National Cervical Screening Programme Sector Update – May 2023
What’s happening with the HPV Primary Screening Project
The Road to Rollout
The transition to HPV primary screening will be achieved in a phased approach – three phases in total -- with 26 July being the first day when HPV testing becomes Aotearoa New Zealand’s primary screening test for cervical cancer prevention.
The first phase from late July is the Foundational Step. In this phase participants will be able to choose a self- or clinician- taken swab, or an LBC sample which will first be tested for HPV, and if HPV is detected cytology will be performed. New clinical pathways and the new NCSP-Register will be established. There will be a particular focus on Māori and Pacific participants and increasing screening in the under- or unscreened populations.
The second phase will be called Expanding Reach and will extend from August to December. The focus is on getting more people onto the screening pathway through notifications and new approaches, including under- and unscreened populations both not enrolled in primary care and those enrolled. Better information on screening histories will be available.
The third phase will be called Full Benefit and will extend to March 2024. This is where the full future vision of HPV primary screening will be achieved. A more complete pool of participants will be encouraged into screening, increasing our screening coverage, patient experience and whānau satisfaction. All workforces involved in providing HPV primary screening services will have access to the right information to do their role in supporting wāhine and whānau.
What will be achieved:
a) HPV testing as the primary screening test – HPV testing will find more pre-cancers and prevent more cases of cervical cancer, supported by the speculum and colposcopy tests within the pathways.
b) New NCSP-Register – A single source of truth for screening records and individual schedules.
c) New pathways – Embedding more choice and flexibility into screening, removing barriers to entry and better supporting and increasing equitable outcomes for Māori and Pacific people.
d) Additional workforce and training – Accredited cervical screen-takers/GPs/midwives to do HPV testing as well as the LBC test. Other clinical workforces will be trained to support HPV primary screening, this will also be expanded through to our non-clinical workforce.
More information will be coming through our engagement with you explaining how different parts of the sector will be impacted by the change to HPV primary screening.
Notifications to Boost Screening Numbers and Improve Equity
The new National Cervical Screening Programme (NCSP) Register will be launched in July 2023. It is a population-based register, which will use NHI and National Enrolment Service (NES) information to identify eligible participants. The NES provides a patient register used by general practices. The NCSP-Register will have the capability to contact all people who are eligible for primary HPV screening and enable tailored, comprehensive information to be sent to individuals (known as a notifications), reminders and recalls.
Identifying all eligible people — whether enrolled in primary care or not – is a significant step towards equitable outcomes by capturing the currently ‘invisible’ people with a cervix who are not enrolled in primary care and are unscreened or under-screened.
All current data will be migrated to the new Register so those who opted out will remain out until/unless they request enrolment.
More details about how the new Register will work, the multiple channels for communications and the interface with healthcare providers will be shared with you soon.
Speculum tests remain an important part of the Cervical Screening Programme
We have been told that some health staff mistakenly understand there’ll no longer be a need for people (previously known as smear-takers), to be trained to take LBC samples for cytology, once HPV is the primary screening test.
There will continue to be a strong need for staff with this skill and training. Around 10% of swabs will have HPV detected, and where the HPV type is HPV-Other (about 7.5% of those screened) the recommendation will usually be to return to their screen-taker for LBC to obtain cytology via a speculum. Where HPV 16/18 is found (about 2.5% of those screened), colposcopy is the next step.
People returning to primary care for a test of cure after cytology will also require a speculum exam.
In addition, some people may prefer to have an LBC test in the first instance, so that if HPV is detected they do not need to come back for cytology.
Full training on the clinical pathway is under development, but in the meantime, we’d like to clarify that primary care nurses who are trained and skilled in speculum exams and test-taking will continue to be an essential part of the cervical screening programme.
Engagement with the Sector
The HPV Primary Screening Project Team are ramping up our engagement with sector groups to share the latest information on the Road to Rollout. We are currently engaging in a series of regional screen-taker hui across the motu. The purpose of our presentations is to build awareness, specifically on the changes, training and support for the transition to HPV primary screening.
Initial education sessions for screen-takers have recently been completed in Canterbury/South Canterbury, Hutt Valley, Wellington, Wairarapa, Taranaki, Tairawhiti, Nelson Marlborough Districts, Bay of Plenty (Tauranga, Whakatane, and Rotorua), and Otago/Southland.
We’ve received positive feedback on the presentations and encourage you to attend upcoming hui if they are being held in your region (see sessions below). We will be offering open online sessions later in May and June for those who have not been able to attend the regional sessions. We will share these dates with you immediately they are available.
Sessions planned in May and June include:
- 9 May – West Coast Screen Takers (see photograph of the flyer)
- 11 May – Waikato Screen Takers (online)
- 15 May – Hawke’s Bay Screen Takers (in person Napier and Hastings and online)
- 16 May – Comprehensive Care PHO CME/CNE Session
- TBA May – Mahi Tahi – Northland (on zoom)
- 30 May – Canterbury/South Canterbury Screen-Takers (online)
- 6 June – Goodfellow Webinar for Auckland/Northland Screen-Takers (online)
- 28 June – Mid Central Screen Takers (online)
A big mihi to the regional teams we have been working with to get these sessions scheduled. We have really appreciated the commitment you have for your region and assisting us with getting education out to the sector.
