HPV self-testing: nurses stress profession’s ‘key role’ and the need to monitor workload impact

Nurses working in primary care have highlighted the ‘key role’ the profession will play in the roll-out of new self-testing HPV kits and the importance of an effective follow-up pathway.

But questions have also been raised around the potential for increased demand put upon general practice nurses (GPNs) and workload within primary care.

In August, the at-home testing kits began being rolled out to almost four million women who have not attended cervical screening appointments. It is hoped the programme will encourage more women to complete the screening to detect HPV, which can increase the risk of cervical cancer.

If high-risk HPV is found through self-testing, individuals will be invited to book a follow-up cervical screening appointment at their GP surgery or sexual health clinic, where a nurse will then take a sample from the cervix to check for cell changes.

Carried out as an invitation-only offer, the scheme will begin with those aged between 30 and 65 in England, who have not attended cervical screening following previous invitations.

Following the launch, Nursing in Practice has spoken to nurses working in general practice about what the roll out will mean for both the profession and for patients.

They stress that despite patients being able to swab themselves and send the sample back to the NHS for free, they will still play a ‘key role’ in the process, including through providing advice and completing follow-up screenings if needed.

‘There will be an impact on GPNs who have a key role’

Advanced nurse practitioner Ruth Bailey, who works in sexual health and contraception, said the self-testing kits are ‘great news’ and ‘open up another route’ for people to access screening.

‘This is great news for everyone eligible for cervical screening. We know that screening saves lives however there are many people who have not participated because the current screening process is not acceptable to them,’ she said.

‘Self-taken HPV tests opens new opportunities for people to engage with screening and I think it is a pivotal step in breaking down barriers in access.

‘Current screening requires an intimate examination is simply not acceptable to some women for a wide variety of reasons such as a history of birth trauma, sexual violence, cultural concerns or body dysmorphia.

‘Sometimes barriers are organisational like appointments being in work time, or clinics are not accessible – self-testing opens up another route.’

Ms Bailey stressed the self-testing kits are not a replacement for in-person cervical screening in which patients aged 25 to 64 are invited by their GP surgery for a screening by a nurse every five years – or more if they are HPV positive. But she said she hopes it will help widen access.

‘There will be an impact on GPNs who have a key role in explaining the process and how it works,’ she told Nursing in Practice.

‘It doesn’t replace the current test, as it won’t be initially available to everyone and those with an HPV positive test will still need to attend for a cervical sample.

‘It does offer wider access to health care and that is good news for everyone.’

When announcing the launch last month, NHS England (NHSE) also described the self-testing kits as an ‘additional choice’ for people who have not taken up previous invitations and stressed that clinician appointments ‘remain the best way to help prevent cervical cancer’.

According to NHSE, the latest figures show that 68.8% of eligible women are up to date with their cervical screening, below the national target of 80%.

‘We could see an increase in GPN demand initially’

Lead practice nurse Natalie Holdaway told Nursing in Practice that self-testing HPV kits could increase the demand for GPN appointments for patients who need follow-up appointments, advice, and clarification.

She said: ‘If uptake increases significantly among people who would otherwise never attend screening, we could actually see an increase in demand initially, as more patients seek advice, clarification of results, and follow-up appointments.

‘There may also be a cohort of patients who receive a positive HPV result and then require clinician-led assessment.

‘Ultimately, I see self-testing as an additional option rather than a replacement for cervical screening.

‘If it succeeds in reaching people who currently do not engage with screening programmes, it has the potential to be a valuable public health tool.

‘However, careful evaluation will be needed to understand its impact on patient outcomes, follow-up attendance rates, and workload within primary care.’

She added that the self-testing kits are important for patients who avoid screenings due to ‘embarrassment, previous traumatic experiences, cultural concerns, anxiety, physical disabilities, or simply finding it difficult to attend appointments’.

‘Giving patients the option to self-test allows them greater autonomy and may help engage groups who have historically been under-screened,’ she said.

‘I would like to think the introduction of self-testing will improve uptake, particularly among those who have not attended screening for several years.

‘Any initiative that helps identify people at risk earlier should be welcomed.’

‘The success of the programme will depend on engagement with any follow-up pathway’

Ms Holdaway stressed the importance of follow-up screenings where required and also raised questions around the ‘quality’ of self-testing.

She said: ‘The success of the programme will depend not just on participation in self-testing, but on engagement with any follow-up pathway.

‘There are also questions around the quality of self-collected samples. While many patients will follow instructions carefully, some may find the process challenging or may be uncertain whether they have completed the test correctly.

‘This could potentially lead to invalid samples, repeat testing, or increased demand for advice and support from primary care teams.’

NHSE reiterates that people who routinely attend for a cervical screening test with a clinician at their GP practice or sexual health clinic should continue to book their appointments as normal.

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