Cervical screening (CS) - QOF indicator

Cervical screening in QOF 2026/27

The cervical screening indicators reward practices for providing screening at the recommended ages and maintaining uptake. Although routine screening intervals changed for some patients from 1 July 2025, QOF retains two separate indicators for 2026/27 because they measure screening already undertaken; indicator changes are not expected to be needed until 2028/29.

Cervical screening indicators

CS005 draws on NICE IND176; CS006 draws on NICE IND177.

Why CS005 and CS006 remain separate

The indicators support screening offers that match NHS Cervical Screening Programme recommendations for each age group, alongside sustained high participation.

From 1 July 2025, the routine interval increased from every 3 years to every 5 years for women and people with a cervix aged 25 to 49 whose screening result is negative for high-risk Human Papillomavirus (hrHPV). That change applies prospectively, whereas QOF looks back at previous screening. Consequently, CS005 and CS006 remain separate in 2026/27, with no QOF change anticipated to be necessary until 2028/29. Invitations for people affected by the interval change should still follow their next test due date.

These indicators have particular Personalised Care Adjustment requirements, which the cervical screening guidance signposts to Section 6.

During 2025/26, NHS Cervical Screening Programme transformation projects helped practices work towards their QOF indicators. Further projects will provide support in 2026/27. Details will appear on the NHS Cervical Screening professional guidance pages on GOV.UK once arrangements are confirmed.

Reporting and verification for CS005 and CS006

The definitions in the indicator table set out the achievement requirements. Commissioners may ask practices for a computer-generated report giving the numbers:

• Eligible for screening on the practice list.

• With a personalised care adjustment.

• Screened within the required interval.

Before applying a personalised care adjustment for non-response, eligible women and people with a cervix must have been sent a minimum of three invitations, as set out in section 5 of the guidance. The national call/recall service sends the first two, with the practice responsible for the third. A dedicated SNOMED code is available for recording non-response after three cervical screening invitations.

Personalised care adjustments

Personalised Care Adjustment (PCA) distinguishes the reasons why care has been adjusted and a patient removed from an indicator denominator. These reasons are:

• The intervention is unsuitable for the individual, for example because of medication intolerance, allergy or contraindicated polypharmacy.

• The patient decides against the intervention after shared decision-making.

• Invitations offering care have not received a response.

• A required service cannot be accessed; this applies only to a limited set of indicators.

• The patient has recently registered or received a new diagnosis, within the existing rules.

If the QOF intervention has not been provided, recording a PCA removes the patient from the relevant indicator denominator. Their inclusion on the disease register or other target population is unaffected.

An exclusion is different: it arises from the indicator's definition rather than an adjustment to care. A person may remain on a clinical register but fall outside an indicator because it covers only a particular age group, status such as smoking, or duration since diagnosis.

The business rules specify which PCAs are available for each indicator. Where the patient fulfils the achievement requirements, that achievement takes priority over a PCA, including when a PCA code is already present.

Principles for applying a PCA

Practices should consider the following whenever deciding whether an adjustment is appropriate:

1. Responsibility for the patient's care continues regardless of a PCA.

2. Clinical judgement should guide the decision, taking account of the patient's preferences and shared decision-making. The record must contain a clear, auditable explanation, either coded or in free text.

3. Adjustments must be individual rather than applied to whole groups. Clinicians should assess the relevant circumstances for each patient at every level of the clinical indicator set and revisit the decision regularly.

4. Recording must go beyond the information required for payment under the business rules. The reason needs sufficient detail to support safe, effective care and audit. For example, a medication intolerance code should be accompanied by an explanation of the nature of the contraindication.

PCA criteria and extraction order

The business rules extract reasons for personalised care in this order:

1. The relevant investigation or secondary care service is unavailable, where the indicator permits this reason.

2. The intervention is unsuitable on clinical grounds.

3. The patient has decided not to have the intervention.

4. The patient has not replied to invitations: a minimum of two invitations for the intervention in the preceding 12 months is required, except for cervical screening, where women should receive a total of three invitations.

5. Registration with the practice or diagnosis of the relevant condition occurred in the preceding 3 months, and the specified clinical measurements, such as blood pressure measurement, have not been obtained.

6. Registration with the practice or diagnosis of the relevant condition occurred in the preceding 9 months, and the specified clinical standards, such as blood pressure within target levels, have not been met.

The recording and interpretation requirements for these categories are explained below.

More than one reason may apply to a patient. Record every applicable reason to support their care, but the business rules will recognise only one PCA for each indicator, using the first applicable category in this hierarchy. For instance, if someone registered in the preceding 3 months and has also declined the intervention, the extracted reason will be their decision not to receive care.

This ordering gives greater weight to clinical judgement and patient choice than to the other criteria. Consistent use of the hierarchy, together with the recording arrangements below, is intended to identify the reasons for adjustments more accurately and make discussions between clinicians, commissioners and regulators more useful.

Unavailable investigation or secondary care service

Only DM014, OB004 and OB005 allow a PCA on this basis.