Closer to Go Live we will schedule online drop-in sessions to share information and for the sector to ask questions.
If you would like more information on one of the sessions in your region, please contact your regional coordinator directly, or alternatively we can assist at [email protected]
Questions raised at these sessions are being added to list of questions and answers on NSU website.
Webinar and Resources
We are updating our Resources page on the NSU website with questions and answers from recent engagement hui with the sector, plus answers provided earlier such as in summaries of information from the Goodfellow Unit webinar held in September. The Q&As from that webinar will form the base of the new material, refreshed with more recent questions raised at the engagement hui. The new material will be added soon.
The page can be found here and the webinar is available to view on the Goodfellow website here: https://www.goodfellowunit.org/events-and-webinars/cervical-screening-update
Educational Video for Health Sector
Prior to Christmas we posted an online video for health sector professionals detailing the move to HPV primary screening. Based on feedback received, we’re in the process of revising some wording for greater clarity. The video is close to being finalised and an update will be provided to let you know when the video is available.
This will be the first in a series of planned educational and learning tools to be made available in the run up to the transition to HPV testing in late July 2023. Keep an eye out for our updates as more resources become available.
Online Training Modules
Development of online training modules is underway. The modules will be a key part of the training and education for the sector alongside other educational resources. The modules will cover topics such as: the HPV virus; how to communicate with participants about HPV and the new screening programme; and the new clinical pathways. These will be available to all roles across the sector but tailored for a clinical audience.
Unit Standard Update
Toitū te Waiora with Te Whatu Ora are undertaking a review of Unit Standard 29556, Undertake Cervical Screening. Accreditation of nurses to support cytology procedures as part of follow up and surveillance will continue to be an important part of the new clinical pathway. Public consultation was undertaken from 16 December to 23 January and subsequently the new standard has been endorsed by the HPV Primary Screening Project Steering Committee and has now been submitted to NZQA. We will share the link to the standard when it is available.
Parliamentary Review Committee
The final sign-out process is underway, after which the Parliamentary Review Committee report will be tabled in the House of Representatives before it is published. We will provide the link to the report when it is available.
Clinical Practice Guidelines
The NCSP Clinical Practice Guidelines have been reviewed and are currently going through the editing process.
NCSP Policies and Standards
Work is progressing on updating the NCSP Laboratory and Colposcopy Policies and Standards, with feedback from the working groups collated and reviewed. They are going through the editing process before they can be published.
A childhood Immunisations campaign has been launched, supporting parents and caregivers to better protect their tamariki from a host of vaccine-preventable diseases.
To help normalise immunisations as one of the things parents can do to protect their children, and to encourage whānau to catch up on any missed vaccinations, a range of material is being released including a television advertisement. There are three different scenes in the promotion that embody the ways parents protect tamariki, drawing an implied link with vaccination.
It will be on mainstream free-to-air channels, Sky TV, and Māori television, as well as TVNZ+ and ThreeNOW, the TV media will run until 4 June. TV will be supported by targeted YouTube and online video placements, as well as screens in medical centres, partner packs, collateral updates, and our immunise.health.nz website.
You can view the advert here: Acts of Aroha – Childhood immunisations.
In addition to the advert, new resources for the health sector, a new immunisation website for parents and caregivers, www.immunise.health.nz and other targeted Māori and Pacific resources all aimed at increasing childhood immunisation rates in Aotearoa are being released.
All our immunisation collateral is available on Dropbox for healthcare providers at Dropbox: NIP – vaccine resources – Simplify your life.
For any other School-based Immunisation Programme collateral like consent forms for use by health professionals please visit the HealthEd website. You can also find a range of vaccination stories on our YouTube channel.
NCSP Advisory and Action Rōpū
The rōpū will meet on Thursday 25 May (in person hui). Minutes of previous meetings are in the process of being updated and can be found here.
Support to Screening Services web page
The web page for our SSS teams supporting the work of both the National Cervical Screening Programme (NCSP) and BreastScreen Aotearoa (BSA) has been updated to include a new provider in the Hutt Valley. The page is available here.
Screening support services are available for eligible wāhine/whānau who are referred to, or who independently access services from the support to screening providers. This support can assist wāhine/whānau who experience barriers to accessing breast and cervical screening, assessment, and treatment services. Some support to screening providers have mobile teams who make community visits and home visits, while others are based in clinics around the motu.
The NCSP coverage app is available at https://tewhatuora.shinyapps.io/nsu-ncsp-coverage/
Answers to Your Questions
We are receiving regular feedback and questions to [email protected]. More information is available on the website here: Frequently asked questions | National Screening Unit (nsu.govt.nz).
Staying in Touch
If you have colleagues who would also like to receive this monthly update, they can join the distribution list by emailing us at [email protected] . We really appreciate your feedback and are here to answer any questions you may have.