Cervical screening in general practice - strategies for improving participation.

Background: National cervical screening rates have plateaued at around 60%. Each method of recruitment has an upper limit to uptake and the benefits of multiple strategies are additive. There is debate about reallocating Pap testing to nurses in general practice.

Objective: To assess the effects on cervical screening rates in one small general practice.

Methods: An audit of the effect of: updating Pap test details in electronic records; active recruitment by letter; follow up telephone call if no appointment made; altering the letter to invite women to separate themselves into Pap test 'plus other issues' or 'screening test only'; and the offer of a Pap test for the 'Pap test only' group to be performed by a nurse.

Results: Over 18 months there was a 27% improvement from a biannual screening rate of 53% at baseline to 67.5% at the end of the audit. Over the past 6 months, 49% of women elected for the 'screening only' test provided by a nurse.

Discussion: All four strategies are feasible and associated with a considerable increase in screening rates. Patients can choose to have their test performed by a nurse in general practice. This study suggests that each strategy's improvement in uptake is independently additive.