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1. Overview

Cervical screening (also known as the smear test) helps prevent cervical cancer. It detects abnormal changes to the cervix so they can be monitored or treated before they get a chance to turn into cervical cancer.

Cervical screening should be offered to all women and people with a cervix aged 25 to 64.

It is offered:

• every 3 years for those aged 25 to 49
• every 5 years for those aged 50 to 64

See NHS population screening: information for transgender people for information on access to cervical screening for trans and non-binary people.

has shown that screening uptake is lower in people with compared to the general population.

NHS England works with service providers and other partners to remove gaps in services that prevent everyone being able to access screening.

Health professionals should use this information and resources to help individuals with learning disabilities better understand cervical screening and take part if they choose to.

2. Resources

There are resources for health professionals to help improve healthcare access, including guidance for health professionals, social care staff and family members to help someone with learning disabilities to be screened for cancer. Health services should be aware that it is a legal duty to make reasonable adjustments for people with learning disabilities.

Clear, concise, easy to understand information helps support communication and understanding.

2.1 Cervical screening easy guide

The easy guide to cervical screening explains cervical screening to help individuals with learning disabilities decide if they want to attend. Some people without a learning disability may also prefer the easy guide format.

Local cervical screening providers should download and print off this leaflet in colour for people identified by primary care as needing information in an easy read format.

2.2 Easy read invitation letter template

We have also developed an editable easy read version of the cervical screening invitation letter.

Local screening providers should use this template to invite eligible people identified by primary care as being known to have a learning disability. They should send the easy read invitation letter along with the easy guide instead of the standard national invitation letter and the helping you decide leaflet.

3. Overcoming barriers to screening

There are a number of factors affecting cervical screening uptake among individuals with learning disabilities.

The following advice for cervical screening provider and primary care staff can help to increase understanding and remove barriers to screening.

Consider:

• how the individual communicates 鈥� you may need to ask carers
• if the individual will need an interpreter or signer at the screening appointment (some people with learning disabilities would also use rather than
• which word the individual uses for vagina so that you don鈥檛 get misunderstandings
• offering a pre-visit so the individual can feel safe while you explain the test
• using an alternative venue, if appropriate
• showing the speculum and sample brush to the individual 鈥� let them handle it and explain how they work
• showing the individual the position they will need to be in when they have the test and encouraging them to get onto the couch to see what this feels like
• suggesting the individual practices the position at home so they feel more comfortable about it (this can be done with their clothes on in their bedroom where they feel relaxed and carers may need to support this)
• reassuring the individual that they can have a friend, relative or carer present during the test if they would like to
• offering a longer appointment and a first appointment if needed
• ways to help the individual feel relaxed, such as music

Remember, the individual needs to have an understanding of what will happen at the test.

They must be able to:

• remember this information for as long as it takes to do the test
• understand that by having the test it will help her to stay healthy
• give consent, by any communication means, to try to have the test done
• have an understanding of the signs and symptoms of cervical cancer (see an easy guide to cervical screening)

4. Making a best interest decision

If the individual has not understood enough to make their own decision on cervical screening you need to make a best interest decision for them.

To make a best interest decision, you need to have a discussion with people who know them well. These would usually be their family and carers. Include the individual in your discussion as much as possible. Discussions do not have to be face to face. Opinions on what is in their best interest can be collected through telephone calls.

A best interest decision is based on your reasonable belief at that time.

Also consider:

• obtaining the opinion of an independent advocate if professionals, families and carers cannot or do not agree on what is in the individual鈥檚 best interest
• reviewing the individual鈥檚 past screening history
• their beliefs and wishes, which could influence a best interest decision for them

If the individual has previously attended screening, this implies they once felt it was important. This knowledge could influence you and others when making a best interest decision for them.

When an individual cannot manage to have cervical screening, you must consider other ways of keeping her safe from cervical cancer. This can include educating the individual, their family and carers about the signs and symptoms of cervical cancer.

Every time a best interest decision is made that cervical screening is not appropriate, education should be given. This ensures all family and carers have up to date information.

5. Tips for administration and reception staff

Primary care administration and reception staff play a crucial role in supporting people with a learning disability to access cervical screening.

5.1 Know your population

Ensure people with a learning disability are flagged on your computer system. The community learning disability team can help verify lists.

5.2 Know who is due to be invited for screening

You can identify individuals about to be invited for cervical screening who have a learning disability and may need additional support by using the prior notification list provided by the screening service.

A member of the practice team may want to contact the individual or their carer before they receive their invitation letter to ask if they need any support.

5.3 Know your community learning disability link

Find out who your community learning disability team link person is for your GP practice. This person may be able to offer additional support for an individual with a learning disability invited for cervical screening.

5.4 Know the facts

All women and people with a cervix over 25, whether they are sexually active or not, are entitled to cervical screening. It is then the individual鈥檚 decision if they take up the invitation. This decision can only be made by the individual or through a best interest decision.

5.5 Know where to get more information

Read the NHS England easy guide to cervical screening.

5.6 Know who else in your practice can give support

Find out who performs cervical screening within your practice and who you can go to if you have any questions.

You could consider:

• using a clock face to show time as well as writing in numbers the appointment information
• making sure a double appointment is booked to enable reasonable adjustments