Dr. Peter McKenna:

At the start of this year we visited each colposcopy unit and asked those involved how they were coping with the crisis, how they would cope with the increased number of patients who would come on stream when the HPV arrangements were put in place and how they would cope when the increased pressure of the Royal College of Obstetricians and Gynaecologists disclosure arose. We discussed what was required under the headings of personnel and staff, equipment and minor infrastructural changes. These requirements have been collated; the plan has been submitted and funding allocated to approve them. One of the most striking things we found was a consistent increase across the country in the number of non-cytology referrals to colposcopy clinics. The colposcopy clinics are designed to deal with people with cytology abnormalities. Historically, a small proportion - between 5% and 10% - of those going to colposcopy clinics were women who had symptoms such as abnormal bleeding. In the last year that small proportion has increased to between 35% and 50%. The colposcopy clinics are finding it difficult to cope with the extra cohort of patients. The reason for the increase in the number of clinical referrals reflects an anxiety in the community and primary care services. Patients are very conscious of the need not to neglect symptoms. The number of patients being processed in colposcopy units has increased. Arguably, these clinical referrals are inappropriate for colposcopy units. With that in mind, we are seeking to find a method to take them out of colposcopy clinics. We are exploring how funding can be sourced to see them being dealt with more rapidly outside the colposcopy environment.