These Women Want To Get A Smear Test, But They Can't Actually Book One

Women are waiting several months for a smear test, or being placed indefinitely on a waiting list, despite actively trying to book an appointment.

A new campaign launched this week supported by health secretary Jeremy Hunt encourages women to book a smear test, but women told BuzzFeed News that doing so "seems impossible".

Staff shortages at GP surgeries, and reduced access to cervical screening via sexual health clinics, have been blamed.

Stacy Edgington, 30, from Birmingham, has a history of cancer in her family and made sure she tried to line up a smear appointment as soon as she received a letter urging her to do so, but five months later still doesn't have one scheduled.

"I went to the doctors the same day and asked for an appointment and have been on average once a month since to see if they have appointments," Edgington told BuzzFeed News. "I am on a list which is a piece of paper floating around the reception area."

Instead she visited her local sexual health clinic, but was unable to get an appointment there either. "They said in December that I would need to come back in January, then when I visited in January they told me they no longer do them and to contact my GP," she continued.

Because there is only one practice nurse able to perform smear tests at her GP surgery, Edgington remains on the waiting list.

The Royal College of Obstetricians and Gynaecologists, alongside the Faculty of Sexual and Reproductive Health has warned that urgent action needs to be taken by Public Health England, which is responsible for cervical screening, noting that cuts to local sexual health services and "overburdened" GP surgeries have made it increasingly difficult for women to access smear tests.

Cervical screening can detect cell changes that could lead to the later onset of cancer. Early diagnosis of cervical cancer, or abnormalities that could develop into the illness, has been shown to significantly improve health outcomes. Women aged 25 to 49 are most at risk of developing cervical cancer.

NHS England reported this week that the number of women completing cervical screening after receiving a letter reminding them to book a test had decreased dramatically, with 72.7% of women aged 25 to 64 attending appointments in 2016, compared to 75.4 in 2012.

As part of cervical cancer awareness week, people are using the hashtag #SmearForSmear to raise awareness of the importance of screening and to encourage women to book a smear test, including health secretary Hunt, who tweeted: "Please support #smearforsmear & book your test today."

Lucinda, a 26-year-old from London who preferred not to give her last name, has been struggling to book a smear test appointment for over six months now.

"It took me over two months to get an appointment with my local surgery. When I finally got one at the beginning of November 2017, I was turned away because they told me they didn't have my records on the screening register," she said.

As a result of the continuing administrative error she was promised a further three appointments over the subsequent three months, without actually getting a smear, and said that she couldn't get cervical screening at her local sexual health service either.

"The nurse said she couldn't give me a screening and no other service in the area would be able to either until my records made it onto this register," she continued. "I could get a smear with a GP but only if I had symptoms which I don't."

While Lucinda has been told she could visit a sexual health clinic that does offer screening, she is still not guaranteed to get an appointment. "Having already taken one-and-a-half days off work to attend cancelled appointments, I can't really take another day to sit and wait for an appointment that might not happen," she said.

A 30-year-old woman from London, who did not want to share her name, has only managed to get an appointment for a smear test after eight months of waiting because she has agreed to take a day off work.

An appointment she managed to get with her family GP in Sussex before Christmas was cancelled as a result of staff shortages, so on returning to London she switched to a new "GP at hand" service offered by the NHS in the capital, which is run by medical app service Babylon. While most consultations take place through the app, appointments for procedures such as cervical screening are available at certain locations.

But she couldn't get a smear appointment that wasn't during work hours that way either. "I keep ringing for appointments after 5 p.m. and again they can’t give me one. They just say ring back each week to see if the clinics are updated."

She noted that if she was in a job that meant she couldn't take a day off without losing pay, that wouldn't have been possible. "And it isn’t like I’m being fussy – literally I’ll take any after-5 p.m. slot anywhere in London."

Annemarie Nicholson, 36, told BuzzFeed News that while she’s fully aware of the importance of cervical screening, her embarrassment was a serious barrier to visit her GP for a smear test. For the last 18 years she got regular smear tests at her local sexual health clinic, but when she contacted them to book one last September, she discovered the clinic no longer offered them.

She lives in a small village just outside Wakefield in Yorkshire said there is just one GP surgery and practice nurse in her tight-knit community, and she said she preferred the anonymity of a sexual health clinic rather than having an intimate procedure done by someone she knows.

“Quite often you’ll see the local nurse in the co-op! That’s an issue and it makes me feel really uncomfortable,” she said.

“Something like a smear test and sexual health is private,” she continued.

“When you go to a family planning clinic you don’t have to worry about seeing them again.

