PCSE	Practice
Call and recall	Ensure all women are included in the programme Check with the GP Practice to ensure invitation is appropriate (Prior Notification Lists/e-PNL) Send a disclaimer letter to women who wish to opt out of screening and are fully informed of what this involves	Complete and return Prior Notification Lists (PNL).  GP or PN to sign the PNL if a woman is removed for any other reason than leaving the practice. Ask PCSE to postpone invitation if appropriate (sample at not right time, fully informed woman declines current invitation) Practices should notify PSCE of any Ceased, Deferral and Amendment to cytology forms before the cut off shown on the Open Exeter PNL to avoid inappropriate invitations
Invitation	Send an invitation 4-6 weeks before the sample is due - 1st invitation lettter Send reminder letter 18 weeks later if no response to the first invite - this is the 2nd invitation letter 12 weeks later send non-responder card to the practice if no result is received after 2 invitattions.  At this point the woman is returned back into the system for appropriate montths depending on the result of her last test.	Flag reecords for discussion when woman next attends the practice. Practice should send 3rd invitation letter The practice can code "Excepted from cervical screening quality indicators - no response to three invitations" CID 11099110000000100
Sample taking	NHSE are responsible for commissioning suitable cervical screening services	Obtain consent in accordancee with the "Helping you decide" leaflet Agree with the patient how she will be informed of the result Take cervical sample according to national guidance Complete requst form wiht accurate name, demographic and clinical details, sampler used, previous abnormalities, treatment and HPV discussed with the woman Record sample taker code on the request form Document the consultation Give patient information on results and the possibility of direct referral Verify the sample labelling and send the sample on the same day to the lab.
Results	Send the patient the results letter (unless asked not to) Notify the sample atker/GP surgery if for any reason the result cannot be sent	Give the woman her test result in person if invasive.  Ensure appropriate referral is made. If urgent referral is required, the patient should be notified on a personal basis in the manner that is appropriate for her circumstances. Document result in medical records
Managing Non Attenders	Send non-responder card to practice if no result received after 2 invitations (3rd invitation must be sent by practice)	Fully inform the patient of the implications of non attendance - preferably face-to-face. Urgency depends on the situation: - Call/routine recall - flag record for discussion when the patient next attends - Early repeat sample - flag record and ask the patient to attend the practice -Non-attendance at colposcopy - flag record and ask the patient to attend the practice - GP is responsible for ensuring colposcopy has taken place even if direct referral operating - GP responds to laboratory failsafe enquiry
Ceasing policy	Only cease women who fulfil criteria or who have asked in writing to be removed from the screening programme.  Ensure that they have received sufficient accurate information to make an informed choice. Ensure the woman has been advised in writing of how she can be included in the programme at a future date should she change her mind. For further information see: NHS Cervical Screening Programme NHS Cervical Screening: Call and Recall Guide to Administrative Good Practice. Withdrawing from the NHS Cervical Screening Programme: interim guidance, NHSCSP October 2009. Both are available at www.gov.uk	Ask PCSE to cease recall due to: • Age. • No cervix. • Radiotherapy for cervical cancer. • Other. In accordance with current NHSCSP guidelines. If a woman requests to withdraw from the Cervical Screening Programme, ensure she has sufficient, accurate information to make an informed choice, is capable of making and communicating that choice, and that she has expressed the desire to be ceased in writing. Women are required to provide written confirmation to the PCSE of their intention to be removed from the programme and must sign the appropriately worded Disclaimer Form/letter.