2.The NSW Program

The OAPCC commenced in NSW in 1991 and Phase 1 of the Program was managed by the NSW Cancer Council on behalf of the NSW Health Department from 1991 to 1995. In late 1995, the Department issued a limited invitation for proposals to manage and implement Phase 2 of the NSW Cervical Screening Program and a consortium comprising Western and Central Sydney Area Health Services was awarded the contract.

The invitation for proposals for the management and implementation of Phase 2 of the NSW Cervical Screening Program required that, in addition to conforming to the National Goals, Aims and Objectives for the Program (see appendix A), Phase 2 would focus on the key areas of recruiting hard to reach women, quality assurance in relation to Pap smear providers, the development of minimum standards for Pap smear providers and the medico-legal issues confronting the Program. In addition, this Phase of the Program would focus on the:

• establishment of a statewide Program within existing infrastructure in NSW Health Services;
• establishment of a statewide Program in consultation with the Divisions of General Practice, professional agencies of the pathologists, colposcopists, cytotechnologists and women’s health nurses;
• establishment of quality assurance/management systems in relation to health professionals involved in the cervical screening pathway;
• provision of pathology for non medical Pap smear providers employed by Health Services;
• training of Pap smear takers and readers; and,
• developing communication strategies for women and health professionals in relation to the Program, the Pap Test Register and the limitation of the Pap smear test.

The Program is managed by Western and Central Sydney Area Health Services through a funding and performance agreement with the NSW Health Department. The Program Co-ordination Unit, based at Westmead Hospital, is responsible for Program management, co-ordination and implementation. Operations -oriented research and evaluation is undertaken by the Research and Evaluation Unit located in the Needs Assessment and Health Outcomes Unit at the Central Sydney Area Health Service. In addition, a network of Cervical Screening Coordinators will be located in each Health Service in order to more effectively target Program delivery at the local level.

An Inter-Area Management Committee has been established to provide managerial oversight of the Program. Membership includes the Chief Executive Officers and Directors of Health Services Planning for both Western and Central Sydney Area Health Services and a senior nominee of the NSW Health Department.

A State Advisory Committee (Appendix 2) has been established by the NSW Health Department to provide policy advice to both the Program and the Pap Test Register. The Committee includes representatives of key stakeholder groups and other relevant experts such as consumers, general practitioners, women’s health practitioners, laboratories, gynaecology, law, and health economics

The NSW Pap Test Register commenced operation in July 1996 and is managed by the NSW Cancer Council on behalf of the NSW Health Department. It maintains a record of Pap smears taken by laboratories and the results. It sends a letter to women reminding them when they are overdue for their next Pap test and provides follow-up service to health practitioners and women where an abnormal smear is reported. Women can elect to ‘opt off’ the Register. The Register will provide data to the NSW Cervical Screening Program and publish benchmark cytology data.

A framework for collaboration between the Program and the Register has been established and clear contractual obligations have been set down for provision of data to support the Program.

Phase 2 of the Program will combine public health and clinical perspectives in a statewide Program aimed at reducing the incidence of and mortality from cervical cancer in NSW. It will take a strong collaborative approach by establishing and supporting links with Area Health Services, Divisions of General Practice, professional associations and colleges and women. It will be firmly grounded in an operations-oriented research approach which identifies best practice and effective strategies across all aspects of the screening pathway.