Guidance

Breast screening: guidance for providers on ‘out-of-area screening’

Published 19 December 2017

This publication outlines national policy on the screening of women at a different NHS breast screening unit from the one the local screening provider invites her to attend. Attending an alternative screening unit is called ‘out-of-area screening’.

A small percentage of women ask to be screened ‘out of area’.

Wherever possible, services should try to accommodate these requests to help maximise screening uptake.

Reasons for women asking for ‘out-of-area screening’ include:

• having to travel further to their designated screening service than an alternative service
• wanting to attend screening near their place of work
• physical difficulties accessing their local screening unit

Services have a responsibility to screen women who ask for breast screening at their unit. The national breast screening service specification reinforces this responsibility. Accepting women from ‘out of area’ should not compromise the provision of screening at a service. This means it should not have a significant impact on capacity or maintenance of the screening round length plan within 36 months.

Advising women

Women should be advised if it is not possible to accommodate out-of-area screening requests in the short term due to organisational reasons.

This is usually if a screening unit has delays to screening, for example due to a shortage of staff. Accepting additional women into the screening service would then make these delays longer, and this is unacceptable.

Women asking for screening elsewhere

The following process applies:

1. The woman tells the screening service which has invited her for screening that she wants to be screened at a different service.
2. The host screening service contacts the service where the woman wants to be screened.
3. If the receiving service can screen her, the contact details of the receiving unit should be given directly to the woman.
4. The host service asks the woman to contact the preferred service directly and ask for an appointment at a convenient time.
5. The host service tells the woman that no permanent re-assignment to her preferred service is possible.

Contact details for breast screening services are available on NHS.uk.

If women screened at an alternative (requested) service need further tests or investigations, the same service will carry these out. Women will not be able to return to their original (inviting) breast screening service for such additional tests. The service that invites the woman (inviting service) will inform her about this. The service chosen by the woman (receiving service) will also inform her.

It is not possible to permanently transfer to an alternative breast screening service unless the woman moves address and registers with a GP within the receiving service’s catchment area. The programme will continue to invite women to breast screening from 50 up to their 71st birthday at their original (inviting) screening unit. Women should be informed that this is the procedure if they want to be screened elsewhere.

Managing requests for out-of-area screening

Inviting service

The inviting service should accept the woman’s request, but make it clear there is no guarantee the receiving service will be able to accept her (due to the reasons outlined above).

The inviting service should contact the receiving service directly to ask if they can screen the woman. If this is possible, the contact details for the receiving service should be given to the woman. The woman then contacts the receiving service directly to arrange a mutually convenient appointment.

If the woman does not contact the receiving service, she may still attend her original appointment. If she fails to do so, the inviting service will automatically send her a second timed appointment.

See Appendix 1: Inviting service managing a request for screening elsewhere

Receiving service

The woman will contact the receiving service to request an appointment if this has been confirmed possible by the inviting service. The receiving service must agree to take on the whole screening episode (from screening to results) including assessment if this is required.

The receiving service must be confident that accepting the woman will not adversely affect capacity or screening round length.

See Appendix 2: Receiving service: accepting an out-of-area screening request

Women moving from a receiving service to private health services

Women may be screened in one service and then decide to go elsewhere for assessment, for example via private sector providers. In this case, the service which has invited and screened the woman should obtain details of the assessment outcomes and enter them on to the National Breast Screening System (NBSS).

These will then appear on the service’s KC62 outcome statistics.

Women screened through the high risk programme

This guidance is applicable to women invited as part of very high risk screening. More details are provided in organising very high risk screening guidance.