Cervical screening: ideas for improving access and uptake
Guidance to help primary care, commissioners and local authorities plan and evaluate initiatives around cervical screening coverage in their area.
The following initiatives can be used to address areas of low coverage identified in the cervical screening quarterly coverage data reports.
Invitation letter
Evidence demonstrates that GP endorsement has a positive effect on cervical screening uptake.
The cervical screening programme sends a standard invitation letter and a reminder letter 18 weeks later to women who are eligible for cervical screening. Standard letters sent by the programme can include an additional paragraph of free text specific to a GP practice.
The registered GP sends out a second reminder letter to non-attenders. This provides an opportunity to tailor the practice invitation according to the services the practice provides and the practice population. Helpful content includes:
- surgery opening times
- reassurance that the sample taker will be female
- offering opportunities for a conversation about any screening concerns
Women with specific needs or with disabilities
It is important to consider specific needs in relation to cervical screening in order to maximise opportunities for women to attend.
Primary care is well placed to know their practice population needs, and to identify reasons why women are not attending. These reasons may include:
- access problems
- lack of time, or inability to attend during usual clinic hours
- disability (physical or mental)
- language barriers
- cultural beliefs
Women with disabilities have the same right of access to cervical screening as other women. No disabled woman can be assumed to be sexually inactive. All women are entitled to information to make their decision about cervical screening, and are entitled to reasonable adjustments to support them attending an appointment.
Primary care should consider the clinic facilities for women with a physical disability, including:
- access to the venue (can an alternative be offered?)
- the height of the couch
- the woman’s physical limitations
- the possibility of a domiciliary visit
- the need for assistance and seeking specialist advice if necessary
In the case of paraplegic women, the sample taker may need to make special arrangements, for example with the local colposcopy service, to take a sample at a clinic where a hoist is available.
A local learning disabilities team can offer support including assistance with consent, and individuals to accompany women to appointments. An easy read leaflet is available which has been designed to be used by women with learning disabilities alongside family members or carers. The leaflet is intended to help them to make their own decisions about cervical screening, and to prepare them for the screening process.
Language and cultural differences can affect understanding or the screening process. It is important to take measures to ensure all women understand the purpose of the screening programme and the procedure for taking the sample. Language translations of the screening invitation leaflet are available to download, and alternative formats (such as braille) can be made available on request.
Primary care is responsible for sourcing and offering language support during sample taking if needed.
Pre-appointments
Women who have never been screened may benefit from being offered a no obligation pre-test appointment to discuss the procedure and raise any questions or concerns. This may also be beneficial for women who have previously had negative experiences of screening.
Open Exeter
Sample takers may wish to use the Open Exeter IT system to check screening status and follow up non-responder notifications. Also use the system to download the electronic HMR 101 (cytology request) forms.
Screen prompts and alerts
The use of alerts or screen prompts for defaulters provides an opportunity for clinicians to raise awareness that screening is available and that individuals remain eligible.
Awareness campaigns
2019 saw the first PHE national multimedia cervical screening campaign, highlighting the risks of cervical cancer and the preventative benefits of screening. The campaign website includes information, case studies and resources that local providers can access.
Practice campaigns to raise awareness of cervical screening and invite women who are overdue have been shown to be useful to increase attendance for screening.
Methods for prompting women who are overdue or who have never attended include:
- reminder letters
- text reminders
- postcards
- telephoning women directly
Posters in waiting rooms and toilets are a simple way to raise awareness and promote screening.
Jo’s Cervical Cancer Trust provides awareness raising resources for primary care, and there is a cervical screening awareness week in June each year.
Data cleansing
GP list validation and list cleansing is helpful to ensure removal of ‘ghost’ patients to support the practice in identifying eligible women.
An audit of hysterectomised women at a practice level will identify women who no longer need to be invited for screening. Women who have undergone a sub-total hysterectomy will continue to be eligible for screening as the cervix is not removed.
Consulting room
Review the consulting room where screening takes place. Consider the layout and location of rooms to ensure there is a confidential quiet, private area that is welcoming. Make sure all your equipment is ready at hand before you start and make sure you will not be disturbed.
Positive experience
Fear and embarrassment are some of the main influencing factors for women who choose not to have screening.
Previous experience is important when women are deciding whether to make an appointment. Ensure women are put at ease and all their questions are answered during their appointment. They may tell their family and friends if their experience was positive or negative.
Access
Providing a variation of appointment times during the day and in the evening will help women in choosing when they can attend for screening. Limiting access to screening appointments can impact on coverage.
A whole team approach is important to ensure women can access screening. It is therefore important that all clinicians and reception staff are aware of the importance of cervical screening.
Making an informed choice
All women must be given the opportunity to make an informed choice about whether or not to attend for cervical screening. The decision should be based on an understanding of:
- why they are being offered screening
- what happens during the test
- the benefits and risks of screening
- the potential outcomes (including types of result, further tests and treatment)
- what happens to their screening records
If a woman is provided with the above information about the programme and chooses not to attend screening, then this is a valid choice and must be respected.
Additional data and resources
NHS Digital interactive dashboards on:
Powerpoint presentations on:
- cervical screening coverage
- cervical screening coverage against levels of deprivation
- cervical screening coverage against census health data
See also:
- Jo’s Cervical Cancer Trust ideas for increasing cervical screening attendance
- Cancer Research UK cervical screening resources, including good practice guide for health professionals