Leading change

The practice nurse from Cobridge General Practice Surgery identified unwarranted variation in the uptake of cervical smear tests. By implementing small changes across the whole general practice (GP) team, the practice nurse supported an increase in the uptake of cervical smear testing.

Where to look

The practice nurse identified unwarranted variation in the uptake of cervical smear tests. Across all eligible registered patients, the uptake rate was 60%, which was well below the national average, the recommended General Medical Services (GMS) rate of 80% and the Stoke average of 75.4%. Evidence shows that the higher the smear test rate, the greater the reduction in cervical cancer.

What to change

Before the change, the surgery undertook cervical smears tests only when women booked-in after receiving a letter from the national screening programme. The practice nurse recognised the need to be more proactive in encouraging patients to have cervical smears tests as the uptake rate following the national screening letter was not representative the female population registered with the practice.

How to change

The practice nurse created a plan for effective patient engagement, involving  the whole general practice team including reception staff, the practice secretary, midwife and doctors. The plan  identified a range of patient contact opportunities  to support conversations regarding cervical smear tests, and opportunities for the practice to be more flexible and responsive to undertaking cervical smear tests within the surgery schedule.

The plan included:

• Utilising every patient contact, reception staff were requested to initiate a relevant conversations for patients when booking or attending a different routine appointment, adding notes against their name when due a cervical smear test, so that the practice nurse or doctor could discuss it with the patient.
• Ensuring a shared initiative across all general practice staff to improve the uptake rates.
• Providing patient leaflets in a range of languages to support any hard to reach groups. This also included showing a film explaining what happens when a smear is taken.
• Enable flexibility to provide cervical smear testing immediately if a patient identified she was ready to have the test, for example mothers attending baby immunisation clinics.

Adding value

• Better outcomes – The practice’s cervical smear testing rate has increased from 60% to 78%, with increased cervical cancer detection rates.
• Better experience – Patients’ understanding of cervical smear testing has increased, with many giving feedback that the experience was better than expected. Individual patients, who had previously not had smears and who through the practice nurses efforts went on to discover abnormal results, have personally thanked the nurse. Practice staff have been enthused by the shared initiative.
• Better use of resources – Increasing access to cervical screening significantly supports the prevention agenda. Making every contact count has proved to be an efficient way of achieving the practice’s goal.

Challenges and lessons learnt for implementation

No matter how large the problem, it is possible to make improvements over time through small steps. In this case, it was important to include the entire practice team from the outset, explaining why the effort was being made and providing updates. Investing the time in the practice team ensured effective outcomes for patients and a shared investment form the whole team.

Find out more

For more information contact:

• Hazel Nelson, Practice Nurse, hazelnelson@nhs.net.uk