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The percentage of patients aged from 25 to 64 (in Scotland from 21 to 60) whose notes record that a cervical smear has been performed in the last five years
Standard 40–80%
This indicator reflects the previous target payment system for cervical screening and is designed to encourage and incentivise practices to continue to achieve high levels of uptake in cervical screening.
The practice should provide evidence of the number of eligible women aged from 25 to 64 (from 21 to 60 in Scotland, from 20 to 64 in Wales and from 20 to 65 in Northern Ireland) who have had a cervical smear performed in the last 60 months.
This indicator differs from all the other additional service indicators in that a sliding scale will apply between 40 and 80%, in a similar fashion to the clinical indicators.
Exception reporting (as detailed in the clinical section) will apply and specifically includes women who have had a hysterectomy involving the complete removal of the cervix.
There should be a computer print-out showing the number of eligible women on the practice list, the number exception reported and the number who have had an a cervical smear performed in the last five years (Grade A). In many areas the PCO may provide these data although, other than patients with hysterectomy, they will be unaware of exceptions, for example patients who have been invited on three occasions but failed to attend or those who have opted out of the screening programme. Practices should remove patients from the denominator in the same way as with the clinical indicators.
The print-out should be inspected.
The assessors should enquire on how patients who are exception-reported are identified and recorded.
The practice has a system for informing all women of the results of cervical smears
It is generally accepted as good practice for all women who have had a cervical smear performed to be actively informed of the result. Responsibility for the system may be outwith the practice.
There should be a description of system and example of letters sent to patients. (Grade C)
The team should be questioned on how women are informed of the way they will obtain the result of their smear.
A letter sent to the patient containing and explaining the result is ideal.
The practice has a policy for auditing its cervical screening service, and performs an audit of inadequate cervical smears in relation to individual smear-takers at least every two years
In this audit the criteria, the results, analysis of results, corrective action, the results of the re-audit and a discussion of them needs to be presented. The standard or level of performance against which the criterion is judged would usually involve looking for smear-takers who are obvious outliers in relation to the reading laboratory’s average for inadequate smears.
An audit of inadequate smears should be recorded. (Grade A)
A discussion with smear-takers should take place, dealing with the audit and any educational needs which arose and how these were met.
All the elements for an audit stated in the practice guidance need to be present.
The practice has a protocol that is in line with national guidance and practice for the management of cervical screening, which includes staff training, management of patient call/recall, exception reporting and the regular monitoring of inadequate smear rates
If a robust system for the management of cervical screening is not in place then this is an area of great risk for general practice. The policy may have been drawn up outwith the practice and should be in line with national guidance.
There should be a written policy covering the issues outlined above. (Grade A)
The policy should be discussed with relevant staff and the practice should demonstrate how the systems operate.
It may be necessary to ask the practice to demonstrate how its policy operates.
Child development checks are offered at intervals that are consistent with national guidelines and policy
The child health surveillance programme should be based on national guidelines. It is important that the practice has a system to ensure follow-up of any identified problem and that referrals are made as appropriate.
See: Hall,D. and EllimanD.(2003) eds Health for all children (fourth ed) Oxford University Press Oxford
Health for All Children 4 (Hall 4): Guidance on Implementation in Scotland
www.scotland.gov.uk/Publications/2005/04/15161325/13269
There should be a description of the child health surveillance programme and how problems are followed up. (Grade C)
The practice team is asked for details of child health surveillance in the practice and how problems are followed up.
The practice should be aware of which guidelines it has adopted. The assessors should be content that there is a process to ensure problems are followed up.
Antenatal care and screening are offered according to current local guidelines
Most local areas have produced guidelines, which should be adopted within the practice.
There should be written guidelines on antenatal care and screening. (Grade A)
The assessment should involve a description of antenatal care, using the illustration of one case.
The case should show that the guidance is known and is being used.
The team has a written policy for responding to requests for emergency contraception
The purpose of the policy is to ensure requests for emergency contraception are appropriately handled so that it can be offered within the effective time. Receptionists as well as clinicians will need to be aware of and act on the policy.
There should be a written policy on responding to requests for emergency contraception. (Grade A)
The policy should be discussed.
The policy must allow emergency contraception to be given within the effective time.
The team has a policy for providing pre-conceptual advice
The policy should cover such areas as smoking, alcohol, diet, prophylactic folic acid, rubella status, any genetically inherited condition, substance abuse and any pre-existing medical condition.
There should be a written policy for providing pre-conceptual advice. (Grade A)
The policy should be discussed.
All the elements contained in the practice guidance (2.1) should be present in the policy.
Prepared By Jean Keenan