Changes ushered in under the 2013 Health and Social Care Act led to a drop in cervical screening uptake in some areas, a study suggests.
A move from primary care trusts being solely responsible for delivering the cervical screening programme to a system where CCGs, local authorities, Public Health England and NHS England all had a part to play, led to ‘confusion’ and disruption of services, researchers found.
And figures published in BMJ Open show that the areas most at risk from lack of clarity over roles saw a greater drop in uptake.
Interviews with 143 commissioners and senior managers suggested that the 2012 Act had introduced confusion over responsibilities for cervical screening and led to variation in service provision.
This included disagreements over whether sexual health clinics would continue to offer screening and some CCGs having to coordinate with multiple local authorities who had different spending priorities.
Some interviewees predicted that the confusion over budgets and responsibilities and reduced choice for patients would have led to a drop in uptake.
A lack of capacity in general practice in areas where sexual health clinics had taken part in screening before the changes was also flagged as having the potential to cut screening rates, the researchers said.
To look at the impact in more detail, the researchers analysed figures before and after the Health and Social Care Act and found greater decline in cervical screening in GP practices in CCGs who had two or more local authorities to coordinate with and potentially more upheaval to services.
The national cervical screening programme has faced a host of problems recently.
In March, Capita was stripped of its contract to run the cervical cancer administration with NHS England announcing the service would be brought back ‘in house’ from June.
The move came after it emerged the company had failed to send thousands of letters regarding invitations, reminders and results.
The same month Public Health England launched a campaign to tackle a 20-year low in attendance rates for smear tests.
A review of all NHS cancer screening programmes is currently underway.
Study leader Dr Jonathan Hammond, a research fellow at the University of Manchester said previously PCTs had funded sexual health clinics and GPs so it did not matter where women had their smear test but after the Act came in issues with budgets and who should fund what came into play.
‘The post-Act arrangements were a source of confusion and frustration for various parties.’
‘Taken together, our findings suggest that there is an urgent need for clarification as to who holds the budget, and therefore who should be commissioning, cervical screening in the English NHS, and for local agreements to ensure that issues over funding and budgets do not disrupt screening programmes,’ he concluded.
Professor Azeem Majeed, professor of primary care at Imperial College London said the Health and Social Care Act had a lot of negative effects including on fragmentation of public health.
‘In my view, it would be more appropriate for responsibility for these public health functions to lie with the NHS.
‘In some cases, such as smoking cessation and sexual health, GPs and their teams have been put in a difficult position because they have been expected to fill in for the shortfall in local authority-funded services.’
He added that GPs should be lobbying for public health functions to ‘move back to the NHS’.
[paper https://bmjopen.bmj.com/content/9/4/e024156.long]
