Sample Taker Training Policy 1. Training Requirements for Sample Takers 1.1 The NHS Cervical Screening Programme (NHSCSP) guidance recommends that only doctors and nurses who are professionally trained and who have undertaken appropriate training in line with NHS Cervical Screening Programme guidance should undertake cervical cytology testing. Core Foundation Training 1.2 All cervical sample takers must have completed a two day Core Foundation (initial) training course followed by a period of supervised practical training, in accordance with the guidelines in NHS Cervical Screening Programme Publication No 23 (April 2006) Taking Samples for Cervical Screening - Resource Pack for Trainers. Appendix 1 provides an outline of these requirements. Update Training 1.3 The NHS Cervical Screening Programme recommends that all cervical sample takers attend a minimum of one half day update training on the programme and its developments, every three years and that all sample takers should conduct continuous self evaluation to ensure continuing competence in accordance with their professional codes of conduct. Appendix 1 provides an outline of these requirements. 1.4 Sample takers should also audit their individual adequate and inadequate test result rates in comparison with the rates reported by the local laboratory. Workload and Audit 1.5 The Regional Cervical Screening Quality Assurance Team, Public Health England recommends that all sample takers undertake an audit of 20 consecutive samples each year. 1.6 GPs may screen very few women each year, however opportunistic cervical screening in non/lapsed attendees is strongly encouraged. Therefore the South West Quality Assurance Reference Centre position is that for GPs only, if they carry out less than 20 samples per year, their annual individual audit should cover 20 consecutive samples taken and should demonstrate the reason for being taken, i.e. that the woman is within the eligible age range and parameters for the NHS Cervical Screening Programme, and is overdue for screening. It is good clinical governance that all sample takers carry out an annual audit, regardless of professional background. All sample takers, need to be up to date with the requirements of the programme.
2. Commissioning Responsibilities 2.1 The NHS England-South (South West) Region maintain a duty of care to ensure that all sample takers are trained and competent to undertake this role in line with national guidance. The commissioning responsibilities include: Providing Access to Sample Taker Training NHS England-South (South West), Screening & Immunisation Team has a responsibility to organise and ensure that the training provided meets with nationally agreed standards; sufficient training is available to meet demand, and that registers are available to identify all trained professionals working within the Cervical Screening Programme. the employing organisation has a responsibility to ensure professionals can access recognised validated training to meet NHS Cervical Screening Programme standards Validating Training Courses 2.2 Validated training refers to those training courses approved by the local Screening and Immunisation team. This will ensure that the skills of all health care professionals working within the cervical screening programme are deemed to be competent and able to demonstrate that their skills meet the standards set out by the NHS Cervical Screening Programme (NHS CSP Publication No 23 April 2006). Specifying Local Policy 2.3 The NHS England-South (South West) Region, Screening and Immunisation Team will specify their cervical sample taker training and working requirements, in line with NHS Cervical Screening Programme guidance as a minimum standard. These will be documented in the local cervical screening policy document which will also specify the procedure for reminding sample takers where training update is overdue and the process for removal from the register when these requirements are not met. Maintaining an Active Training Register 2.4 NHS England-South (South West) Region is required to maintain a sample taker register. To remain on the register sample takers will be required to have undertaken Core Foundation Training and undertake formal update training every three years. If a sample taker has undertaken training outside of the region, then evidence will be required to ensure that the training meets national recommendations.
3. Cytology Sample Taker Training Aim 3.1 To ensure that the skills of all doctors and nurses who are professionally trained and working within the cervical screening programme are deemed to be competent and able to demonstrate their skills to meet the standards set out by the NHS Cervical Screening Programme. (Publication No 23 April 2006). 3.2 The responsibility for training lies with: the individual professional to understand their limitations and competence the employing organisation to ensure professionals have recognised validated training to meet NHS Cervical Screening Programme standards NHS England-South (South West) Region Screening and Immunisation Team will organise and ensure adequate up to date training is available and that registers are available to identify all trained professionals working within the cervical smear programme. 4. Requirements to Become Approved as a Competently Trained Sample Taker Who Can Perform Cytology Tests 4.1 Doctors and nurses who are professionally registered and working across NHS England-South (South West) Region who have successfully completed a NHS Cervical Screening Programme training programme and attended formal three yearly updates. Registering as Trained Sample Taker 4.2 To be recognised as a trained sample taker and remain on the NHS England-South (South West) Region, Screening and Immunisation Teams register, sample takers must have attended a training course approved by the team, provide course details with dates of training along with a statement of competence from the training provider. This information should be provided to the contacts detailed below: Contact Title Email Telephone Emilie Chedzoy Mike Crew Team Administrator BNSSSG Screening and Immunisation Team NHS England South West House Blackbrook Park Avenue Taunton Somerset TA1 2PX england.bnsssg.screening@ nhs.net 01138255084 4.3 On completion of training, sample takers will be given a unique identification code and held on a central register by the designated Screening and Immunisation Team. The identification code should be used on all correspondence with the laboratory.
