Summary: This page details our cervical smear protocol.
Who’s it for: Reception, Nursing Associate, Practice Nurse and GP.
What is a Cervical Smear?
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.
Call & Recall
Eligibility
We offer smear tests to all women and people with a cervix in certain age groups:
- 25-49 years of age: offered every three years
- 49-64 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
For more information on smear tests for non-binary people and trans men, click here.
Booking the Appointment
Reception
- Log into app.hippolabs.co.uk to find patient lists (see for more information)
- Call the patient to book the relevant appointment as instructed by the recall list (usually a single appointment F2F with a Nursing Associate or Practice Nurse).
Avoid booking the smear during menstruation.
Explain what the appointment is for, and ask them if they would like any further information about cervical smears. If they say yes, send the Accurx text ‘NHS Cervical Screening - Helping You Decide’.
Trans-men will not be on the recall list, 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’.
Clinical Admin or the Data Controller will also identify and code patients due a smear who are living with HIV.
Always check if the patient requires an interpreter, and if they do, book them a double appointment.
Screening
To perform a cervical smear, you must have completed certain mandatory training courses. These can be viewed by opening the toggle below. Mandatory Training
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The Appointment
Nursing Associate or Practice Nurse
- 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.
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Key Points to Note🗒️What to do for cervical screening in people living with HIV (click this toggle for more information)
- Don’t 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 our Waste management page for more information).
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Sending Samples to the Lab
- All samples must be clearly labelled with the patients details
- Cervical samples are collected twice a week by The Doctors Laboratory (TDL). For more information, see our Samples page
Non-Responders & Patient Refusal
- Non-responders should 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, 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
Cervical Smear Refusal Disclaimer (1).docx70.3KB
Test Results
Actioning
Clinical Admin
Review electronic smear results via Path links, on EMIS workflow manager. Then action as follows:
- Normal result (no HPV in sample): file and code results. The patient will be automatically invited for screening in 3/5 years. At the earliest, the next smear can be done 12 weeks prior to the 3 year mark.
- Abnormal result (HPV in sample): assign to the nursing team to action.
- Inadequate test (results unclear): assign to the nursing team to action. Send Accurx to the patient requesting to repeat the test a minimum of 12 weeks later.
Nursing Team
A member of the nursing team must then review the result, and action appropriately:
- If HPV is 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), and again a year later if they still have HPV. If HPV persists after 2 years, a colposcopy is required.
- If HPV is found in sample, with abnormal cell changes: patients must have a colposcopy.
The lab will directly refer patients for a colposcopy, if deemed necessary based on their results. However, the clinician that performed the initial smear is responsible for making sure that the patient does receive an appointment.
After colposcopy, the practice will be sent a report. The Lab Reports team are responsible for reviewing this. 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
- In the first instance, failure to attend a colposcopy will result in the colposcopy clinic sending the patient another invitation
- If the patient DNAs for a second time, clinical admin are responsible for notifying patients of their appointment and enquiring about the reason for their non-attendance. Patients should be notified via letter, AccuRX and/or telephone call
- If attempts to contact the patient are unsuccessful, clinical admin should report this back to TDL via email. A nurse must sign off the report.
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