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Cervical screening in over-50s, and learning from the Covid pandemic

Cervical screening in over-50s, and learning from the Covid pandemic

Lucille Kelsall-Knight summarises recent qualitative research looking at how general practice nurses can increase cervical screening uptake by women aged over 50, and lessons from primary care nurses’ and healthcare assistants’ pandemic experiences

Challenges and opportunities for cervical screening in women over the age of 50 years.1 Cancer of the cervix is a preventable disease. Routine screening started in 1988 in the UK2 and is estimated to prevent up to 3,900 cases and save 4,500 lives every year.3,4 However, cases in women over 50 are predicted to rise by 60% in the next two decades, yet this group is less likely to attend for screening than younger women.5

Bravington and colleagues (2022)1 set out to explore practitioner and service-user experiences of cervical screening as a way to determine novel solutions to the challenges of uptake.

They undertook semi-structured interviews with 28 practitioners and 24 service users aged over 50. Participants were recruited from 10 general practices via UK primary care networks in northern England, in 2016–2017. The interviews were analysed thematically, and three themes emerged: exploring the barriers to successful cervical screening; the role of relationships; and what constitutes good practice.

Barriers included the lasting significance of early experiences of screening, sexual partnerships and changes to family dynamics over the years. The study also suggested that preventive healthcare can become less of a priority as women age, and that conversations among peers shape attitudes towards screening.

Good teamwork among practitioners and seeing the promotion of screening as a collective responsibility were positive factors. Relationships between women and primary care over time can significantly affect the intention to attend; participants highlighted the importance of a sensitive and practical approach to screening, tailored to women over 50, and of investing in time to communicate with non-attenders.

The main limitation of the study was the minimal cultural or sexuality diversity in the participant group, in view of evidence in the literature of reduced uptake among different cohorts. Overall, this study encourages practitioners to consider people’s early experiences of cervical screening and the structural and practical reasons for non-attendance among over-50s, especially given the predicted increase in cervical cancer incidence.

What can general practice learn from primary care nurses’ and healthcare assistants’ experiences of the Covid-19 pandemic?6  In response to the pandemic, general practice in the UK had to rapidly alter provision of care, notably through the wider implementation of telehealth.7,8 GP teams, including practice nurses, advanced nurse practitioners, healthcare assistants and nursing associates, have been central to navigating these changes in practice.9

This study by Russell and colleagues (2022)6 aimed to explore primary care nurses’ and HCAs’ experiences of the changes enforced by the pandemic. Semi-structured interviews were conducted via video call or telephone with participants recruited using convenience and snowball sampling. A total of 24 people from GP practices in England were interviewed: practice nurses (n=12); healthcare assistants (n=7); advanced nurse practitioners (n=4); and nursing associates (n=1). Interviews were done between February and March 2021.

Three main themes were identified: difficult changes; dealing with change, and an opportunity for improvement. Participants highlighted the major changes made at the onset of the pandemic; they experienced a number of negative emotions, heightened by a fear of infection, confusing government guidance, shortages of PPE and friction with doctors. However, these could be overcome by their own coping strategies, peer support and effective communication within the practice. The participants also said some of the changes, such as greater use of telemedicine, were beneficial although they did not negate the need for in-person care.

The main limitation was that participants were from just three regions of England, so the findings may not reflect the experiences in other areas of England, the devolved British nations or internationally.

The study suggests the key learnings from the pandemic were the need to support and develop the resilience of nurses and HCAs and to ensure adequate PPE for staff to work safely and with confidence. Also emphasised were the importance of improving collaboration and communication, and the potential ongoing role of telemedicine if properly implemented.


  1.  Bravington et al. Challenges and opportunities for cervical screening in women over the age of 50 years: a qualitative study. BJGP 2022;72:725:e873-e881. Link
  2.  Albrow R et al. Cervical screening in England: the past, present, and future. Cancer Cytopathology 2012; 120(2): 87–96. Link
  3.  NHS. Public health indicators and population statistics. Cervical screening programme England 2019–2020. 2020. Link
  4.  Peto J et al. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004; 364(9430): 249–256. Link
  5.  Castanon A et al. Prediction of cervical cancer incidence in England, UK, up to 2040, under four scenarios: a modelling study. Lancet Public Health 2018; 3: e34–e43. Link
  6.  Russell A et al. What can general practice learn from primary care nurses’ and healthcare assistants’ experiences of the Covid-19 pandemic? A qualitative study. BMJ Open 2022;12:e055955. Link
  7.  Majeed A, Maile EJ, Bindman AB. The primary care response to COVID-19 in England’s National health service. J R Soc Med 2020;113:208–10. Link
  8.  Khan N, Jones D, Grice A, et al. A brave new world: the new normal for general practice after the COVID-19 pandemic. BJGP Open 2020;4:3. Link
  9.  Health Education England. The general practice nursing workforce development plan, 2017. Link

Lucille Kelsall-Knight is a lecturer in children’s nursing at University of Birmingham School of Nursing


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