Making health and social care services work better, for everyone

NHS England and NHS Improvement for the Midlands have released the following update on Breast screening services locally:

Since March 2020, NHS Breast Screening services have been affected by a range of clinical and operational impacts due to the Covid-19 pandemic. Local breast screening services took the decision to reschedule appointments and invitations for tests to a later date to protect patients from the virus and redeploy staff to support coronavirus-related work.

Since that time NHS England and Improvement, as commissioners of breast screening services, have been working with providers to restore the breast screening programme, focussing on the highest priority patient groups first.

A reduction in screening capacity has been inevitable due to the requirements for personal protective equipment, enhanced infection control and social distancing to ensure that staff and clients stay safe. This, in conjunction with the pause in issuing invitations, has unfortunately resulted in a backlog of those who are due appointments.

Guidance has already been issued to services on phase 1 of restoration and recovery to ensure that women who are high risk, have screened positive, whose results were not processed or who were invited but not screened, are invited and have their screening pathway completed. Following this, people who were delayed an invitation will be invited for screening.

For those delayed an invitation (phase 2 of restoration and recovery) guidance will be to screen women based on the priorities below:

  1. Women aged 53 and not previously invited
  2. Women aged 71+ who were due screening pre-Covid-19 but who have not been screened
  3. Women aged 50 to 70 years

The following women will not receive any invitations until further notice:

  • Self-referrals aged 71 or over

Any women aged 71 or over who contact the service to request an appointment will be advised that self-referrals are not currently available. If women notice any symptoms, they should contact their GP.

Women in the AgeX trial:

Women who were already invited or due an invitation prior to screening being rescheduled will continue to be issued an invite for breast screening as part of the AgeX trial. On completion of screening for these women, all further screening invitations will not include AgeX women until further notice.

In order to fully reinstate routine breast screening services and best address the backlog, a national decision has been taken, initially as an interim measure, to encourage providers to move to issuing open invitations for routine clients where possible, as opposed to the usual timed appointments.

The use of open invitations is intended to make the best use of the capacity available by reducing Do Not Attend (DNA) rates and thereby maximising the numbers of women screened. Some providers will be opting not to move to an open invitation system, e.g. if they are a small provider, have no screening backlog or high numbers of people without English as a first language in their population. Please note that high risk clients and those with a learning disability will continue to be issued with timed appointments.

A number of Midlands providers will move to open invitations from mid-August with more following on 30 September 2020. Where adopted, open invitations will initially be in place until 31 March 2021.

Open invitation letters will ask women to contact the service to book a convenient appointment by phone or email.

We know that the use of open invitations may adversely impact some groups e.g. where English is not the first language or for those with verbal communication difficulties. For those providers moving to an open invitation system this needs to be balanced against the impact of the backlog leading to increasing the screening round further beyond 36 months. We will be working with providers to identify any issues and how we can mitigate these.


For further reading, a Q&A sheet is available here: 200811 Breast Screening Restoration QAs