In this current climate of great change within our discipline, a brief summary of some of the issues that are being discussed in National committees is offered, with some useful action points to note. Of course with change often comes controversy. Hopefully some members may be sufficiently moved by some of the outstanding issues to openly debate these on the new FORUM facility featured elsewhere on this site.
As you will see from the published Council Minutes, after a lengthy delay from the original Manchester Conference, the BSCC is now taking this forward via Dr Karin Denton (Dyskaryosis) and Dr Mina Desai (Adequacy), and they are leading small focus groups for this task with some vigour. News of progress will be published on this site as soon as it becomes available
Dr Mina Desai and Mr Nick Dudding are charged with overseeing the redrafting of the Codes of Practice for Gynaecological cytology and Dr Ashish Chandra is doing likewise for Non Gynae Cytology, the latter already being in an advanced draft form. We are hoping to invite general membership comments on the Non Gynae protocols via a web-based facility shortly.
This latest document had now been published (December 2004, NHSCSP Publication No. 21), and subsequently distributed to the Programme. It was refreshing to note that the only mandatory lab failsafe provision now is to get women into colposcopy who need it (as opposed to following up and chasing first low grade abnormalities or after treatment).
The national office of the NHS Cancer Screening Programmes is in the process of appointing a company of technical consultants to assist in the transfer of the Exeter system onto the new national spine. The company has been briefed to involve appropriate professional groups to ensure that the laboratory perspective on matters is considered during the system development process. Progress is bound to be slow and painful, but I promise you will have any news when it breaks via this forum.
The latest draft of this document, similar in structure to that proposed with the help of the National Quality Assurance Group, is still in discussion as well as a proposed National Data Base of Cervical Cancers. The document is now with the Healthcare Commissioners for their final approval.
The national office of the NHS Cancer Screening Programmes has approached the the NHS Health Technology Assessment Programme (HTA),with a view to determining criteria for the cellular adequacy of LBC preparations. Dr Mina Desai, Dr Karin Denton & Mr Nick Dudding, helped HTA in clarifying the research need towards the preparation of their vignette on behalf of the BSCC, and this topic has now been prioritized for the research. The call for the research project is now on the HTA website
Eight of the nine Cytology Training Centres in England have so far either converted to LBC or are in the process of converting. At the end of the current calendar year there should be 24-25 establishments converted to LBC.
The latest summary was:
| North East, Yorkshire and Humber | Surepath |
| North West | Surepath and ThinPrep |
| East Midlands | Surepath (Trent) and ThinPrep (LNR) |
| West Midlands | Surepath and ThinPrep |
| East of England | ThinPrep |
| South East (East) | ThinPrep |
| South East (West) | To be decided |
| South West | ThinPrep |
| London | ThinPrep |
| Northern Ireland | To be decided |
| Wales | Surepath |
| Scotland | ThinPrep |
| Eire | To be decided |
The NHSCSP has recognised the need to devise a system to evaluate the clinical performance of any new LBC technologies prior to their being marketed in the NHSCSP and the process for achieving this. The purpose was to make a qualitative assessment of new entries into the market in order to safeguard the public, and leading professionals and experts have already been assembled and a draft protocol has been circulated to the National QA Group for their comments. News on progress will be on this site upon its receipt.
Mr Mike Rowell (Bristol) has been instrumental in delivering a programme of national assessor training for the National Technical EQA Scheme. Overall, the training has been well received. All regions have been advised to pilot the scheme in advance of the scheme's launch date of 1 April 2005. The scheme has not been without issues, mainly within the SurePath automated staining procedure and the ThinPrep staining reagents required for use with the Cytyc automated imager areas; notwithstanding the availability of control material for use in the scheme, and several action points regarding substandard performance.
