A cervical screening test is an intimate examination. A trained and competent registered professional can provide the appropriate communication, empathy, skill and assurance.

Staff who are not part of a regulated profession should not undertake cervical screening in NHS Ayrshire and Arran. Members of regulated professions must have a licence to practice if that is required by their regulator.
The standard for practice is set out in the National Sample Takers Handbook.

Nurses and midwives

Nurses/Midwives in Ayrshire and Arran may undertake cervical screening providing:

1. The nurse/midwife is registered with the Nursing and Midwifery Council, the nurse/midwife has undertaken NHS Education for Scotland’s (NES) initial programme for cervical screening and has completed a self-certification of competence; or the nurse/midwife has completed training equivalent to the NES training programme and has completed the self-certification of competence; or the nurse/midwife has undertaken an accredited Contraception and Sexual Health training course and has completed the self-certification of competence.
2. They follow the guidelines of the NHS Cervical Screening Programme.
3. They keep their professional knowledge and skills up to date through three yearly update training as recommended in the NES Cervical Screening Educational Standards 2021.
4. They are able to use Scottish Cervical Call-Recall System (SCCRS) correctly to manage requests and results.
5. They have a SCCRS identity so the test can be requested in their name.

Doctors

Doctors in Ayrshire and Arran may undertake cervical screening providing:

1. They can demonstrate competence in taking cervical screening: all doctors are expected to have completed an adequate level of theoretical and practical training as part of their undergraduate, foundation level or specialist training.
2. They follow the guidelines of the NHS Cervical Screening Programme.
3. They keep their professional knowledge and skills up to date through three yearly update training as recommended in the NES Cervical Screening Educational Standards 2021.
4. They are able to use SCCRS correctly to manage requests and results.
5. They have a SCCRS identity so the test can be requested in their name.

In NHS Ayrshire and Arran it is expected that all nursing staff eligible to take the NHS Education for Scotland training will do so.

NHS Education for Scotland (NES) training

The NES Cervical Screening Education Standards were published in 2021¹. The document aims to support high quality and continuous improvement in cervical screening practice through effective and consistent education.

The essential course contents for initial education are:

• Anatomy and physiology of female reproductive system
• Consultation skills
• Cervical sample taking
• Cervical screening results pathway
• Colposcopy overview
• Laboratory overview
• Scottish Cervical Call Recall System overview / links to resources
• Sexual health overview
• Equality and diversity
• Barriers and enablers to cervical screening engagement
• Menopause overview
• Trauma informed care.

Learning outcomes as specified in the NES Cervical Screening Education Standards 2021 on successful completion of the initial training course are:

• Apply knowledge of basic anatomy and physiology to recognize a healthy cervix and apply skills in the role of the health care professional in cervical screening.
• Demonstrate knowledge of the incidence, pathophysiology, and treatment of cervical cancer.
• Understand the principles and criteria for screening and apply them to cervical screening, showing knowledge of the Scottish cervical call recall system (SCCRS).
• Recognize common vulval, vaginal and cervical conditions.
• Carry out person centered consultations
• Initiate effective health education based on the health beliefs of the person and supportive conversations for any previous negative experiences and trauma informed practice.
• Demonstrate awareness of primary HPV testing, clear understanding of results and offer appropriate responses in relation to cervical cell changes, Colposcopy pathways and treatment options.
• Understand barriers and enablers to participate in cervical screening.
• Understand the principles of taking correct cervical samples and ensuring correct preparation of the cervical samples which are dispatched safely to the laboratory for analysis.
• Undertake and critically analyse a minimum of 5 supervised cervical samples that cover the whole patient consultation and a minimum 5 unsupervised cervical samples that cover the whole patient consultation.

NHS Education for Scotland created a pathway for Cervical Screening initial training in June 2022. This includes completion of theoretical modules; practical training under the supervision of a practice assessor, and a summative assignment, for example, a piece of quality improvement work.

NHS Education for Scotland developed a training module that is available through the Turas learning platform for General Practice Nurses. The theoretical module is estimated to take approximately 8 hours to complete.

NHS Education for Scotland have provided proformas to be completed during practical training under the supervision of a Practice Assessor. The Practice Assessor must be registered with the NMC or GMC and have an up-to-date certification of update training. It is advised that General Practices ensure the Practice Assessor has adequate time to support the learner.

A Quality Improvement (QI) project is required to be submitted within a specified period. There will be three opportunities within each calendar year for submission. QI projects will be appraised against standardised criteria.

The NES module is free to access. Learners will be notified on Turas when their training has expired and requires renewal. Update training is required for active screeners every three years.

Local Ayrshire and Arran training

Staff members starting in roles which will require skills in cervical screening, who are not eligible to undertake the NHS Education for Scotland cervical screening training, will be supported with training on an individual basis.

