Experts are calling for more smear tests that check for cervical cancer to be offered in sexual health clinics, after attendance for life-saving screenings fell to a 21-year low.
NHS statistics released at the end of November showed that smear test attendance in England has fallen to 71.4%, with 1.28 million women failing to turn up to their appointment.
BuzzFeed News can reveal that local authorities with the lowest attendance are grappling with sexual health funding cuts of up to 36%, according to figures from the Health Foundation, a charity that aims to improve healthcare provision in the UK.
Analysis found that the 10 local authorities with the lowest attendance rates — which are all in London — have seen their spending on sexual health services cut by an average of 22.6% since 2014.
At present, the majority of smear tests take place in GP surgeries. Local authorities previously provided additional screenings at sexual health clinics to give women a greater choice of date, time, and location. However, these are just one of many sexual health services that councils have been forced to roll back following cuts of £600 million to public health funding between 2015 and 2020.
The result has been that many women who would have previously had their smear tests at sexual health clinics now find that they are only able to go to their already stretched GP surgeries. The number of tests at sexual health services centres has fallen from 140,793 in 2009–10 to just 37,718 this year.
Kate Sanger, of Jo's Cervical Cancer Trust, said that many women struggle to get appointments with their GPs, and, therefore, providing smear tests in sexual health clinics could improve the overall attendance figures.
“Some GPs might only offer screenings on a Tuesday morning, for example, as that’s when the nurse is in,” she told BuzzFeed News. “It’s fitting it in around work and childcare, having to take time off work for an appointment, having to take holiday.”
One of those women is Rachel Lofthouse, 49, a professor at Leeds Beckett University, whose smear test was cancelled at short notice by her GP surgery.
She lives near Gateshead in Tyne and Wear, but, with work around 100 miles away, could only get to appointments on Mondays and Fridays.
“I visited the surgery on the day I had made time for the original appointment to discover that they now only had appointments available on Wednesdays,” she told BuzzFeed News.
Unlike in other local authority areas, Lofthouse was given the option of going to a sexual health clinic — but its appointments were only available on Thursdays. Gateshead has suffered cuts to its sexual health services of 23.8% in recent years.
The GP then offered her a private appointment for £150, which Lofthouse said she was “disappointed” to hear as an initial response. Eventually, four months after receiving her letter, she rearranged her working week and travelled back for a midweek appointment.
“I was frustrated that a standard clinical procedure critical for women’s health has been difficult to access,” she said. “It is very worrying that preventable cancers might not be detected in time due to systemic delays in scheduling appointments.”
Smear tests, which are offered every three years to women aged between 25 and 49 and every five years between 50 and 64, detect abnormal cell changes in the cervix and are estimated to prevent at least 2,000 cases of cervical cancer a year. In 2016, 2,564 women were diagnosed with cervical cancer.
Sanger said that providing screenings at sexual health clinics is also important because some women prefer to visit clinics, rather than their GPs, for a variety of practical and cultural reasons: “It’s more convenient, they’re already there [for other services], they can’t get a GP appointment, they don’t like going to their GP, they might not be registered with a GP.”
Dr Jane Dickson, vice president of the Faculty of Sexual and Reproductive Healthcare (FSRH), said that young women, especially, used to opt to have their smear tests in clinics. But now women are being turned away from sexual health services.
“[Sexual and reproductive health] services have become too stretched to manage to deliver everything that is currently in their service specifications and, therefore, ‘non-core’ services suffer as a result,” she said. “In many cases, cervical screening is not included in their contracts anymore.”
GPs, meanwhile, are struggling to pick up the extra demand. In London, limited GP opening hours present an obstacle for women wanting to book a smear test.
“These factors act as extra barriers on top of the existing ones — embarrassment, fear of results, and other concerns about the procedure — driving coverage down,” she said.
The local authorities with the lowest attendance rates were Kensington and Chelsea (51.6%), Westminster (53%), Camden (55.1%), Hammersmith and Fulham (55.8%), Tower Hamlets (59.7%), Islington (60.9%), Newham (62.2%) Harrow (62.3%), Ealing (62.5%), and Brent (62.6%).
Part of the reason for London's low attendance rates is its highly mobile population, with people moving frequently between boroughs. This year, the NHS launched a text message reminder service to overcome that issue.
Sanger added that wealth disparities feed into the problem.
“You’re going to have low literacy rates, difficulty in accessing services, people who travel for work so difficulty in physically getting there... You’ll have language barriers, culture barriers,” she said.
To improve the availability of smear tests in sexual health clinics, Jo's Cervical Cancer Trust wants NHS England to provide additional funding (as part of its public health functions agreement) for smear tests to be delivered through sexual health clinics as well as GPs.
FSRH wants to see a whole-system approach with collaborative commissioning for cervical screening, with screenings provided in both GP surgeries and sexual and reproductive health clinics.
“It is also important that service specifications for [sexual and reproductive health] services include cervical screening, which would help significantly lighten the burden on GP practices and increase access and choice for women,” said Dickson.
The NHS, concerned by the low attendance rates, is working with providers of sexual health services to ensure that women who are overdue a smear test can be offered it when they attend for family planning services.
“Screening is a vital and effective tool in our fight against cervical cancer. We encourage all women across London to attend regular screening,” Dr Kathie Binysh, head of screening for NHS England in London, told BuzzFeed News. “Smear tests are quick and simple and could save your life.”