiality statement displayed in the training room

4.3 Staff resources checklist

Training providers must clearly define staff roles, responsibilities and authorities. They should make sure that:

• trainers have the appropriate specialist expertise for the sessions they teach on the theoretical course
• there are adequate numbers of assessors for the cohort of trainees
• mentors and assessors have sufficient information to be able to carry out that role to the standard described in the national guidance (induction)

Training providers should have a:

• procedure describing cover arrangements and contingency plans in the event of unexpected absence
• document describing the staff recruitment process (including induction, performance review and appraisal)
• procedure describing how to conduct pre-employment checks (professional registrations and qualifications)
• procedure describing how to check the experience, competencies and continuing professional development (CPD) records of teaching staff, including invited speakers
• procedure describing how contracts or agreements are set up (for example sessional commitments for outsourced training provision)
• document describing the staffing structure (organisation chart)

4.4 Training and assessment checklist

Training provision must adhere to this guidance and meet all competencies outlined in the national occupational standard CHS37 ‘Obtaining cervical cytology samples from individuals (pdf)’.

Training providers must have systems for assuring the quality, content and safety of training and assessment.

They must develop and evaluate courses using the expertise and experience of all those involved in planning and providing the training.

Courses must cover all the required competencies and the minimum training content described in the guidance.

Training providers must:

• use a range of teaching methods on the initial training (theory) course (for example, lectures, discussion, role play and case studies)
• have a procedure describing how to assess and evaluate trainee participation on the course
• have a document describing the course aims, objectives and learning outcomes (a scheme of work or teaching aid)
• make sure courses enable trainees to connect their learning to their routine practice
• ensure courses observe the relevant Royal College of Nursing (RCN) Principles of Nursing Practice
• ensure courses observe the professional body codes of conduct (GMC, NMC)
• consider anti-discriminatory legislation, diversity, human rights, ethical and medicolegal aspects when planning course content and provision
• consider copyright legislation and accurately credit and cite all resources
• identify and mitigate any operational and reputational risks associated with the training (and record these)

The training provider is responsible for supporting and or providing the initial (theory) training course. This includes:

• inviting guest speakers to provide specialist elements of the theoretical course
• providing an overview of the education pathway at the start of the course
• explaining the importance of developing and maintaining a personal training record (this can be an electronic or hard copy resource)
• providing an overview of the practical training and assessment requirements including:
  • limits on the number of samples to be undertaken at each stage of training
  • where and to whom they submit their completed training record (portfolio) following final assessment
  • what options are available to them if they fail to complete their training in the designated time, or fail to complete their training to the required standard

The training provider is also responsible for making sure the trainee:

• has booked to visit a colposcopy clinic (and produces a reflective account of their visit)
• has booked to visit a cervical screening laboratory where logistics permit; a virtual tour supplemented with up-to-date information provided by the cervical screening laboratory is an acceptable alternative (must be part of the theoretical course)
• knows how to make a complaint in the event they are unhappy about any aspect of their training
• participates in the course evaluation process

They should remind trainees to book their colposcopy visit early in their training due to the variation in local availability. Trainees must attend for the duration of a clinic. Record this in the learning plan and factor in protected time for the visit (and any follow up visits where necessary).

Course information for trainees should include:

• marketing and publicity flyers
• a welcome and introductory letter
• contact details of the course co-ordinator and lead trainer
• a course profile (a description of the full training pathway)
• the scheme of work (the course aims, objectives and learning outcomes)
• a course timetable outlining topic areas, and list of guest speakers including a brief resumé for each
• a pre-course reading list
• a description of pre-course learning activity as applicable
• an explicit statement about Intellectual Property Rights (IPR) and copyright (this can be part of the course introduction)
• an explicit statement about patient confidentiality (this can be part of the course introduction and displayed in the training room)

4.5 Adapting theoretical content for delivery on a virtual platform

Training providers who offer blended learning programmes and provide some or all theoretical content on a virtual platform (such as Microsoft Teams) must take account of the following:

• how they invite course participants to attend, and register their attendance
• the maximum group size at any one event
• how many times the event will be repeated (if necessary)

Training providers must provide guidance for course attendees to include:

• pre-course requirements (preparation and reading)
• information and materials to be downloaded for the course
• IT requirements and troubleshooting (browser, sound and camera checks, internet connectivity issues)
• access to the system and joining instructions (practice ‘sign in’)
• advice on ‘virtual etiquette’ (chat function, camera, microphone, limiting distractions)

Where sessions are recorded, training providers must be explicit that participation includes consent to be recorded (refer to local employer policy in this area).

Training providers must be able to:

• adapt course content into shorter sessions if necessary
• adapt learning outcomes and content to revised teaching time frames without compromising training quality
• ensure all participants can ask questions
• check student understanding of course content
• assess student attainment of the required learning outcomes
• evaluate the course post completion

Training providers must make sure that any certificate of attendance issued for the course makes clear that it was a virtual or online event.

5. Guide to the initial assessment

The initial assessment is obligatory. Its purpose is to make sure the trainee is confident and safe to start their unsupervised clinical practice. The initial assessment is not a test, and there are no set criteria for a pass or fail outcome.

NHS England provides a library of numbered images of cervices for use in the interim assessment. To access this library, staff must register on the NHS England eLearning for Health website.

Once registered, click on the module title and follow the instructions.

For the initial assessment, the trainee should be able to:

• apply their knowledge of basic anatomy and physiology to recognise the features of a healthy cervix and identify correctly which images are normal and abnormal
• make an assessment of the appearance of the cervix
• state if they would take a cervical sample, and if so describe how they would do it (using the correct sampling device to demonstrate this)
• identify correctly the type of os seen
• identify correctly the squamo columnar junction (SCJ) and the area known as the transformation zone (TZ)

The trainee should understand:

• common vulval, vaginal and cervical conditions and how to approach these
• how to recognise situations where specialist advice may be required
• when an individual should be referred directly for routine or urgent colposcopy

5.1 Guidance for the mentor

Select a minimum of 5 images from the library to discuss with the trainee. The trainee reviews the case information for each image selected. For each image selected, the trainee discusses the screening needs of that person. The mentor uses the screening history and clinical information provided for each image as trigger points for discussion.

The mentor can prompt the trainee during the discussion. For example, ask the trainee:

• to consider whether they would do anything further in addition to taking the sample
• how they would advise the person if they identify any normal cervical conditions, and what action is required
• whether any specialist advice is needed
• whether they would refer the individual for routine or urgent colposcopy (check their understanding of the follow up pathway)
• to describe what information they would enter on the sample request form

If the trainee does not identify an image correctly as normal or abnormal, gives an incorrect or vague response or offers both correct and inaccurate information in their response, the mentor should select another image for the trainee to review. The trainee and mentor should also revisit any incorrectly answered image, with the mentor providing the correct feedback.

As a guide, only the mentor should allow approximately 60 to 90 minutes for the trainee to complete the initial assessment. The trainee and mentor must plan and document their preparation for the assessment.

The mentor must also document the discussion and trainee responses (see the example form provided for this exercise in the training record example forms accompanying this guidance). The trainee writes a reflective learning account of the initial assessment.

The mentor must be satisfied that the trainee is confident and safe to proceed to their unsupervised clinical practice. If the trainee does not complete the exercise satisfactorily within the allocated time, the mentor and trainee should agree and document an action plan to repeat the initial assessment. The mentor should notify the training provider if there is any concern about progress at this stage.

The trainee can print off an (elfH) system-generated certificate after completing the exercise (this applies to single or multiple attempts). The certificate is a record for the trainee’s portfolio and does not imply completion of the full training pathway.