An NHS Ayrshire and Arran Learning Log for Cervical Screening training has been adapted from NES documentation.

Commercial provider

Cervical screening initial training is available through commercial provider sources, for example, Napier University.

Register of sample takers approved to undertake cervical screening in Ayrshire and Arran

A local register of all sample takers working in NHS Ayrshire and Arran will be kept by Public Health, to support local governance of the Cervical Screening Programme. The register will include sample takers working in:

• Primary Care
• Women and Children’s Directorate
• Other areas of the organisation, for example blood borne viruses (BBV), Addictions or Prison service.

The register will be updated on an annual basis.

Both training options below are provided in accordance with the NES Cervical Screening Education Standards 2021 and include the following information as specified in the Educational Standards document¹:

• A revision of anatomy and physiology to recognize a healthy cervix and apply skills in the role of the health care professional in cervical screening.
• A clinical update of Human Papillomavirus (HPV) and the principles of taking a correct cervical sample.
• Person centered focus for all consultations to initiate effective health education based on the health beliefs of the person and supportive conversations for any previous negative experiences and trauma informed practice.
• All Scottish cervical call recall system (SCCRS) user updates.
• Education of primary HPV testing, results, colposcopy pathways and treatment options.
• Discussion on the barriers and enablers to participate in cervical screening.
• Sharing best practice across the profession.

NHS Education for Scotland update training

The NHS Education for Scotland (NES) cervical screening training module can be completed every three years to evidence update training. The module provides knowledge essential for understanding the NHS Cervical Screening Programme and for safe smear taking. The NES module is available on Turas learn and is estimated to take a minimum of 4 hours to complete.

The module is available to GP practice nurses, adult nurses, district nurses, GPs and GP trainees. Instructions for GPs/GP Trainees to allow access to the update module via their TURAS Learn account are outlined in Appendix A.

Certification of update training is available following completion of the module.

Local Ayrshire and Arran update training

A cervical screening update module has been created and is available on the LearnPro platform. Clinicians accessing the update training will complete a self-assessment to obtain certification of completion of update training. The module is estimated to take under 1 hour to complete and is available to all NHS Ayrshire and Arran staff whether working in primary or secondary care.

Update training for practice staff on administration processes

Prior to the Covid 19 pandemic, Call Recall Office (CRO) staff contacted GP practice managers to offer SCCRS update training. It is acknowledged that staff change regularly, and constant update is required to ensure SCCRS users remain up to date. CRO staff have received good feedback for outreach sessions provided, with both primary care and CRO staff finding the opportunity worthwhile.

Staff from the Call Recall Office will provide a biannual update opportunity, open to practice administration and clinical staff in May and November. This will cover any changes to procedures or usage of SCCRS and provide the opportunity to build relationships and ask questions. Call Recall Office staff are also able to provide bespoke training to practices / clusters if specific learning needs are identified.

Training will include reminders of SCCRS processes, of opt out / opt in processes, and signposting to local and national resources.

Clinical updates for staff

Communications will be circulated via email to primary care, in a timely manner, with relevant information regarding the cervical screening programme locally and nationally.

An annual / biannual clinical update will be provided on wider changes in the cervical screening programme between clinician’s 3 yearly update training certifications. This will ensure clinicians are kept abreast of developments, have an opportunity for peer support, and learning from local incidents can be reviewed.

A recording of the most recent clinical update presentation will be stored on the A+A CPD Teams channel (or current platform used) to facilitate access for clinicians unable to attend. This provides an opportunity for sessional and part-time primary care staff to keep up to date.

Sexual Health staff are supported with departmental training, through which there is an update session on cervical screening.

Clinical update information will be circulated to sample takers working in other departments within NHS Ayrshire and Arran facilitated by the Public Health log of active sample takers and other local channels.

Staff undertaking cervical screening must also be able to use SCCRS, the Scottish Cervical Call Recall System to submit requests for a test to the laboratory.

The Sample Taker QA / User Group, National User Group and the NHS Board Cervical Screening Coordinators have agreed that the SCCRS User Manual should be used as the basis for SCCRS training.

Specific sections in the SCCRS User Manual have been defined as relevant for each individual SCCRS Sample taker in one of 5 'roles':

1. GP sample taker
2. Practice manager/admin staff
3. Practice nurse
4. Community smear taker (e.g. sexual health clinic, gynaecologist, gynaecology nurse) or
5. Mobile user (someone who takes smears in more than one location where the results have to go to different locations)

The SCCRS Smear taker user manual is available over a secure NHS connection at:
http://www.nsd.scot.nhs.uk/services/screening/cervicalscreening/index.html

New users must be familiar with the content relevant to their discipline prior to using SCCRS. The website specifies the sections of the manual relevant to each role.