“You don’t give your name, it doesn’t come up on the screen so everyone knows what you’re going for, you just have a number.”

Nicholson now worries about the risks of not having regular screening. “You could be walking around with a serious illness, but not have had the chance to have it diagnosed because of the way you feel,” she added.

Edgington told us she sympathised with women for whom this was the case, and felt this underlined why it was so important to ensure that appointments were easy to access. She said: "I remember getting my first one done, and I had to build myself up for weeks before I plucked up the courage to even book the appointment, let alone go. If I was told I had to wait for months to get one, I may not have bothered calling back."

These women's problems trying to get an appointments appear not to be uncommon. A spokesperson for Jo's Trust told BuzzFeed News that after launching the Smear for Smear campaign on Monday, they received several messages from women who had struggled to access cervical screening.

Several women replied to tweets from NHS England affiliated Twitter accounts also promoting the campaign to say that they wanted appointments but were unable to get them.

In a Twitter direct message conversation seen by BuzzFeed News between NHS England's London division and a woman who is unable to get an appointment, a spokesperson suggests she leaves feedback with her GP, and directs her to a webpage which lists alternative screening services nationally.

NHS England declined to comment on the reaction the campaign has received on social media from women who cannot get screening appointments.

All the women we spoke to seemed frustrated that campaigning efforts focused on raising awareness of the importance of booking a smear test, rather than shining a spotlight on the fact that even when women were proactive about cervical screening, services were not always sufficient.

"It's obviously very important that they are encouraging women to go, but I think some focus should be put on women who are trying to get a test and 'doing the right thing' but getting nowhere," Lucinda said. "If you're going to run a campaign like this, you need to make sure you are actually able to provide the tests."

Since 2012, when cervical screening rates began to decline, local authorities have been responsible for providing cervical screening through sexual health clinics, and clinical commissioning groups decide whether a GP surgery will provide the service. Financial pressures on the health service and local authorities has meant both have seen their budgets stretched.

In 2015, public health budgets were cut by £200 million, and are expected to lose a further £331 million by 2021, which has seriously impacted local sexual health services. Many are no longer offering cervical screening or have closed entirely.

A report by the Royal College of GPs, which looked at the state of sexual health services, highlighted an additional pressure on surgeries offering cervical screening as a result of the service not being consistently offered by dedicated sexual health services.

Recent analysis by Jo's Trust found that only 31% of local sexual health services who responded to a Freedom of Information Act request were able to offer cervical screening to all women, and 60% offered selective screening, which varyingly included screening for women who are sex workers, HIV positive, presenting symptoms or not registered with a GP. In some cases screening was offered to women who were overdue their screening. Nine percent of local sexual health services offered no screening at all.

"Its seems so crazy that you can't get a sexual health check, smear, and coil check all at one time," a 30-year-old from London, who can no longer get a smear at her sexual health clinic, told us. "That means three different appointments and three different places, I have found it very frustrating."

"The pressures on the NHS cannot be underestimated, however if women cannot access this potentially lifesaving test then lives could be in danger," a spokesperson for Jo's Trust told BuzzFeed News. "Screening needs to made more easily
accessible with evening and weekend appointments available in more areas and
access through sexual health services must be increased."

Dr Anne Connolly, a GP and vice president of the Faculty of Sexual and Reproductive Healthcare, believed the fragmentation of services was much to blame for issues with accessing cervical screening.

"Some of the contracts for sexual health clinics don’t include screening even when a woman is having a coil fitted, and some women are going to a clinic where they used to get their smear done and are being turned away," she said.

"It’s not OK that the current system means women aren’t always able to get a test by the people who are most skilled to do it."

While Connolly didn't doubt that factors such as embarrassment, fear, or simply a lack of awareness of the importance of a smear test contributed to a decline in cervical screening, she believed they were secondary issues.

"It’s an easy thing to make excuses for, but I don’t think it’s all on the woman," she said. "We should be making it simpler [to get a smear test] because we know that the cervical screening programme has been so successful and we know that we have reduced cervical cancer deaths because of it."

Dr Anne Mackie, director of screening at Public Health England, emphasised the importance of GPs and practice nurses in ensuring more women received a smear test.

“Evidence shows that GP endorsement has a positive effect on cervical screening uptake," Mackie said.

"They could also consider offering a variety of appointments in the morning and evening, making it easier for women to attend at a time that suits them.

“Screening is not for all women and they must make an informed choice on whether it's right for them.

"GPs in their everyday consultations with patients can inform them about what cervical screening involves, which can help reduce any anxieties about taking the test."