Prominent among the looming diary entries of 13 health authority chairs is a date with health secretary Frank Dobson.
Mr Dobson wants to meet them personally to emphasise the priority they must give to running a fully effective cervical screening service - all 13 have failed to reach the government's target of 80 per cent coverage.
The health secretary expects all HAs to meet the 80 per cent target by March 2002 and is insisting that action plans must be prepared within the next month to show how the 13 'failing' HAs plan to achieve this.
The 1997-98 coverage rate in Redbridge and Waltham Forest HA is 77.9 per cent, up from the 76.3 per cent recorded in 1996-97, says an HA spokesperson. But that figure was down from 77 per cent recorded in 1995-96.
The HA is addressing the problem by working intensively with the poorest- performing GP practices, explains Dr Liz Holford, associate director in public health.
'By improving management and administrative systems - updating patients' addresses, getting rid of 'ghost' patients from the lists, flagging patients' notes so that, when they come to the surgery for whatever reason, the fact that they are due for a cervical smear test is brought to their attention - some practices have already improved their coverage rates from 50 per cent to 80 per cent,' she says.
'It is a hearts and minds issue with GPs. What counts is getting GP, practice manager, practice nurse and receptionist to understand that this is an issue worth bothering about.'
The worst performing HA is Kensington & Chelsea and Westminster, with 69.3 per cent coverage. Chief executive John James says the position is not irretrievable. 'We ought to be pulling our socks up,' he concedes. 'There is room for the HA to achieve a significant improvement in performance.'
But he also proffers a number of reasons why his and other London HAs often find achieving 80 per cent coverage 'is like achieving a 95 per cent coverage rate in the shires'.
The district has a highly mobile population, including significant numbers of students, says Mr James. It also has large ethnic minority communities, members of which may be culturally averse to screening or find the service difficult to access, perhaps because of language barriers.
And it has a large number of affluent women who use the private sector to have their smears taken but whose results do not always get into their GPs' records.
Mr James also cites poor service from laboratories, including 'unacceptable delays' in turning round results.
Much of the improvement work will fall to primary care groups. Paul Haigh, chief executive of South Kensington, Chelsea and Westminster PCG, says it may appoint a team to identify women who fail to respond to screening invitations.
The PCG also wants to spread the good practice identified in GP practices that have exceeded the target, says Mr Haigh. 'We have to understand better what those which are successful are doing that others do not seem to be able to do.'
High population turnover and large ethnic minority communities do not necessarily influence figures greatly, he adds.
Only two of the 13 HAs currently below target are outside London. One of them, Liverpool HA, has been working to improve its 78.8 per cent record.
Last year a nurse practitioner working in five GP practices raised coverage from 54-75 per cent to more than 80 per cent, says Dr Joyce Carter, a consultant in public health medicine with the HA.
'First she worked with the practices on clearing up lists and getting rid of all the 'ghost' patients, then she wrote personal letters to all those women who had not responded to invitation to screening and got an 80 per cent response,' says Dr Carter.
'She made home visits to women who still did not respond and about half of these then came forward. If women had trouble getting out of the house, she carried out a smear test in their own home.'
Coventry HA achieved 82.9 per cent coverage in 1997-98 - up from 79.5 per cent in 1996-97. Dr Madhu Bardhan, consultant in public health medicine, says it is about 'flogging away patiently'.
Training administrative staff is important 'so that they realise there is a time frame that they must work within', she says. The HA also identified practices 'which needed a bit more help' and moved people in.
'But there are no quick fixes. We will continue to work on it - achieving 82 per cent coverage is not a matter for complacency.'
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