Practices should use the specific codes identifying service unavailability. Before entering such a code, they are expected to explore fully with their ICB whether an appropriate investigation or secondary care service could be commissioned for the patient.

The required recording frequency varies. Some codes require annual entry; others need recording only once within the indicator's specified timeframe.

Clinical unsuitability

Clinical unsuitability is expected to be the most common basis for personalised care, reflecting the need for clinicians to judge whether guideline recommendations fit an individual patient's circumstances.

This category brings together the former exception-reporting grounds covering:

1. Circumstances in which reviewing chronic disease measures would be inappropriate, such as end of life care.

2. Treatment already at the highest dose the patient can tolerate.

3. Medication allergy, contraindication or adverse reaction.

4. Inability to tolerate medication.

5. Another condition that makes treatment of the condition covered by the indicator inappropriate.

Both broad patient-unsuitability codes and indicator-specific codes support this category. The broad codes cover all indicators within a clinical area except VI001, VI002 and VI003. The Vaccination and Immunisation domain instead uses codes specifically identifying clinical unsuitability for vaccination. Further codes describing particular clinical reasons for unsuitability will be introduced over time.

A code for a continuing, permanent reason, such as an allergy to a specified medicine, may be recorded once. Other reasons require annual coding after reviewing whether the intervention remains appropriate for that patient.

Consultant involvement is not, by itself, a reason to adjust care for every patient in that group. Each person needs an individual assessment, with every reasonable effort made to optimise care.

Even where a consultant provides all of a patient's care, the practice must hold evidence that the contractual requirements have been met. Without that evidence, it should treat the action as outstanding and either meet the relevant indicator requirements itself or obtain confirmation from secondary care that the test or check was completed. If the secondary care clinician and primary care clinician agree, using clinical judgement, that further investigation or action is inappropriate, document that decision; a PCA can then be used.

Patient decision not to receive an intervention

This reason requires a documented personal contact or discussion. Ideally, the entry should also explain why the patient declined. Contact between the patient and a health professional may take place in person, by video or by telephone.

Generic informed-dissent codes cover all indicators in a clinical area, while more targeted codes relate to individual indicators. Practices are encouraged to select a more specific code when one is available.

Revisit the patient's decision annually and record it again each year where necessary. CS005 and CS006 are exceptions: the decision only needs to be recorded once within the period specified by the indicator. Nevertheless, regularly checking whether the patient still wishes to decline is consistent with the underlying principles. Women who leave cervical screening call/recall will not receive further screening offers from the central screening service.

For non-response to invitations, removal from an indicator denominator normally requires a minimum of two invitations at two unique time points in the QOF year, 1 April to 31 March, with a minimum of seven calendar days between them. For CS005 and CS006, a minimum of three invitations at three unique time points is required within the indicator's timeframe. Appropriate opportunities to offer care should still be taken.

Non-response: invitation standards and recording

Practices can use a range of communication channels to invite patients, with further options likely as digital technology develops. The NHS must also meet its legal responsibilities under the Accessible Information Standard so that people with a disability, impairment or sensory loss receive information they can access and understand.

An invitation therefore needs to use a format accessible to the individual. Record communication preferences proactively and when opportunities arise, such as the next patient contact. If a preferred method is documented, use it for the first invitation; the second may use any method.

Address every invitation to the individual by name and make clear which care is being offered. Letters and emails should also explain the reason for the offer and its importance to the patient's health care.

Enter invitation codes when invitations are sent. Data extraction requires a minimum of seven calendar days between invitations, although practices should judge the most suitable interval for their population and may need to leave longer. Existing codes can identify either the communication channel or use of the patient's preferred method; either is acceptable for QOF.

Patients should receive a minimum of two invitations during the QOF year, 1 April – 31 March. Correct coding allows the business rules to identify these invitations without an additional year-end code for non-response.

General messages do not count as invitations. This includes prompts on the right-hand side of prescriptions and waiting-room notices asking groups of patients to book appointments or attend clinics.

Cervical screening invitations

National screening programme requirements continue to require invitations on three separate occasions. Responsibility depends on the local call/recall arrangements:

• If the central screening service sends the first two invitations, the practice must provide the third.

• If the central service sends only one letter, the practice must provide both the second and third invitations.

• Practices operating their own call/recall system must issue all three invitations.

• After non-response to all three, the practice must code that outcome. Record each invitation individually, as evidence may be requested during assessment or audit.

• Women can decide to leave the national screening programme, but withdrawal needs careful consideration because the central service will make no further screening offers. An active decision to decline cervical screening should be recorded as such.

Recent registration or diagnosis: clinical measurements

For patients who register or receive a new diagnosis in the last 3 months of the QOF year, 1 January – 31 March, the PCA for missing specified clinical measurements applies automatically. It does not apply if the practice has recorded those measurements within the indicator's timeframe, because achievement takes precedence over an adjustment.

Recent registration or diagnosis: clinical standards

For patients who register or receive a new diagnosis in the last 9 months of the QOF year, 1 July – 31 March, the PCA for not meeting specified clinical standards applies automatically. If those standards have been met within the indicator's timeframe, achievement takes precedence instead.