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The waiting game

NHS England is reviewing suspension of national screening programmes

Exclusive NHS England is reviewing whether to suspend national screening programmes during the coronavirus (Covid-19) pandemic, Pulse has learned.

GPs in several areas of England have reported they are already being forced to delay routine cervical smears because collection services are unavailable.

NHS England has told Pulse that it will be shortly making a decision on continuing screening programmes during the pandemic.

The devolved nations administrations have already paused many screening programmes.

The BMA has told Pulse that many practices are currently unable to do routine smear tests.

Dr Chandra Kanneganti, the BMA GP Committee's policy lead on NHS England, said that only samples for patients who previously had a suspicious smear are being collected to go to labs, meaning practices are unable to do routine smears.

Dr Kanneganti said: ‘With the routine smears, the main issue is the collection. It’s not [that] we don’t want to do it - we want to do it but it’s not being collected.'

He added: ‘The urgent ones that are abnormal smears - those are being collected and sent to the main lab so those ones are continuing. But routine smears in the majority of practices have been postponed, mostly because the collection service is not there for obvious reasons.’

This is not only the case in his area but is ‘all across the country’, with the GPC aware of collection problems in ‘three or four’ areas, he said.

Previous guidance from NHS England said that practices should ‘aim to sustain a normal cervical screening service’ during the pandemic.

However, the guidance for commissioners, dated 6 April, added that practices can postpone routine smears for six months if ‘unable to sustain a normal cervical screening service due to the Covid-19 pressures and social distancing requirements’. 

It added that samples already taken and awaiting collection should be sent to the lab ‘without undue delay’ and within five days, but that practices may be asked to use alternative methods of transport if collection services are ‘disrupted’.

Smears for women who need screening following treatment or who require an early repeat of their smear can also be postponed for three months but screening appointments should be rescheduled rather than postponed ‘to avoid losing individuals from the system’, the guidance said.

Meanwhile, women who should be given priority ‘if screening is requested, at the GPs discretion’ during the pandemic include:

  • 'Women at risk due to history of abnormal results who have failed to attend colposcopy and remain on early recall.'
  • 'Cases where a delay to screening would significantly raise levels of anxiety and have a detrimental effect on the mental health and wellbeing of the woman.'

The guidance added: ‘However, there may be individual cases that do not fall into these categories and GPs can take clinical decisions on managing these and prioritising them on a case by case basis.’

GPs should also continue to refer any women requiring a colposcopy as a result of their smear ‘as usual’ although appointments ‘may take longer than usual’, it said.

The document adds that the guidance will be ‘reviewed regularly and updated as necessary in light of the emerging situation’.

However, a spokesperson for NHS England told Pulse that a decision will be made soon about whether or not national screening programmes should continue during the crisis.

Wales, Scotland and Northern Ireland have all temporarily paused routine screenings for breast, cervical and bowel cancers; abdominal aortic aneuryms; and diabetic retinopathy in light of the pandemic.

GPs in England have already been warned that some of their urgent cancer referrals may need to be downgraded or avoided when hospital ‘capacity is particularly constrained’ during the coronavirus emergency.

But, despite this, NHS England has said that PCNs should 'make every possible effort’ to start work on the network DES’s early cancer diagnosis specification ‘as planned, unless work to support the Covid-19 response intervenes’.

To date, NHS England has made a number of contractual changes to free up GPs for the Covid-19 effort including suspending QOF reportingFriends and Family Tests, list cleansing and providing access online to historical medical records.

Readers' comments (7)

  • Can someone please explain to me what space time continuum NHS E inhabits.

    Where do they seriously think PCN’s have the time to consider the DES in the midst of the current situation.

    I am our local Cancer Lead for CCG and have some working notes/thoughts but I’m both too busy working and value my self respect to even think about broaching this with my colleagues currently.

    Bit of local maths regarding what’s coming next. Our trust gets approximately 1000 2WW referral per month. Each need investigated before any diagnosis. Let’s take 8% conversation rate (generalisation and varies between specialty) so that is 80 cancers per month. 12 week shutdown is 240 outstanding plus ongoing.

    Haven’t even considered IHD, Dementia etc etc

    We may get through Covid-19 and hats off to all my colleagues of all grades in NHS but it’s the fallout after that scares me big time!

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  • What a splendid way to make a bad situation worse. The number of non Covid 19 deaths will, I fear, eventually outnumber the Covid 19 ones as we now have a NCS, not an NHS.

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  • Extremely surprised to here that GPs have been doing routine smears in the last few weeks when we have had no idea of amount of circulating covid in the community and with poor quality PPE supplied to us!
    Surely at this moment in time the risk of doing routine smears to staff and patients is much higher than the benefit to the patient.

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  • I have complete faith in the Chain of Command.

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  • Herd immunity imposition through the back door. Sneaky.

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  • At this point I'd prefer advice and leadership from our South Korean medical community.

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  • National Hopeless Service

    Reviewing what exactly. Whether or not our nurses should be put at further risk by undertaking a routine procedure that can readily wait another few months?
    NHSE are so detached from frontline GP it beggers belief. I am fed up of being 'managed' by a group of people with half my qualifications, half my age and half my life experiences.

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