Screening

Screening and the role of primary care clusters

Introduction

Screening is a process for identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate (ideally early) treatment to reduce their risk and/or likelihood of complications arising from that disease or condition. The UK National Screening Committee and Wales Screening Committee decide which screening programmes are delivered in Wales; all are evidence-based using an established set of criteria for appraising the viability, effectiveness and appropriateness of a screening programme.

Public Health Wales (PHW) deliver seven national population-based screening programmes across Wales, and coordinate the all-Wales managed clinical network for antenatal screening.  These programmes are either primary prevention with the aim of reducing incidence of disease (e.g. cervical screening), or secondary prevention with the aim of early diagnosis to reduce the impact of the disease (e.g. breast screening). The PHW long-term strategy aspires to increase disease prevention and earlier intervention through approaches to maintain and improve focus on national population-based screening programmes. When disease is detected, pathways of care will be seamless. Each of the screening programmes is delivered across the NHS according to its target audience. For further information, cluster-level uptake data, and the key messages within each programme, click the respective programme graphic below:

Abdominal aortic aneurysm screening	Antenatal Screening Wales
Breast Test Wales	Newborn Hearing Screening Wales
Bowel Screening Wales	Newborn Bloodspot Screening Wales
Cervical Screening Wales Cervical Screening sample taker training (professionals only)	Diabetic Eye Screening Wales

 

Why is screening important to clusters?

The important role of screening is already well-recognised in many cluster plans and this reflects a national strategic context for prioritising improvement action in this area, including:

A healthier Wales: our plan for health and social care 2018 (WG 2018; link) highlights the need for a shift towards greater prevention and early intervention.

The Cancer delivery plan for Wales 2016–2020 (link) recognises the role of screening programmes (together with targeted prevention and equitable access to care) in helping to drive down
socio-economic and geographical variation in cancer outcomes; it also notes the need for improved screening uptake.

Uptake/ coverage data for several screening programmes, reflecting the primary care contribution, are reported to Welsh Government as part of the Primary Care Measures quality improvement indicators (link).

The Prevention and well-being workstream within the National Strategic Programme for Primary Care includes the aim of “Reducing variation between clusters and making overall improvements in
vaccination and screening programme uptake.” Clusters are advised to review their screening uptake as part of their cluster IMTP and consider reasons for variation between practices within the cluster, learning from good practice and supporting those with lower uptake.

What can clusters do to help improve screening uptake?

Broad cluster-level improvement action may include one or more of the following for incorporation into the cluster IMTP:

Make every contact count by opportunistically asking about screening participation

Raise staff awareness of screening programmes

Raise awareness of screening among patients visiting GP practices

Raise public awareness of screening programmes

Review screening uptake data and relate this to cancer incidence

Ensure awareness and implementation of NICE guidance relating to the role of community pharmacies in promoting health and well-being (link)

Consider adopting learning from implementing screening-related improvement actions in other clusters or practices across Wales

Engage with your cluster population to consider any community views on local barriers or facilitators to screening access

Identify relevant local assets or partnership opportunities that may help promote screening

Consider whether any additional local data might be needed to help inform a decision on best-value improvement action

For bowel cancer screening, provide routine GP endorsement to encourage screening participation

For cervical cancer screening, review access to cervical screening appointments

Many clusters share GP practice uptake data within their cluster in order to identify learning and best practice.

What support is available to clusters to make uptake improvements?

Support is available to help ensure that screening is considered for inclusion in all cluster and IMTPs. The Primary Care Needs Assessment (PCNA) tool (link) provides uptake data and further detail/ signposting around the above improvement actions for uptake of bowel (link), breast (link) and cervical (link) screening. Similar advice to clusters may be added for other screening programmes as the tool develops.

The PHW Screening Division’s Screening Engagement Team (SET) can offer:

• Screening uptake data at cluster, local authority and health board level—updated annually and available from each programme website as above
• Support to clusters with low uptake of screening, providing information on evidence-based initiatives aimed at reducing inequalities and inequities both in uptake and outcome, alongside improving informed choice and uptake 
• Resources including accessible information, for example for people with learning disabilities (downloadable from the programme websites )
• GP practice-specific uptake reports and hardcopy versions of some resources are also available.

For more information, contact SET via screening.feedback@wales.nhs.uk.

Local public health teams (LPHTs) are based within each health board, and may be in a position to support clusters with access to public health advice; advice on developing plans; advice on implementing action; and evaluation advice around proposed improvement actions. LPHTs typically have a named screening lead. Links to LPHT information in the seven health boards are given below:

• Aneurin Bevan University Health Board
• Cardiff and Vale University Health Board
• Betsi Cadwaladr University Health Board
• Hywel Dda University Health Board
• Powys Teaching Health Board
• Swansea Bay University Health Board
• Cwm Taf Morgannwg University Health Board

Signposting to related learning/ other support resources

• Programme-specific promotional resources may be available from the individual programme websites or via the Screening Engagement Team.
• For Making every contact count (MECC) e-learning (to level 1), see here [ESR or other login/ registration required]. For MECC training contacts by health board, see here [intranet].
• Advice to clusters relating to cancer incidence (link) and prevalence (link) is available as part of the PCNA tool.
• A broad range of cancer intelligence products are available via the Welsh Cancer Intelligence and Surveillance Unit (WCISU) website (link).
• Primary Care Cancer pages, including the Cancer Quality Toolkit for Primary Care, are hosted by Macmillan.

Acknowledgement: Input into this page was received from PHW Screening Division, Primary Care Division, and local public health teams based in health boards. Directors of Public Health and Directors of Primary Care were provided with an opportunity to review draft page content.