Cervical screening and breast screening performance report

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					                                                                         ENCLOSURE M




TRUST BOARD – SUMMARY REPORT

                                   th
Date of Trust Board meeting:     9 March 2006

Name of Report: Cervical screening and breast screening performance

Author(s): Dr Gillian Holdsworth

Approved by (name of Director): Dr Alan Maryon Davis

Presented by: Dr G Holdsworth

Purpose of the Report: Brief board members

Action required:
Note the contents
Risk Implications & Actions Taken:

Not applicable
Public & User Involvement

Not applicable
Equality & Diversity Implications
None

Legal Issues:

None known
Relevant Core/Developmental Health Care Standard
Core standard C23

This report addresses ongoing activities in Southwark to improve breast and cervical
screening coverage
                                                                                                                             ENCLOSURE M


Cervical screening and breast screening performance report, Southwark PCT,
March 2006. Dr G Holdsworth, Screening Commissioner

Cervical screening

Cervical screening programme performance is assessed on cervical screening
coverage. This is calculated as the number of eligible women between the ages 25 to
64 year who have received an adequate smear in the last five years.

The cervical screening coverage target is 80%. Nationally coverage is 80.3%1 and
has been falling.        Coverage at September 2005 in Southwark was 71.88%.
Cervical screening coverage has decreased in Southwark since December 2004
(72.8%). The higher coverage in December 2004 is a result of the impact of the
‘women never screened initiative’ on the programme.       Current coverage remains
above the pre December 2004 rates. Practice coverage in Southwark ranges from 86%
to 49%.

London coverage is 75.5%1. Southwark has the third lowest coverage in London after
City and Hackney and Westminster.



                                                          Trends in cervical screening coverage rates
   Percentage of eligible 25-64 wome n




                                         78%
                                                77.1%77.1%                                                            76.76%
                                                                76.2% 76.3% 76.44% 76.1%                     76.33%         76.36%76.56% 76.23%
                                         76%                                                  75.68%75.62%
                                                74.5% 74.2% 74.3%
                                                                                                                      75.53%
                                         74%                                    75.05%74.9%               74.82%            74.75% 74.73%
                                                                        74.4%                 74.25%74.30%                               74.18%
                                                71.6%           71.7%                                                 72.80%
                                         72%            71.2%                 72.39%
                                                                                   72.0%                  71.76%           72.30% 72.15%71.88%
                                                                        71.7%                 71.58%71.52%
                                         70%

                                         68%

                                         66%
                                               Sep-   Dec-   Mar-       Jun-    Sep-   Dec-   Mar-   Jun-   Sep-   Dec-   Mar-   Jun-   Sep-
                                                02     02     03         03      03     03     04     04     04     04     05     05     05

                                                                               Lambeth        Southw ark       Lew isham




The main reasons for low cervical screening coverage in Southwark are high
population mobility, ethnic diversity of the population and language barriers.        In
addition the ‘inadequate rate’ of 9.9% will also contribute to our inability to meet our
coverage targets (although the London inadequate rate is similar to the national
inadequate – so all are affected equally).
                                                                       ENCLOSURE M

Current activities ongoing to address cervical screening coverage rates in Southwark

1.       Introduction of ‘Electronic Prior Notifcation Lists’ (EPNLs).
         Prior notification lists are issued to practices in advance of their women being
         invited for screening. This allows the practice to update clinical and
         administrative details (particularly address) since the last invitation. If these
         are not returned in time then the invitations may be sent out to an earlier
         address.      Currently in Southwark we are introducing electronic PNLs –
         which allows practices to update information on line. Fifty percent of PNLs
         are now returned on time, compared with 8% in September 2005.

2.       Improving coverage action plan developed by the PCT screening coordinator –
         this covers a number of approaches to working with practices on coverage,
         including:

        Targeting low coverage practices - the PCT screening lead has identified the
         lowest performing practices in Southwark and is working with them on
         developing their systems to address this.
        Practice Coordinators - Each practice to provide a named Cytology Co-
         coordinator for the practice.
        Open Exeter - Promoting awareness of the web based system Open Exeter that
         provides practices with individual patients screening history.

     3. Introduction of liquid based cytology – this new technique for taking cervical
        smears will be introduced in 2006. It is likely to reduce the inadequate rate
        over the next few years from 10 per cent to 1-3 percent, which will almost
        certainly impact positively on coverage rates.




Breast screening

The breast screening programme offers mammography to women between the ages of
50 and 70 years on a three yearly basis. Performance of the programme is measured
on the number of eligible women between the ages of 53 and 64 years who have had a
mammogram in the preceding three years.      The national target for breast screening
coverage is 70%.

Currently in Southwark our breast screening coverage at June 2005 was 62%. This
compares with 63% coverage in Lewisham and 57% in Lambeth, 75.5% in England
and 64.3% in London. Southwark PCT is the ninth lowest PCT in London Region in
breast screening, although the overall trend in breast screening has been upwards over
the last few years.
                                                                                                                                                                                    ENCLOSURE M


                                      Breast Screening Programme: coverage of women aged 50-64 at 31 March
                                           1996 to 2001 and women aged 53-64 at 31 March 2002 to 2004


                                      80
    Coverage (less than 3 yrs since



                                      70

                                      60

                                      50
              last test) %




                                      40

                                      30

                                      20

                                      10

                                      0
                                           1996             1997                 1998                1999                 2000                 2001               2002*                2003*                2004*
                                            * T he f i gur e s f or 1 9 9 6 - 2 0 0 2 a r e ba s e d on a s c r e e ni ng a ge r a nge of 5 0 - 6 4 howe v e r i n 2 0 0 3 i t wa s a gr e e d t ha t c ov e r a ge wa s
                                                  be s t a c c e s s e d us i ng t he 5 3 - 6 4 a ge gr oup a s wome n ma y be c a l l e d a t a ny t i me be t we e n t he i r 5 0 t h a nd 5 3 r d bi r t hda y s




                                                       England                                                London                                                 LSL
                                                       Lambeth                                                Southwark                                              Lewisham



Improving Breast Screening in Southwark

The South East London Breast Screening Programme in collaboration with Southwark
PCT Department of Public Health have developed a Breast Screening Information
Pack for Practice Staff and have initiated a targeted programme of health promotion
in Primary Care.     Practices who’s women will be called for breast screening over
the coming year will be visited by the team and a pack of health promotion materials
including a template for ‘pre invitation letters’ and ‘DNA letters’ which the practice
can use – an approach which has been demonstrated to improve uptake in other areas.
The programme will be evaluated and rolled out if appropriate.

There are a number of proposals which are being considered by the London Cabinet
which may be implemented London wide – if they are thought to improve uptake in
London, these include possible centralisation of the call recall service.

				
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