Dear Colleague
Restoration of Screening Programmes
During the first peak of Covid -19 pandemic, screening services were paused to protect people from infection and allow the staff, running the screening programmes, to support critical services. All screening services have now restarted and aim to invite people, who have had their screening invitation delayed, as quickly as possible. Infection control processes are in place to minimise the risk of Covid-19 transmission.
It will take some months for all screening programmes to be fully restored, but we are now seeing the screening rates increasing. We would like to thank you for the efforts you and your staff are taking which has achieved a rate of cervical sample taking in London that exceeds pre-Covid levels.
There are some points that we would like you to be aware of and messages that may be helpful when talking to your patients:
• Previous barriers to screening may be exacerbated by the pandemic
• Be proactive in contacting people about the importance of their screening and raise it opportunistically during appointments
• If your patients express concern about the delay in their appointment, please reassure them that will they will be receiving one as soon as possible.
• Please encourage your patients to attend for screening when they receive their appointment.
• Reassure patients that infection control processes are in place for all screening programmes. When your patients attend for their appointment there may be some changes in the previous process. For example, they may be invited to a different venue. They will be expected to wear a face covering and may have their temperature taken when they arrive.
• Specific information about individual programmes is included in the attached annex
• If a patient presents to you with symptoms, please refer them using symptomatic pathways
If you have queries about the changes that have taken place in relation to screening please contact your local programme or email england.ypa@nhs.net
Yours faithfully
Liz Wise
Director – Primary Care and Head of Screening
Dr Kathie Binysh
Public Health Commissioning
Annex
Cervical Screening:
• Invitations delayed due to Covid -19 have now been sent.
• All practices should be offering cervical screening services for women aged 25-64.
• Intervals for issuing invitation letters have returned to normal
• Practices are asked to pro-actively contact: Non-responders who have previously been invited to screen and older women who should complete their final screening test.
• Women who call to book an appointment may be more worried than usual about visiting their GP surgery. Practice staff are encouraged to reassure them that measures have been put in place to ensure their safety. (i.e. PPE, social distancing, and extra sanitisation of waiting rooms and treatment areas).
• IPC/PPE protocols should be followed. https://www.england.nhs.uk/coronavirus/primary-care/infection-control/
• Colposcopy services continue to be available.
• STPs/ICSs, Cancer Alliances continue to work with NHSE&I, PHE, secondary and primary care to deliver the safe return of cervical screening services across London.
Bowel Screening:
• Bowel Cancer Screening Programme has recommenced for all people aged 60-74 years.
• Bowel Scope Screening is still paused until further notice.
• Progress with the recovery plan will be monitored via the established Bowel Cancer Screening Recovery Board.
• Please only refer someone who has a positive bowel cancer screening test to the 2-week wait urgent referral pathway if they have symptoms suggestive of colorectal cancer.
• If the patient is not symptomatic and eligible for screening, please advise them to contact the free bowel cancer screening helpline (0800 707 6060) for advice.
Breast Screening:
• Breast screening services have been providing screening with mammography and/or MRI for women who are at higher risk of developing breast cancer, such as BRCA gene carriers, throughout the course of the pandemic.
• Assessment services continued for women who had an abnormal mammogram.
• Infection control measures have led to a significant reduction in the capacity in breast screening services.
• Services are appointing women who have had their appointment delayed.
• National changes agreed, have paused the Age Extension (Age X) trial.
• Women due /overdue for screening and women over 71 years may self-refer for screening. Priority for appointments is being given to women in the 50 – 70 year age range.
• Some women are receiving invitations that ask them to phone up and make a screening appointment (open invitation) rather than giving them a definite appointment time. This invitations method will be rolled out across London over the next few weeks.
• Please encourage your patients to take up the offer of screening, but if they have an appointment, they are unable to attend, it is important that they ring and inform the screening service so that appointment may be offered to someone else.
• The Breast Screening Hub helpline remains open for women who have queries. Telephone number is 0203 758 2024. The Hub website may also assist women with their queries. https://www.london-breastscreening.org.uk/home.aspx
• Any woman who presents with symptoms should be referred via the two-week rule rather than advising her to wait for her screening invitation.
Diabetic Eye Screening Programme (DESP):
• Diabetic Eye Screening is available across London and screening providers are inviting patients in-line with the risk stratified guidance produced by Public Health England and supported by NHSEI.
• Screening for some high-risk patients continued although the wider service paused.
• Referral pathways into hospital eye services for urgent and routine patients are established across the region, although in some areas patient’s may be asked to go to a different hospital than they would normally, in order to support hospitals, manage demand and capacity challenges
• Please encourage patients to attend when invited as a critical part of managing their diabetes and contact the services via the usual contact number and/or email with any query.
• Anyone with diabetes who experiences changes to their vision, should be given immediate access to eye care services.
Abdominal Aortic Aneurysm Screening (AAA)
• The Abdominal Aortic Aneurysm Screening (AAA) has recommenced
• Men are being invited for screening according to a hierarchy of risk that has been produced by Public Health England and supported by NHSEI
• Referrals into vascular treatment centres are re-established across London, with treatment centres managing all AAA patients according to clinical risk.
• This may mean that some screen detected AAA referrals are not seen within the timelines agreed nationally. Lists and surgery prioritisation are being managed by the vascular centres.
• Screening continues to be offered out of community-based venues that have been risk assessed and where a COVID-secure environment and pathway has been established.
• Please encourage all men to attend for screening when invited and contact the local screening programme with any queries.
• If any man presents with symptoms of AAA, they should contact 999 for emergency assistance.