Requirements for GPs 4.4 The Screening and Immunisation Team, acknowledges the extensive training that GPs undertake and which is likely to cover many elements of the core foundation training. In recognition of this, all GPs will be requested by the Screening & Immunisation Team for NHS England-South (South West) Region, to complete a self-assessment competence questionnaire (appendix 2) to confirm their competence and knowledge about the Cervical Screening Programme and their ability to undertake cervical cytology testing. GPs will be requested to either confirm their competence or will be able to request further training best suited to their needs. GPs unable to confirm their competence will be removed from the register and advised to refrain from sample taking until competence confirmed. New GPs Moving into the Area 4.5 To be entered onto the NHS England-South (South West) Region sample taker register, GPs new to the area will also be requested to complete the competence questionnaire and undertake update training. This will ensure an awareness of local policy and provide an update regarding any new requirements/policy introduced by the National Cervical Screening Programme. Maintaining Registration with NHS England-South (South West) Region 4.6 All sample takers performing cytology testing should ensure they undertake an approved training programme in line with local policy: participate in three yearly updates by a provider validated by NHS England- South (South West) Region, Screening and Immunisation Team in conjunction with the regional QARC participate in continuous self evaluation to ensure continuing competence be held on a register of trained sample takers with NHS England-South (South West) Regional team maintain a personal training record book/reflective log provide evidence of training and annual self-audit for Quality Outcome Framework (QOF) visits Removal from the NHS England-South (South West) Region Sample Takers Register 4.7 In those instances where a professionally trained nurse has not maintained the required training and competencies outlined above; the Director of Nursing, NHS England-South (South West) Region will be notified and requested to inform your organisation.
4.8 Should the required training not be completed then the sample taker will be removed from the central register and requested to stop taking samples until such time that the appropriate training has been completed. The Director of Nursing, NHS South West Region will notify the individual sample taker s organisation that this action has been taken. 4.9 In the event that sample takers continue to practice once removed from the register; the Screening and Immunisation Team will seek guidance from the Director of Nursing, Nursing and Quality Team, NHS England-South (South West) Region. 5. Training Providers 5.1 To be recognised as a quality training provider, providers must be approved by NHS England-South (South West) Regional Screening and Immunisation Team. Currently approved quality training providers are: Professional Development International (PDI): Foundation and Update training Dr Clare Seemark: Update training Dr Sarah Gray: Foundation and Update Training South West Cytology Training School (based at Southmead Hospital) : Foundation and Update Training 5.2 Course information will be advertised via the Regional GP Bulletins, LMC websites and training provider flyers or directly by approved training providers. 5.3 Sample takers are not limited to the training courses detailed above. Any course which has been accredited by the NHS Cervical Screening Programme will be recognised. Approved Training Courses 5.4 Trainers involved in all types of training courses covered by this policy will be expected to have in place a memorandum of understanding with NHS England-South (South West) Region. 6. Practical Assessment 6.1 Trainee sample takers will be required to make arrangements with an approved assessor (external to the individual s place of work) for sessions of practical observation and training. Approved assessors will have fulfilled the requirements as set out by the NHS Cervical Screening Programme and be registered on the NHS England-South (South West) Region cervical sample takers register. Becoming an Assessor 6.2 It is a requirement that approved assessors will: have been taking samples for a minimum of two years following successful completion of an approved training course maintain accreditation with NHS England South West Region
hold a recognised teaching qualification, D32/33 or A1 assessors award, City & Guilds 730, mentorship module or equivalent qualification participate in continuous self-evaluation to ensure continuing competence attend assessor updates in line with local policy 6.3 Sample takers fulfilling the above criteria and interested in becoming assessors should contact the approved training providers directly.
