This week the consolidated standards for the NHS Breast Screening Programme were published by Public Health England, and there are a few changes that those working in the service might need to know about.
Opportunity to improve your knowledge of the NHS standards
If you’re a health professional needing CPD, reviewing these changes and reflecting on how this affects your practice or improves outcomes for patients could be a worthy topic for inclusion into your CPD portfolio.
Screening population programmes are by nature, large unwieldy entities, and the UK National Breast Screening Programme is no different. Public Health England is part of the huge Department of Health, and is the organisation that is responsible for providing the National Breast Screening Programme, amongst other screening programmes.
As every health professional working in breast screening knows, we are subject to lots of quality assurance and targets – the list seems endless! It’s there for a good reason: to ensure that the programme is safe and effective – basically, does it do what it says on the tin? Quality Assurance, or QA is the process we use to make sure that it does, and this process stretches from the accurate identification of the eligible population to the closing of the screening episode: it’s not just the equipment tests!
Where to find all the standards we work to
These new standards replace all other versions from April 2017, and are the standards which our services report on annually every October. If you’re searching for standards or documents, they are all on the main GOV.UK site – try here
(for those of us who still remember the consternation felt when the old NHSBSP website with all the documents on disappeared – I think they all eventually uploaded onto GOV.UK as this looks fairly comprehensive to me!) However, one change to come will be that pathology and surgery standards will not be published on GOV.UK, but on the Royal College of Pathology (RCPath) and Association of Breast Surgery (ABS) websites. Heads up for you there!
The guidelines explained
The main changes are summarised on page 5 of the document, the document itself can be found here NHS Breast Screening Programme Consolidated standards. What do you think? I’ll give my interpretation, and then if you want to comment below you would be most welcome.
- Does every service get their results out within two weeks? The standard for that (No. 8) just got higher, 95% or more, up from 90%. I think we’re all pretty much on target here, I don’t hear of many services struggling to reach that.
- Referral to assessment rate (No. 9) for the prevalent round has been affected by the Age Extension trial, and the words ‘minimum’ and ‘target’ have been changed to ‘acceptable’ and ‘achievable’ and the age ranges have been altered to reflect the younger age cohort coming through via the Age Extension trial.
- The three week rule of standard 11 has been changed slightly, but significantly. From the moment a client is screened, we have three weeks for them to be offered an assessment appointment. Now, it used to be that they had to attend, and as those who work in screening know; if everyone is on holiday in August then there’s your target blown, right there. So the fact that we can offer an appointment and the clients preference does not then affect our targets is a small relief.
- Now, onto the maths in standard 15. Indeed. The invasive cancer detection rate has been withdrawn – but only to be replaced by standardised detection ratios. Say what? Well, the ratio is a measure of how many cancers the service detects against the number of cancers it is expected to detect based on the population characteristics that has been screened. This again has been changed to reflect the changing screening population due to the Age Extension trial, so that services, both participatory and non-participatory, can be compared fairly.
- Similarly in standard 13, the age range and cohort has been altered to reflect how the Age Extension trial has affected the screening population, so that we can include those aged 45-49 within the QA process.
- Interval cancer rates have been increased, and this makes sense considering the overall increase in breast cancer across the population. They have also been split into three parts, years one, two and three following the negative screen. The interval cancer rate, along with the cancer detection rate is a good quality indicator of a service’s performance, so any way to make it more measurable is welcome. Does any radiographer get involved in interval cancer audit? Case discussion can be a great learning tool for film readers, identifying trends can be very valuable.
So there’s the revised guidelines – do we think the QA process has improved? Minor tweaks, but could they make all the difference?