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Announcement on the Outcome from Quality Review Meetings re: cervical cytology backlogs and mitigation plans from NHS England

As members may be aware, there has been work over the last few months by NHSE working with PHE on plans to help alleviate the current cervical cytology backlogs across England.

This has culminated in the announcement below, cascaded via NHS Commissioning teams in the last couple of days (dated 24th October).

It would appear that in many places this has not as yet reached down to laboratory level. If this document is of relevance to you in your own laboratory then discussion with your local commissioning team/lead may be necessary soon, given the deadline given of 10th November for feedback centrally.

We are hopeful that there will also be an announcement in the very near future on HPV laboratory configuration for England. We will of course announce this as soon as we are aware of it. All of this gives great relevance to the BAC ASM 2017 being held on the 4th November in York, where part of the programme includes an update and discussion on the roll out of HPV primary screening across the UK.

The e-mail sent to Heads of Public Health Commissioning on 24th October reads:

Dear Colleagues,

Outcome from the Quality Review Meetings (cytology backlog additional mitigation options)

As you will be aware, the central Public Health Commissioning Team in liaison with colleagues from Public Health England established a national mitigation plan in January 2017 utilising the existing HPV primary screening pilot sites, with the intention of reducing the rising cytology backlog levels present in a majority of cervical screening laboratories across England.

Currently, four out of the six pilot sites have extended the population that is screened by HPV primary testing as part of the national mitigation plan. Although the additional cytology capacity that this created has been utilised by some laboratories who struggled to maintain the cervical Turnaround Times (TAT) target, it has long been recognised that this plan alone will be insufficient to meet the anticipated demand for cytology testing.

In consideration of this, work has been ongoing between NHS England and colleagues from Public Health England to identify further options to aid the existing national mitigation plan through a series of Quality Review Meetings (QRM) in August and September. These meetings, attended by Regional Medical Directors, local commissioning colleagues and representatives from the national Cancer teams, considered a wide range of options to reduce the TAT backlog, and sought to establish an agreed package, acceptable to NHS England and PHE as our advisors. The following package of four mitigation actions in addition to the existing National Mitigation and local provider to provider mitigation processes were identified as feasible for commissioning teams and the local Screening Quality Assurance service to further explore and implement on a local basis:

1.        Expanding HPV Primary Screening to non-pilot sites (for the purposes of mitigation only)

2.        Full conversion of all six HPV primary screening pilot sites (for mitigation only)

3.        Contract remedial action plans (RAP) for implementing HPV primary screening

4.        Financial incentives for providers and staff (e.g. retention allowance or ‘golden handcuffs’)

Further detail and accompanying guidance for the options (such as the PHE service requirements for HPV implementation in non-pilot sites and the commissioning guidance) will be provided to all local commissioning teams shortly, but the central team thought it was important that all teams are sighted on these options as soon as possible to enable the initial conversations with their local finance leads and service providers around viability and affordability.  To support your discussions we have also developed a series of FAQs below. 

The national scale of the backlog and associated risks require regular reporting and some national co-ordination.  However, as a result of your local team’s initial assessment on the mitigation options listed above, we would like each team to report back to the Public Health central team on each of their current providers against the following, by Friday the 10th November, 2017 please:

·         An overview of provider risks; any potential risks to the future sustainability of the current workforce (e.g. taking into account retirement plans) and any risk of withdrawal from the programme

·         Those providers who are interested in conversion to HPV Primary Screening as part of mitigation

·         Possible HPV Primary Screening capacity

·         Pilot sites:

o    The additional number samples that could be converted to HPV primary testing (samples processed/week) (put a footnote: labs would need to continue to process a minimum of 35k cytology samples a year)

o    The cytology screening capacity  that could be released following expansion of HPV primary testing

o    Any provider risks to the expansion of HPV (e.g. workforce)

A summary of these plans will in turn be shared with the Mitigation Prioritisation Group to ensure implications for QA are aligned. Once the plans have been agreed, we will expect each team to provide regular assurance reports, as part of the accountabilities for the delivery of the national cervical screening programme. These reports will cover the following areas:

·         Finance

·         Contracting/ commissioning structures

·         Communications requirements

·         Impact on capacity (based on PHE TAT reports)

·         Local and national Governance to support delivery

We hope that this update provides you with enough information to begin the early discussions internally around additional cytology backlog mitigations and we will be in touch with further information and clarity shortly.

However, if you do have any questions or queries in the meantime please do not hesitate to contact my team

Frequently Asked Questions (FAQs):

How can we expand the HPV Primary Screening to non-pilot sites?
The expected process for the expansion of the HPV Primary Screening into non-pilot sites will be via the Remedial Action Plan (RAP) route.  This route can only be utilised following proof of full exploration of delivery of other actions to reduce the TAT, ensuring that the risk to challenge is minimised and can only be implemented if agreed by local PHE QA teams, following publication of the service guidance expected in November.

Can an existing non-pilot site convert their entire cohort to HPV Primary Screening?
No, the non-pilot sites will be required to maintain a through put of 35.000 cytology primary screen samples per annum.

When will the service guidance and commissioning guidance be available?
The service guidance requires an interim agreement for genotyping prior to the UK NSC decision, and agreement about the reporting datasets.

How long will the mitigation process need to be in place?
NHS England has agreed to rollout HPV Primary Screening as part of the Public Health functions Agreement (section 7a) by December 2019.  The mitigation process will therefore be required from now until at least April 2019, if not up to December 2019, dependent on local circumstances.  


Best Wishes


Dr Sandra Anglin

Assistant Head of Public Health Commissioning

Primary Care Delivery and Public Health Commissioning

Operations & Information

NHS England