Patients Pathway

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FAILSAFE
Maggie Luck Screening Commissioning Lead London
QARC
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Responsible for failsafe
Primary Care Trusts - Call Recall teams -
Primary Care - Screening Leads Primary Care -
GPs - Practice nurses - Administration staff
Community Clinics - Clinicians -
Administration staff
Screening Commissioners
Laboratories - Screeners - Pathologists -
Administration staffColopsocopy clinics -
Consultant Colposcopists - Nurse
Colposcopists - Colspocopy nurse -
Administration staff
Hospital Based Programme Co-ordinators
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Patients

• Invitation letter issued

Appointment made at either the surgery or
community clinic for a smear test
Smear sample is sent to the laboratory for
reporting
Smear is reported and returned to the smear taker
and the Call Recall team
Patient informed of her full test result by
either call Recall, laboratory or GP
Normal
Early repeat
Referral
Patient referred to colposcopy clinic
Called again in line with national policy
Called as per laboratory recommendation
Following attendance and or treatment the woman
will be discharged back to her GP or responsible
clinician
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Call Recall Responsibilities

• Issuing invitation letters to women -
  letters should adhere to national policy and
  include the national leaflet

• Entering result details onto the Exeter
  database - confirm the number of results with
  the laboratory - all results where possible
  should be recorded using the national
  laboratory code and national action codes

• Issuing result letters if within local
  policy - letters must include the full result
  and must be sent at the beginning of the week
  
• - If letters are not issued by the PCT there
  should be adequate failsafe arrangements in
  place to ensure results are sent out

• Issuing non-responder cards to GPs - Teams
  should ensure that non-responder cards for non
  negative
• smears are identifiable as GPs receive many
  cards.

• Additional failsafe for women with previous
  abnormal results - If the system rejects the
  current result as it has failed validation they
  must notify the laboratory in writing and ask
  for the test to be reviewed.

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Prior Notification
PNLs are sent to the surgery monthly and provide
vital information on the number of women due for
a smear test. They allow practices to make
advanced assessment of their future Cervical
Screening workload
PNLs should be updated and returned to the
screening team
Invitation and reminder letters issued to the
woman
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Smear Taker Responsibilities

• If General Practice check and return PNLs
• Woman attends for a smear test either at her
  surgery or clinicwhere she will be seen
  by - Administration staff - Practice
  Nurse - GP

Must remember Ive changed my address
Women have a responsibility for ensuring their
records are correct when attending either the
surgery, clinic or hospital
Can I just check your details
Staff at the surgery, clinics and hospital need
to ensure that they check the womans details
against their records
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Smear Takers Responsibilities

• Maintain a register of smears taken and
  check that they receive a result for each
  one.

• Ensure that all women who attend for a smear
  test are aware of how they will receive
• the result of their smear.

- this also applies to women who request no
correspondence or who who are not registered
with a permanent GP - Inform women and treat
infections as appropriate

• Act on non responder notification regarding women
  with previous abnormal results

• Deal personally with women who require urgent
  referral

• Refer women to the Colposcopy clinic for
  further investigation and where necessary
• act upon notification from the clinic if
  women have failed to attend.

• Ensure that appropriate follow-up take place

• Cooperate with failsafe enquiries

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Laboratory responsibility to.
Failsafe system for urgent referrals
Hospital Based Programme Coordinator
Call Recall
Screening Commissioner
GP/Primary Care
Transfer results
Set up a failsafe system for monitoring the
referral
Notify both the Commissioner and the Hospital
Based Programme that the woman has failed to
respond to follow-up
Amend action codes if necessary
4 weeks 1st enquiry
Notify test results and make management
recommendation
6 weeks 2nd enquiry
Failsafe enquires should remain open for at
least six months
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National v London

• 3mths 1st letter to GP
• 6mths Contact GP
• 9mths Check PAS, Contact GP
• 10mths Letter to Commissioner
• 16-20mths Urgent letter to GP/Commissioner

• 6wks Confirm woman has been seen
• 4mths Enquiry to GP if no colposcopy outcome
• 6mths Close F/S, inform Colp and GP
• 24mths Call/Recall invites woman for screening
• Audit F/S procedures annually

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Urgent Referral

• Severe Dyskaryosis ?Invasive and ?Glandular
  Lesions (5S and 6S)
• 2 week cancer wait applies to these patients
• Duty to phone GP and follow this up with a letter
• No letter sent through centralised systems
• Inform GP that he/she must personally inform the
  woman and make referral

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Colposcopy Clinic Responsibility

• Following the referral of the woman by either her
  GP or clinician unless local
• arrangements differ and the laboratory has made a
  direct referral

• The colposcopy clinic will be responsible
  for the womans treatment and for
• arranging further follow-up in either the
  clinic or in the community

• For informing the laboratory and the GP or
  responsible clinician of the outcome

• Colposcopy clinics must have a system for
  notifying laboratories of both the
• woman's attendance and the histology
  results

• Issue reminder letters

• ? Inform PCTs of discharge from colposcopy
  for women who fail to attend

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All of these have their part to play in Failsafe
PCT
CONSULTANTS

GPs
SCREENERS
NURSES
ADMIN STAFF
FPC
COLPOSCOPIST
GUM
HISTOLOGY STAFF