APPENDIX I 1. Core Foundation Training Course Consists of a two day theoretical course, a practical component and 3 pieces of reflective writing. Theoretical Component Includes: background and organisation of the Cervical Screening Programme equality and access to cervical screening understanding test results anatomy and physiology of the pelvic organs practical aspects of taking cervical samples Practical Component Involves: maintain regular contact with an external assessor to discuss, identify and meet training needs. This should be an external assessor to the individual s workplace observing two samples being taken taking a minimum of ten samples under supervision of an practice mentor document a minimum of 20 consecutive unsupervised samples, of which 80% must identify the Transformation Zone (TZ) have access to a trained colleague during the training period, a trained colleague must be available on the premises while the individual is in training. visit a local colposcopy unit and cytology laboratory before completion of training Complete 3 written pieces of reflective practice on cases seen during the training period. Written pieces should follow a recognised reflective pattern eg. Gibbs Reflective Cycle. Final Evaluation On completion of the above, the trainee will undergo a final evaluation to agree completion of practical training. The assessor will be required to sign an agreement to proceed. Declaration of approval to be sent to the training provider and the student sent a certificate of satisfaction.
It is essential that the programme is completed within the six months. Failure to complete within this time, (unless in extenuating circumstances) will mean a certificate of completion cannot be awarded. The employing organisation will be notified accordingly. A record of successful students will be sent to NHS England-South (South West) Region Screening & Immunisation Team to be recorded on the central database. Extensions A maximum of a one month extension for submission of the audit will be granted in extenuating circumstances. Trainees who do not meet the deadline will not be given a certificate of completion or be allowed to continue with cervical sample taking. Non Finishers Any student who does not satisfy all the requirements of the programme or who does not complete the required number of smears within the recommended time will be required to repeat the course. Discrepancies in Audit Results in Training If any discrepancies are noted in audit result findings this will prompt a thorough investigation by the training coordinator in cooperation with the assessor and the Screening and Immunisation Team, NHS England-South (South West) Region. 2. Update Training Sample takers should undertake a minimum of one half days update training every three years which will include: NHS Cervical Screening Programme update/re-call system developments in cervical cytology current developments nationally and locally quality control audit and reflection personal learning needs
APPENDIX 2 SELF-ASSESSMENT COMPETENCE QUESTIONNAIRE FOR GPs The purpose of this questionnaire is to ensure that NHS England-South (South West) is aware of the competence levels of GP sample taker training, to update the sample taker register and to identify training requirements. We would be grateful if you could complete the questionnaire and return to the address below. Name: DoB Practice: Signature: Date: G.M.C. number L Code..... YES NO I wish to remain on the NHS England-South (South West) sample taker register. Complete all sections below Completion below not required Please complete the following questionnaire to provide evidence of competency for cervical sampling. Section 1: Practical Competencies 1. I understand the physiological and pathophysiological processes leading to disease of the cervix. 2. I understand the NHS Cervical Screening Programme criteria for taking samples and the rejection policy. 3. I know the practical techniques in sample taking and their impact in ensuring adequate good samples. YES NO 4. I understand local laboratory policy and processes. 5. I know how to visualise the transformation zone (TZ). 6. I undertake an annual quality review of my own cytology samples to ensure quality is comparable with local standards (the current
inadequate rate for the local laboratories is currently around 3% Section 2: Awareness of National and Local Policy 1. I understand call/recall system in current use and the obligations of the GP to follow up abnormal cytology results. 2. I have read the local cervical screening policy within the past year and am confident that I am updated on the latest changes. 3. I understand the role of the GP in the completion of the national cancer audit, if requested to do so by the Hospital Based Programme Coordinator for my local screening programme. 4. I understand the process of the call and recall system and the role of the Primary Care Support Services and responsibilities of informing women of their results and failsafe processes. 5 I am aware of local and national policies, for example, taking vault smears and the ceasing policy. http://www.cancerscreening.nhs.uk/cervical/ 6. I have an understanding of the Open Exeter system, namely its purpose, access to additional information and competence in accessing patient record. YES NO 7. I am aware of the National Quality Assurance policy and standards. Section 3: Confirmation of Competence 1. I am aware of the NHS Cervical Screening Programme sample taker training recommendations and I confirm I am competent at cytology sample taking. 2. I would like to remain on the NHS England-South (South West) Region Cervical Sample Taker Register YES NO Section 4: Request for Further Training YES NO 1. I would like to attend a two day core foundation course. 2. I would like to attend a condensed Core Foundation course. 3. I would like to attend an update. Please return this form to: Emilie Chedzoy via email england.bnsssg.screening@nhs.net or post to Team Administrator, NHS England, South West House, Blackbrook Park Avenue, Taunton, Somerset, TA1 2PX