Cervical screening: ideas for improving access and uptake
Source: gov.uk (2025-04-16)

Guidance to help primary care, commissioners and local authorities plan and evaluate initiatives around cervical screening coverage in their area.

The following initiatives can be used to address areas of low coverage identified in the cervical screening quarterly coverage data reports.

Invitation letter

Evidence demonstrates that GP endorsement has a positive effect on cervical screening uptake.

The cervical screening programme sends a standard invitation letter and a reminder letter 18 weeks later to women and people with a cervix who are eligible for cervical screening. Standard letters sent by the programme can include an additional paragraph of free text specific to a GP practice.

The registered GP sends out a second reminder letter to non-attenders. This provides an opportunity to tailor the practice invitation according to the services the practice provides and the practice population. Helpful content includes:
- surgery opening times
- reassurance that the sample taker will be female
- offering opportunities for a conversation about any screening concerns
Individuals with specific needs or with disabilities

It is important to consider specific needs in relation to cervical screening in order to maximise opportunities for individuals to attend.

Primary care is well placed to know their practice population needs, and to identify reasons why individuals are not attending. These reasons may include:
- access problems
- lack of time, or inability to attend during usual clinic hours
- disability (physical or mental)
- language barriers
- cultural beliefs
Individuals with disabilities have the same right of access to cervical screening as other people. No disabled person can be assumed to be sexually inactive. All individuals are entitled to information to make their decision about cervical screening, and are entitled to reasonable adjustments to support them attending an appointment.

Primary care should consider the clinic facilities for individuals with a physical disability, including:
- access to the venue (can an alternative be offered?)
- the height of the couch
- the individual’s physical limitations
- the possibility of a domiciliary visit
- the need for assistance and seeking specialist advice if necessary
In the case of paraplegic individuals, the sample taker may need to make special arrangements, for example with the local colposcopy service, to take a sample at a clinic where a hoist is available.

A local learning disabilities team can offer support including assistance with consent, and people to accompany individuals to appointments. An easy read leaflet (https://www.gov.uk/government/publications/cervical-screening-easy-read-guide) is available which has been designed to be used by individuals with learning disabilities alongside family members or carers. The leaflet is intended to help them to make their own decisions about cervical screening, and to prepare them for the screening process.

Language and cultural differences can affect understanding or the screening process. It is important to take measures to ensure all individuals understand the purpose of the screening programme and the procedure for taking the sample. Language translations (https://www.gov.uk/government/publications/cervical-screening-description-in-brief) of the screening invitation leaflet are available to download, and alternative formats (such as braille) can be made available on request.

Primary care is responsible for sourcing and offering language support during sample taking if needed.

Pre-appointments

Women and people with a cervix who have never been screened may benefit from being offered a no obligation pre-test appointment to discuss the procedure and raise any questions or concerns. This may also be beneficial for individuals who have previously had negative experiences of screening.

Cervical Screening Management System

Sample takers may wish to use the call and recall system to check screening status and follow up non-responder notifications. Also use the system to download the electronic screening test request forms.

Screen prompts and alerts

The use of alerts or screen prompts for defaulters provides an opportunity for clinicians to raise awareness that screening is available and that individuals remain eligible.

Awareness campaigns

2019 saw the first PHE national multimedia cervical screening campaign, highlighting the risks of cervical cancer and the preventative benefits of screening.

Practice campaigns to raise awareness of cervical screening and invite individuals who are overdue have been shown to be useful to increase attendance for screening.

Methods for prompting individuals who are overdue or who have never attended include:
- reminder letters
- text reminders
- postcards
- telephoning individuals directly
Posters in waiting rooms and toilets are a simple way to raise awareness and promote screening.

There is a cervical screening awareness week in June each year.

Data cleansing

GP list validation and list cleansing is helpful to ensure removal of ‘ghost’ patients to support the practice in identifying eligible individuals.

An audit of hysterectomised people at a practice level will identify individuals who no longer need to be invited for screening. Individuals who have undergone a sub-total hysterectomy will continue to be eligible for screening as the cervix is not removed.

Consulting room

Review the consulting room where screening takes place. Consider the layout and location of rooms to ensure there is a confidential quiet, private area that is welcoming. Make sure all your equipment is ready at hand before you start and make sure you will not be disturbed.

Positive experience

Fear and embarrassment are some of the main influencing factors for individuals who choose not to have screening.

Previous experience is important when individuals are deciding whether to make an appointment. Ensure individuals are put at ease and all their questions are answered during their appointment. They may tell their family and friends if their experience was positive or negative.

Access

Providing a variation of appointment times during the day and in the evening will help individuals in choosing when they can attend for screening. Limiting access to screening appointments can impact on coverage.

A whole team approach is important to ensure individuals can access screening. It is therefore important that all clinicians and reception staff are aware of the importance of cervical screening.

Making an informed choice

All individuals must be given the opportunity to make an informed choice about whether or not to attend for cervical screening. The decision should be based on an understanding of:
- why they are being offered screening
- what happens during the test
- the benefits and risks of screening
- the potential outcomes (including types of result, further tests and treatment)
- what happens to their screening records
If an individual is provided with the above information about the programme and chooses not to attend screening, then this is a valid choice and must be respected.

Additional data and resources

NHS Digital interactive dashboards on:
- cervical screening coverage (https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-programme/cervical-screening-programme-coverage-statistics-management-information)
- learning disabilities (https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/health-and-care-of-people-with-learning-disabilities-experimental-statistics-2016-to-2017)
Powerpoint presentations on:
- cervical screening coverage (https://app.box.com/s/iz06m3hui0wjt88hldxooe4uervco63r)
- cervical screening coverage against levels of deprivation (https://app.box.com/s/t6h0dw65gu0y5sp0xky6cc4ymm4h3a2w)
- cervical screening coverage against census health data (https://app.box.com/s/rif07tirxafvowqaaq909lpv4pdxirkw)
See also Cancer Research UK cervical screening resources (https://www.cancerresearchuk.org/health-professional/screening/cervical-screening#cervical21), including good practice guide for health professionals