Extraordinarily high number of women in one region avoiding NHS tests

[Ceiling]

At one north-west London practice, just 13.8 per cent of patients aged 25 to 49 have been tested in the past three years.

www.dailymail.co.uk/health/article-6663833/The-GP-surgeries-THREE-QUARTERS-woman-miss-cervical-cancer-tests.html

A woman who asked to be seen by a female nurse when she went for a smear test was 'embarrassed' when she was allocated a person with 'stubble and a beard'.

The woman received an apology from the NHS following the incident at a clinic in North West London NHS Foundation on September 16 last year.

www.dailymail.co.uk/news/article-5224421/NHS-apologises-woman-allocated-transsexual-nurse.html

GP surgeries get money based on smears and smoking cessation and so on. Why would a surgery do itself out of money?

That is a shockingly low figure for cervical cancer screening. The reason cervical screening is usually (or is it always apart from our stubbly friend as above?) performed by women is because women won't go otherwise. Breast screening units are also staffed by women for the same reason - I have seen it written that only women can do that work. Any move that would reduce uptake must be vigorously fought against.

But I do find it hard to believe one TW would make such a difference to the stats of one area.

I seriously doubt there is a link. London on the whole probably has a low uptake rate. People move house a lot in London- especially younger women. When I lived there, it was not unheard of for people to move rental property almost every year. You miss appointment letters and there is little effort made by most GPs to actually call you in.

Also you don’t know it’s the same practice. It’s likely it’s a different one. NW London covers a huge area.

Lots of people working in London will have private medical insurance through work as well. Just because they don’t attend NHS clinics doesn’t mean they aren’t being tested elsewhere.

I've had private medical insurance for 25 years and never used it for cervical smears though. You need a referral.

One person might make a difference to the uptake in one practice.

It wouid mist definitely not account for a fall to 13.8%

Hijacking this to the trans agenda might give some people the satisfaction of confirmation bias.

Public health experts will be looking at the whole borough and all the factors. And I hope this is progressing as a matter of some urgency, and that the 'Jade Goody' factor has been properly accounted for (if you start assessing from an unusual and not-repeated high point, the only way is down, sometime sharply so.

I have certainly seen papers on the ebbing of that effect, and highlighting the need to get more women attending. I have also seen threads on MN criticising the current system for leading to over-treatment of the lower levels of change and saying that it was entirely right not to attend.

I don’t think this is a link that can be made. The figures will probably be falling as the Jade Goody effect wears off. I also wonder about GP payments. Long ago I remember apologising to my inner city London GP that I had not gone (a very sick baby was my priority) and hoped I was not costing her money. She laughed and said they had no chance at all of ever making the target. It seemed odd that the practices where women were least likely to attend were the ones who had no financial motivation. I hope someone will have rectified this, but if not it would be part of the answer.

One element, I fear, may be a porn influenced shyness, though obviously there will be cultural and other factors.

Private medical insurance always needs a referral from a gp for consultations. The regular monitoring some people get through their private medical is unisex like blood pressure, stool testing etc I've never heard of medical insurance covering cervical screening. If anyone has it would be interesting to know what insurance company

Are the two links in the OP related to each other or are they put together there so that the reader assumes that's the case?

I would guess that it is to do with the inconvenience factor. Attending for this is not a problem if one lives and works near the GP. I live 2 minutes from my GP surgery which is itself only 5 minutes from my office. The patients registered with this practice are very unlikely to be so fortunate. They might be looking at hours out of the working day to attend an appointment.

I do think it needs to be balanced. Smears are presented as an overwhelming good when actually they can cause serious problems if unnecessary treatment is given. Cervical cancer is nearly always caused by a particular strain of the HPV virus, so they are better off testing for that and monitoring women who test positive. If you don’t have HPV, you are highly unlikely to get cervical cancer.

Also of course, Jade Goody did get several smears and had cells burned off on several occasions and had numerous internal exams when she collapsed. She still died from cancer. It’s always presented as if a smear would have made all the difference when in fact a smear only picks up pre-cancerous changes. Yes, they do save some lives, but they are not the miracle they are held up to be. Testing for and treating HPV and screening those infected more thoroughly would be more effective. As well as reminding women of the importance of condoms in order to protect against it.

In London especially, wouldn't it be mostly a cultural thing? Most women wouldn't know they could get a 'female' nurse with stubble etc until they've actually been there for a female complaint ...

Sorry I meant private health screens, not private insurance. Lots of companies offer these as an employee benefi.

Something is happening in this surgery but are women dying of cervical cancer in that region? Does the surgery make it easy to get appointments? Are the nurses experienced in giving tests well? Or where people avoiding particular nurses?

Interesting how this is a call to action to increase test take up whilst all other female health like maternity, and other health womens issues and there is no call to action for that.

This is an important issue for me: The reason cervical screening is usually (or is it always apart from our stubbly friend as above?) performed by women is because women won't go otherwise.

I have always found smear tests very painful and troubling - I've described it more than once as very much like a sexual assault that's I've agreed to undergo.

I know some women are fine with male doctors performing them - I'm not. The only time a man did mine he was fucking brutal with me. I'm sure some women have had different experiences - but enough of us want only a woman to do them and should have that as a right.

What’s missing is the why.

Is it due to a highly mobile population? Cultural? Poor surgery organisation? Something specific to that surgery? It’s unlikely to be the only surgery in the area so that does suggest a surgery specific factor is at least partially responsible.

I remember at uni at the student health clinic they briefly brought in a very unpleasant male nurse (quote: ‘if you can have sex you can have a smear, haha.’) and rates plummeted. He was really ‘off’ and I refused to have him do mine. He was replaced and rates rose.

Spot on, Bowl.

The surgery with the very low number seems to have closed last year, and the next lowest specialises in homeless people.

I have a screening every year, through work. And I am always offered a smear test.

@2ndWaveFeminist I had a cervical smear as part of a private health check/mot thingy. I'll try and see if I can find who it was with (it was about 4 years ago now I think).

@2ndWaveFeminist it was the Nuffield 360

remainy that sounds like a good health policy & from a corporate point of view getting all those checks done at once leads to less time off work.

I doubt just private medical would be skewing results so much for just one surgery, it will be a combination of factors. I rely on reminder letters for any regular screenings/checks so if they stopped being sent I wouldn't realise for quite a while

I don't think transwoman practice nurses (concerning though that is) explains these statistics.

In the days of PCTs, I used to do informal audits on GP practices. IME the greatest reason for practices missing payments was poor organisation. Larger surgeries, have economies of scale and are usually better at keeping their records up to date (and in some cases gaming the system). If patients choose to opt out of any of the measures or are ineligible for clinical reasons, practices can exclude them from the data.

Some parts of London still have a lot of single-handed and small practices and may be less sophisticated at optimising their data.

And while I hesitate to say this, it is also possible that racism (against practice staff) forms part of the picture.