The NHSCSP has recently commissioned Keele University to undertake a review of quality assurance activity in cervical screening. The purpose of this work was to satisfy the Healthcare Commission that the approach to quality assurance in the Cervical Screening Programme was robust and consistent. This project was led by Professor Ellie Scrivens from Keele University and Mrs. Lynn Coleman, Assistant Director (NHSCSP). They found not surprisingly perhaps that there were varied approaches to quality assurance throughout the country and many areas of good practice have been highlighted in the report. One of the significant findings identified in the report was that primary care was often "outside the loop" in terms of quality assurance. Some activity did take place in terms of visits to primary care premises or questionnaires, but this was currently limited. The National Office has convened a suitable group to take this forward.
Some work has been undertaken in laboratories in Wales and Scotland using rapid pre-screening as an alternative technique to rapid review. Reports from Wales and Scotland has been presented to the Cervical Screening QA Directors for consideration. It was noted that the laboratories involved in this work had expressed a preference for rapid pre-screening, and indeed some laboratories in England have also adopted this practice, however it was not formally recognised as an acceptable alternative to rapid review by the NHSCSP. As such, the Cervical Screening QA Directors felt that the current evidence and experience supported the use of either practice and have sought the view of the National Laboratory QA Group on this issue. As yet it is not clear if this will become a National NHS CSP mandatory recommendation, but it is bound to generate controversy if indeed it does. What is even more pressing is a view on rapid review/preview for LBC. This probably comes into the remit of Dr Mina Desai and her redrafting of the Code of Practice for Gynae Cytology, and we will publish any progress on this as soon as anything is forthcoming.
After some enquiries to the National Office about this issue Mr Richard Winder advised that the DH position regarding the independent sector involvement in the NHS and in particular cytology was:
"The NHS Improvement Plan committed us to developing a 'high quality personal service for all patients'. Waiting times will no longer be an issue – this applies to cervical screening. We are also clear that any provider who can meet or enhance the standard of NHS services could have a role to play. We are looking at the implications of the Plan for a wide range of diagnostic services, including cytology. However, this process is at an early stage and no decisions have been made."
Following concerns expressed from some Units attempting to implement Rapid or Direct Referral for Colposcopy appointments, and the concerns that this would cut across the DoH Choose and Book strategy, Mrs Julietta Patnick allayed some of those fears with the following statement
"Further to our recent conversation about "choose and book" and direct referral I have had discussions with Department of Health colleagues and am now writing to clarify the position.
Where a GP refers a patient for colposcopy as a first outpatient appointment, "choose and book" would apply. However, there is no requirement that colposcopy referrals following cervical cytology must go via a patient's GP.
Direct referral is defined as referral directly from the pathology laboratory to colposcopy. It is a specialist referral and as such "choose and book" is not applicable. Direct referral has a number of advantages including the speeding up of the patient journey and facilitating better management of clinics thus reducing waiting lists. Where direct referral is used the patient must be given clear instructions on how the appointment may be easily changed if it is not convenient.
The move to direct referral is encouraged by this office and supported by the "choice" and "cancer" teams at the Department of Health. During discussions earlier this year with the BMA GPC the move to direct referral was also encouraged by that body. Many parts of the country are introducing this system as a service improvement for both patients and clinicians.
I hope this clarifies the situation for you.
Yours sincerely
Julietta Patnick CBE
Director
NHS Cancer Screening Programmes "
NHSCSP Equipment Report 0401 (replaces NHSCSP Publication No 4). Publication date: December 2004 (distributed February 2005)
NHSCSP Publication No 21 (replaces NCN Guidelines on Fail-safe Actions). Publication date: December 2004
Third edition now available. Publication date January 2005
Second edition of training resource pack. Being updated and revised to take account of LBC. Revised draft takes account of comments from Primary Care QA Group
New publication. NCCETC working group selecting slides for inclusion.
New publication from Joan Austoker, which will replace NHSCSP Publication No 5. Still at draft stage.
Second edition of NHSBSP Publication No 11. Still at draft stage.
New publication. Still at draft stage. Awaiting further comments from DoH
Revised version of NHSCSP Publication No 18 for website only
New NHSCSP Publication
Revised NHSCSP Good Practice Guide
New NHSCSP Good Practice Guide
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