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NHSE announcement on laboratory configuration for Primary HPV screening.

The BAC announced the long awaited decision on the numbers of laboratories within the CSP in England on Saturday at the ASM.  The official announcement was released late afternoon on the Friday 3rd November 2017, and the 140 delegates at the ASM were amongst the first to hear it.



The BAC announced the long awaited decision on the numbers of laboratories within the CSP in England on Saturday at the ASM.  The official announcement was released late afternoon on the Friday 3rd November 2017, and the 140 delegates at the ASM were amongst the first to hear it. The full announcement is shown below:

Dear Colleagues,

INTRODUCTION OF HPV AS PRIMARY TEST WITHIN THE NHS CERVICAL SCREENING PROGRAMME (NHSCSP)

As you will be aware, NHS England has been considering how it will implement the recommendation made in July 2016 by the National Screening Committee that the NHSCSP should replace cytological screening with the Human Papilloma Virus (HPV) test as the primary screen within the programme. 

We understand that it has been a challenging time for providers of cytology services within the NHSCSP and want to confirm our commitment to work with you and other providers to maintain the current programme until this change is nationally rolled out before the end of 2019. A separate communication regarding mitigation work to maintain the current programme will be circulated shortly.

Earlier this year, Public Health England (PHE), with representation from NHS England and other key stakeholders, led a HPV Primary Screening Options Appraisal that considered how the service change could be delivered safely, effectively and sustainably on a national level.  A number of options were considered against 10 key criteria, including service quality and linkage to local services.  The option for the centralisation of HPV testing and cytology testing as a single seamless service was deemed to be above the quality threshold for service delivery.  This option was recommended for either of the two sub options:

  • Option 4a – a minimum number of centralised services (between 4-6 sites)

  • Option 4b – a maximum number of centralised services (between 10-15 sites)

Following this, due diligence was carried out by NHS England on financial viability and workforce implications of these options.  A series of engagements was also carried out with representatives from local commissioning teams around the current position relating to pathology reforms, contracting and laboratory configuration within the regions. This was to determine whether the options were feasible and operationally deliverable.

On 6 October 2017, a paper was presented to the internal HPV primary screening Receiver Board within NHS England and made recommendations for approval in respect of the commissioning and procurement of the laboratory configuration. These recommendations were as follows:

Commissioning Strategy

The recommendation for the commissioning strategy is option 4b. This is the centralisation of between 10 to 15 laboratories, although we have identified (based on initial feedback from the local commissioning teams) that up to a maximum of 13 laboratories will be the optimum number to procure in order to provide HPV Primary screening across England before the end of 2019.

The footprint that laboratories will cover will be determined following further discussions within NHS England’s regional teams and clarity from PHE regarding the minimum number of cytological samples each laboratory would need to undertake.  This will be confirmed in due course within documentation relating to the procurement.

Procurement Strategy

The recommendation for the procurement strategy is that a national provider framework is procured and will involve a national programme of work which will entail a consistent market engagement approach, standardised tender documentation and a national service specification.  A national provider framework will ensure that all existing providers will be treated equally throughout the procurement process.   Providers successful at this stage will then be invited to participate in regional procurement processes. 

The HPV primary screening Receiver Board endorsed these recommendations and they have also received final ratification from NHS England Public Health Oversight Group.

Following this, planning will now commence between the national Public Health Commissioning team, the regional commissioning teams and colleagues from the central Commercial Team/Commissioning Support Units for the agreed National Framework procurement process. We will continue to keep you informed of progress and timescales for the different stages in the procurement as we move further into the planning and preparation stages.  In the meantime, if you do have any questions or queries on this, please do not hesitate to contact your local commissioning team.

The announcement from NHSE is based on the options appraisal undertaken with PHE and other organisations, including the BAC, earlier this year. There are currently no details available on the selection process to deliver the 13 laboratory model, but the announcement alludes to on-going discussions with local and regional Commissioning teams and PHE and NHSE.

It is worrying to see phrases such as “..planning will now commence..” with no timescales or other details provided. However, given that the implementation is scheduled for December 2019 real and concrete plans will be needed in the very near future to allow for detailed planning. This will involve laboratories engaging with their own staff, Trusts and ultimately commissioners to decide if and how they can bid for this work. We have been involved in planning with PHE to date, but have also now been asked to contribute to the planning for the National Framework Procurement by NHSE.

We will accept this invitation and will try to ensure our voice is heard. We would welcome any suggestions from members as to issues to consider, of which we know there are many. This will be not only for those who will continue to undertake CSP work in the future, but also for those laboratories and staff who will cease to do this work, and how we can best help to retain and best use their valuable skills going forward. Far more detail is required - watch this space.