A smear taker is a registered health professional such as a medical practitioner, registered nurse, enrolled nurse or registered midwife.

The smear taker has successfully completed a course of training as a smear taker and has demonstrated competency against the national standards.

All smear takers are required to complete cervical screening training through one of the training programmes listed below:

• training as part of a medical degree
• NZQA midwifery training programmes
• NZQA accredited courses for non-medical smear takers.

Responsibilities of smear takers

Smear takers play a key role in the NCSP and are responsible for:

• identification of women for whom screening is recommended and the maintenance of appropriate call and recall systems
• educating women about the benefits of screening, the NCSP and the NCSP-Register, while at the same time ensuring the limitations of screening are understood
• educating women about the importance of regular smears
• explaining to women, that regardless of a normal smear result, any signs or symptoms suggestive of cervical cancer need to be reported to her general practitioner immediately
• obtaining informed consent regarding HPV testing
• providing a smear-taking service
• ensuring results are received for each smear and HPV test taken and that women with abnormal smears are appropriately followed up
• ensuring women are referred for specialist assessment and investigation when required and coordinating their ongoing care when investigations are complete
• sending a copy of smear and HPV test results to the woman's GP, if the smear taker is not her regular GP, provided the woman has consented to this.

Smear takers have responsibilities through the NCSP Operational Policy and Quality Standards (NCSP OP&QS).  Section 4 of the NCSP OP&QS outlines general requirements that smear takers should become familiar with and incorporate in their practice.  The Standards and Polices are requirements for providers who have a contract with the National Screening Unit but are also guidelines for other organisations, such as Primary Health Organisations.

Informed consent

Informed consent is an important part of the relationship between the smear taker and the woman and it is important that full information about the procedure is provided.  Sufficient information includes discussing the following:

• the preventative function of having a smear and that it is a way of detecting pre-cancerous changes to cervical cells
• the difference between a screening test and a diagnostic test - explaining that the smear test is a screening test only and as such has inherent limitations
• the procedure, equipment and the anatomy involved in the detail required
• how all results will be provided
• where to access information about the NCSP.

112L Duties of persons taking specimens for screening tests

In addition under Section 112L of the Health Act 1956, Part 4A there are specific duties for persons taking specimens for screening tests.

• Every person who takes a specimen from a woman for the purpose of a screening test, and who believes that it is that woman's first screening test in New Zealand, must-
  • explain the procedure and provide information about the importance of having regular screening tests, the objectives of the NCSP, the risks and benefits of participation in the NCSP, who has access to information on the NCSP-Register, and the uses to which that information may be put; and
  • advise the woman that she will be enrolled in the NCSP, but that she may prevent or cancel that enrolment by advising the NCSP manager under section 112G.
• Every person who takes a specimen from a woman for the purpose of a screening test, and who believes that it is not that woman's first screening test in New Zealand, must provide that woman with information about the procedure and about the NCSP to the extent that is reasonable in the circumstances.
• Subsections (1) and (2) do not limit any other obligation to provide information that arises under any other enactment or rule of law.

NCSP standards for smear takers

Section 4 of the NCSP Operational Policy and Quality Standards requires the following standards to be met for smear taking:

Standard 401:  All smear takers will complete a recognised educational course in smear taking practice prior to providing a smear taking service for women.

Standard 402:  Smear takers will invite or recall women and provide a smear-taking service in accordance with the Guidelines for Cervical Screening in New Zealand 2008.

Standard 403:  Smear-taking providers will ensure that women have access to information about a range of providers who take smears.

Standard 404:  Smear-taking providers will ensure that Māori women are given information about a full range of options for smear-taking, including services provided by Māori.

Standard 405:  Smear takers, including specialists, will ensure women have been provided with the required information prior to taking a smear, requesting an HPV test or a histology sample.

Standard 406:  The smear taker’s practice will have appropriate infection control procedures and facilities.

Standard 407:  Smear takers will provide the woman’s family name or surname and initials of first or given names and NHI  number on liquid based cytology vials.

Standard 408:  Prior to sending the referral form and the specimen to the laboratory smear takers must ensure that either of the following is completed;

• minimum information (outlined in Section 4 of the NCSP OP&QS) on a generic laboratory form, or
• all details on the NCSP laboratory form.

Standard 409:  Smeartakers will ensure that 100% of women know how they will be notified of their results.

Standard 410:  Smear takers will have processes in place to ensure that results are obtained from the laboratory within 15 working days of  the laboratory receiving the specimen.

Standard 411:  Smear takers will recall women in accordance with laboratory recommendations on smear results and clinical indications.

Standard 412:  Smear takers will have processes in place which ensure all women with an abnormal smear result or high risk HPV detected result or abnormal histology result are appropriately followed up.

Professional development

The NCSP expects smear takers to have an up-to-date knowledge of smear-taking techniques, screening issues and the NCSP, including its benefits and limitations.

Smear takers are expected to maintain their competence by:

• monitoring their smear adequacy rate via their Quality of Smear report
• taking smears on a regular basis (a minimum of 30 per year recommended)
• reading current information from the NCSP and relevant journal articles
• attending regular clinical updates run by relevant professional bodies, NCSP Regional Services and/or the NSU - one smear taker update session a year is recommended.

Smear takers who persistently have high rates of unsatisfactory smears should seek further training in smear-taking techniques.

NCSP competencies for smear taker training

These competencies for smear taker training provide details of the skills, knowledge and attributes expected of a cervical smear taker as well as the requirements for training entry, assessment and maintaining competence.  

The competencies have been developed by the NCSP in consultation with stakeholders to ensure nationally consistent teaching and assessment standards. Providers of training programmes are required to be registered and accredited by NZQA to deliver Unit Standard 1098: Perform cervical screening and cervical smear taking.

Smear taker training grants

The Smear Taking Training Grant is a reimbursement of course fees that is paid on successful completion of smear taker training at a recognised course.

To be eligible to apply for a training grant you must:

• meet the criteria for entry to smear taker training, outlined in the NCSP Competencies for Smear Taker Training
• be in a position to begin or continue to take cervical smears for the NCSP as a part of your employment; and
• provide the required and other documentation including evidence of employer endorsement and a copy of an NZQA Record of Achivement showing completion of Unit Standard 1098 Perform cervical screening and cervical smear taking.

HPV testing

HPV testing as per the Guidelines for Cervical Screening officially commenced on 1 October 2009.

 

Liquid based cytology (LBC)

Guidance for smear takers: The adequacy of cervical cytology samples/endometrial cells