New users should also have practical training on using the application e.g., demonstrations by colleagues and supervised practice. A limited SCCRS training site is available over a secure NHS connection at:
http://sccrstrain.mhs.scot.nhs.uk/SCCRS/Login/Forms/Login.aspx

Login details are linked from this page: General – SCCRS (scot.nhs.uk)

Supervised demonstration of SCCRS in-house is encouraged.

On completion of the training a username and password allowing access to the system is issued by the Call Recall Office on receipt of a signed proforma, supported with the signature of the applicant’s line manager.

To obtain the appropriate role specific SCCRS application form please contact the local Cervical Screening Call Recall Office in the Gatehouse, Ayrshire Central Hospital. Tel 01294 323450.

To access the SCCRS clinical interface the url is:https://sccrs.nds.scot.nhs.uk/SCCRS/Login/Forms/Login.aspx

Staff must be aware of the local procedure to follow in the event that SCCRS cannot be accessed.

For problems with the system contact the e-health helpline: 01292 513355. The call–recall office may also be able to help: 01294 323450.

Governance

Following recognition of a national incident, GP practices and line managers must ensure that:

• All sample takers have fulfilled all the initial training requirements to undertake the cervical consultation.
• All sample takers are completing the required update training every 3 years as stipulated in the educational standards.

Evidence that could be gathered to ensure sample takers have completed necessary training (as detailed above) includes:

Initial sample taker training:

• Evidence of completing initial training e.g. certification from NES, local training or a higher education institution.

Update training:

• Providing confirmation of having participated in update training within the past 3 years.
• If they haven't taken part in update training in the past 3 years, providing assurance to their employer that they will participate in update training within the next 3 months (which could be followed-up later in the year)

Overall responsibility for the governance of cervical screening and the use of SCCRS remains with the practice / sample taker location.

Suggestions to include as clinical documentation are:

• Reason for attendance – routine or first screen / defaulter / repeat test.
• Procedure explained / understood / consent obtained.
• Chaperone offered / accepted / declined / name of chaperone.
• Symptoms or absence of symptoms, any additional samples taken.
• Problems encountered – position of cervix, speculum size, pain.
• Appearance of cervix – healthy / ectropion / contact bleeding / vaginal atrophy.
• Advice given / how will receive results and timeframes for receiving.

This procedure must be followed to minimise the risk of samples being lost or mislabelled, and to ensure abnormal smears are referred appropriately by SCCRS (Scottish Cervical call Recall System) because they have been requested in the correct SCCRS module
It is the responsibility of the person taking any lab test, including cervical screening samples, to check that the result has been reported and appropriate action taken.

Process for cervical screening samples taken in Gynaecology OPD/theatre

Cervical Screening samples should only be taken by staff members approved by the health board to undertake the sample.

The test should be taken in accordance with the advice of the National Sample- takers Handbook http://www.sccrs.scot.nhs.uk/smtakers.html

Sample takers must have a SCCRS identity so the test can be requested in their name.

The Cervical Screening Call Recall Office (CRO) can set up a SCCRS identity. Contact 01294 323450.

The sample may be logged in by the sample taker or a proxy user. The request can be made via https://sccrs.nds.scot.nhs.uk and a label printed off later.

Samples must be labelled with a CHI number as soon as they are taken. Apply a CHI bar-numbered hospital sticker to the lid of the pot it so that the sample can be correctly identified. A SCCRS barcode label will be applied to the side of the pot when it is available. The hospital sticker can them be removed.

Out-patient clinics and theatres have label printers: requests should be made in SCCRS in the location they are obtained and the sample sent direct to the pathology laboratory.

Samples taken in out-patients or theatre must be put through the community module of SCCRS (pink pages)

This section was accurate at point of writing August 2022:

Please see the below details for you to pass on to GPs and GPSTs who are interested in completing the Cervical Screening update eLearning module:

“We are delighted to make the new Cervical Screening update eLearning available to GPs and GPSTs in Scotland. Please note that access is permitted to the Cervical Screening update eLearning module only and not the Cervical Screening initial eLearning module.

Learners must have a TURAS account to be able to access the eLearning - TURAS registration page.

To access the update eLearning, you will need to ensure that your TURAS registration details are noted as follows:

Once you have updated your TURAS account, you will be able to access the Cervical Screening update eLearning module.

Our work is funded by the Scottish Government to produce educational modules for general practice nurses, and therefore access is restricted. NES working with the National Specialist and Screening Directorate (NSD) fully understand the need for equitable access to Cervical Screening update training for those who have already trained as sample takers. Therefore, access has been extended to include GPs and GPSTs working in Scotland.

For all enquiries, please contact cpdconnect@nes.scot.nhs.uk.”