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Additional services

Dr John Couch continues our series by examining the requirements needed to earn points from providing additional services

Points achieved with complete ease

CS5 The practice has a system for informing all women of the results of cervical smears

Value two points

In the majority of areas, postal invitations and results are generated centrally so practices should continue to follow the current system.

CHS1 Child development checks are offered at the intervals agreed in local or national guidelines and problems are followed up

Value six points

One team member should be appointed to ensure CHS guidelines are followed. A protocol is a good starting point and can also help to provide written evidence at an assessment visit. Keep up to date with your local guidelines and include child protection issues. Close liaison with health visitors is essential, particularly in following up problems. Arrange a team meeting at least annually.

MAT1 Antenatal care and screening are offered according to current local guidelines

Value six points

See CHS1. Close liaison with midwives is essential. The BMA Blue Book guidelines state that at the assessment visit a description of antenatal care should be given using the illustration of one case – be prepared for this.

Points achieved with good planning

CS1 The percentage of patients age 25-64 (in Scotland 25-60) whose notes record a cervical smear has been performed in the last three to five years

Value 11 points – sliding scale 25-80 per cent

Payment for cervical smears has been split between the global sum and the quality framework. There is still a target element but this only applies to the quality framework and is on a sliding scale rather than the two previous thresholds. The key to staying above 80 per cent will be exception reporting (see CS3). For the CS1 indicator have a written protocol and ensure ongoing training, especially with the move to liquid-based cytology.

The assessment visit requires a printout of all eligible women, the number exception reported and the number who have had a smear in the last five years. It is sensible to have these searches prepared and tested in advance. Ensure you have a tight system for coding patients who have had hysterectomies.


The practice has a system to ensure inadequate/abnormal smears are followed up

Value three points

Although patients receive central notification of smear results, most practices also have a mechanism for alerting and where necessary referring patients with inadequate or abnormal smears. This usually takes the form of a letter from the practice, recorded in the notes. Practices should have failsafe mechanisms for this. For instance, letters to patients in this category can be done first and when the smear later goes through data entry the clerk can check that a letter has been sent. Include your method in the protocol.

CS6 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

Value two points

To qualify for points in the 2004/5 year this should be done soon as the results of any corrective action need re-auditing. Although this is an emotive issue for doctors and nurses it is important that retraining needs are explored to avoid the sort of headlines seen in recent years. The results of the audit can be restricted on a need-to-know basis to spare embarrassment. It is important to document how any 'educational needs' were dealt with. Smear takers will be interviewed as part of the assessment visit. Include all the above in the protocol.

CON1 The team has a written policy for responding to requests for emergency contraception

Value one point

Once again a written protocol is important. This must be owned and understood by all relevant staff including receptionists to ensure requests for emergency contraception are dealt with quickly. Make this topic an annual item in a team meeting.

CON2 The team has a policy for providing

pre-conceptual advice

Value one point

Read the Blue Book guidelines. Draw up a written protocol. A template would be useful when seeing patients to ensure uniformity.

Points achieved with real


CS3 The practice has a policy on how to identify and follow up cervical smear defaulters; patients may opt for exclusion from the cervical cytology recall register by completing a written statement which is filed in the patient record (exception reporting)

Value two points

Although there are not many points for this indicator it is tightly linked to the more valuable CS1. At least 10 per cent of practices' eligible patients will be immovable defaulters with another 5-10 per cent a little more persuadable. With the old target system this left many practices uncomfortably close to the 80 per cent threshold. The new sliding scale makes life

a little easier. The vast majority of practices have a computerised system so producing a list of defaulters – last smears more than five years ago – is relatively easy, but getting letters signed is not.

A written statement is required so practices will need to decide whether to invest in a mailshot (cost approximately £50 per GP), opportunistic signing or a mixture of both. Make your letter positive: 'We would be happy to carry out your smear. However, if you chose not to, would you please sign....'

Make use of screen alerts for opportunistic signing. Ensure you enter the appropriate Read code (685L) once signed letters are received. File letters in patient's records (more helpful to other practices if patients move) instead of simply scanning them.

CS4 Women who have opted for exclusion from the cervical cytology recall register must be offered the opportunity to change their decision at least every five years

Value two points

Include this in your protocol. Make diary entry five years ahead from start of CS3. You can then search for and write to any patients who were coded for exclusion five years previously. The indicator does not state that patients need to sign once again so a reminder letter should meet this requirement.

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