A cervical smear (a.k.a. cervical screening, smear test or liquid-based cytology) involves taking a small sample of cells from a patients cervix. This sample is sent to the lab to test for certain types of human papilloma virus (HPV). These tests help us prevent cervical cancer.
Changes to recall interval for 25-49 year olds, as of 1 July 2025
- If a patient tests negative for HPV and have no HPV-positive result in the last 5 years, recall interval will increase from 3 to 5 years, aligning with the intervals for 50–64 year olds.
- If a patient tests negative for HPV but had a positive HPV result in the past 5 years, they will be recalled in 3 years. If that follow-up test is negative, then the 5-year interval applies.
- First-time screeners (e.g. people aged 25) who test HPV negative will go on 5-year recall.
- Those screened before 1 July 2025 will remain on the 3-year recall until their next screening.
Call & Recall
We offer smear tests to all women and people with a cervix in certain age groups:
- 25-64 years of age: offered every five years
- 65+ years of age: should only be screened if they are still to be followed up after a previous borderline or worse result, or have never had a cervical smear
Previously 25-49 year olds were screened every 3 years. See note above for more information about this change.
Patients will be invited to book an appointment once their smear test is due. At the earliest, the smear can be done 12 weeks prior to the 5 year mark.
Non-Responders & Refusals
Non-responders will be contacted three times, at three-month intervals. If there is still no response after this, the patient will be removed from the screening list.
If a patient refuses a smear:
- Book the patient an appointment with a Nurse
- During the appointment, Nurse complete the page ‘Notify CSAS cease/defer smear’ of the clinical template ‘Cervical screening template (v17.5) (Ardens)’ and provide the patient with an appropriate NHS leaflet (see here).
- If the patient continues to refuse, pass to reception. Ask them to complete Part A and B of the letter below. The GP must complete Part C. Once complete, they can be removed from recall and Part B and C sent to The Screening Manager.
- Follow the steps in the clinical template to submit a form to cease/defer smear to CSAS via CSMS
- Registered as female with GP → will be automatically invited for cervical screening, unless they’ve opted out.
- Registered as male with GP → will not be automatically invited for cervical screening, but they are eligible if their cervix is intact. Clinical admin are responsible for identifying these patients when they receive a CSAS deduction letter OR changed NHS number, and updating their consultation notes to state ‘cervical smear due’.
Screening Appointment
- Check that patient is due a smear by asking if they received a recall letter or, by checking NHS Cervical Screening Management System (CSMS)
- Generate a ‘Cervical Screening London’ TQuest
- Open the clinical template: ‘Cervical Screening (v17.6) (Ardens)’
- Complete page 1-5 of the template, performing the smear as per pg. 4 (’Smear Procedure’)
- Let the patient know that they’ll get a letter with their results within 2-4 weeks
- Clearly label the sample with the patient’s details and ensure it is handed to the Welcomes team ready for collection (see Samples for more information)
- Do not leave cervical screening brushes in the pot after a smear — if this does happen, the smear will have to be repeated.
- Before use, check that all equipment used for the smear is in date. Dispose of any out-of-date equipment appropriately (see Waste Management for more info).
Test Results
For all results (normal or abnormal), assign to the nursing team to action.
For all results (normal or abnormal), ensure it has been filed and coded on patient’s record, and update the Cervical Screening Log in Teams to ensure thorough safety netting.
Take any further action needed:
- Inadequate test (results unclear) →
- HPV found in sample, but there are no abnormal cell changes → in the patient's EMIS notes, state that they're due for another screen a year from the date of their previous test (it cannot be done any earlier than this). If this is the third consecutive year they’ve been tested, see below.
- HPV found in sample, but there are no abnormal cell changes (tested three consecutive years) → patient should have a colposcopy
- HPV is found in sample, with abnormal cell changes → patient should have a colposcopy
💬 Send Accurx: ‘HPV Inadequate’
💬 Send Accurx: ‘HPV Positive’
💬 Send Accurx: ‘HPV Positive 3 consecutive years’
💬 Send Accurx: ‘HPV Positive with cell changes’
Colposcopy Referrals & Results
After the colposcopy, the practice will be sent a report. The report will state when the patients’ next smear is due - this date MUST be added to the patient’s EMIS notes. This is often 6 months after the initial smear, but can vary so please check carefully!
Patient DNA Colposcopy
- First DNA → colposcopy clinic will send the patient another invitation.
- Second DNA → we will receive a Cervical Screening Failsafe from colposcopy clinic. Contact the patient and advise that they attend, or find out the reason for non-attendance.
- If attempts to contact the patient are unsuccessful, report this back to TDL via email. A Nurse must sign off the report.
Undelivered Colposcopy Invites
- 👤 Clinical Admin → if the patient reports not receiving a letter from the colposcopy clinic after 4 weeks, send a task to the Nursing team to contact the patient and discuss the next steps.
- 👤 Nursing Associate or Practice Nurse → investigate and action the issue. Follow-up with the colposcopy clinic should be arranged, or a re-referral made if necessary.