NHS screening programmes: information for GPs and practice staff
How to support patients in accessing population screening programmes and obtaining screening results.
Applies to England
Population screening explained
Population screening is the process of identifying healthy people who may have an increased chance of a disease or condition, enabling early treatment.
It is not intended for people who already have symptoms of a disease or condition.
‘What is screening?’ is a 2-minute video explaining the basics of screening.
Screening should always be a personal choice. GPs and other health professionals can offer people information to help them decide if they wish to accept screening.
Population screening in England
There are 11 population screening programmes in England. GPs and practice staff can help reduce screening inequalities by making people aware of the NHS screening programmes and supporting them to make informed choices about screening.
There are 5 NHS young person and adult (YPA) screening programmes. These are the:
- NHS abdominal aortic aneurysm (AAA) screening programme
- NHS bowel cancer screening programme (BCSP)
- NHS breast screening programmes (BSP)
- NHS cervical screening programme (CSP)
- NHS diabetic eye screening (DES) programme
There is also a risk management programme for prostate cancer, but currently no population screening programme.
There are 6 NHS antenatal and newborn (ANNB) screening programmes. These are the:
- NHS fetal anomaly screening programme (FASP)
- NHS infectious diseases in pregnancy screening (IDPS) programme
- NHS newborn and infant physical examination (NIPE) screening programme
- NHS newborn blood spot (NBS) screening programme
- NHS newborn hearing screening programme (NHSP)
- NHS sickle cell and thalassaemia (SCT) screening programme
Different ANNB screening tests are offered at different times during pregnancy and after the baby is born. Every year about 650,000 pregnant women and newborn babies are offered ANNB screening.
The population screening timeline outlines all the NHS screening programmes offered in England.
Information for people invited for screening
PHE produces information on behalf of the NHS to allow people to make informed choices about screening tests offered to them. This includes information on:
- abdominal aortic aneurysm (AAA) screening
- bowel cancer screening
- breast screening
- cervical screening
- diabetic eye screening (DES)
- antenatal and newborn (ANNB) screening
Some of this information is available in other languages, audio and large print formats.
We have also produced:
- easy read resources for people who have a learning disability or who struggle with written English
- information for transgender (trans) and non-binary people
Lifetime screening pathways
There are 2 animations summarising the:
ANNB screening animations
We have published animations explaining the different screening tests for pregnant women and newborn babies. As well as a summary animation there are specific animations for:
- infectious diseases in pregnancy screening
- sickle cell and thalassaemia (SCT) screening
- screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome
- the 20 week screening scan
- the newborn and infant physical examination
- newborn hearing screening
- newborn blood spot screening
Adding or removing patients from screening lists
We provide guidance for people wishing to opt out of receiving invitations to screening.
Patients eligible for screening who wish to be reinstated to screening invitation lists, or check they are on the lists, should contact the relevant screening programmes (see contacts section below).
For cervical screening, GPs are responsible for contacting Primary Care Services England (PCSE) and asking for the patient’s details to be removed from the screening list. Patients cannot request this from PCSE themselves.
Screening results and appointments
The information below details how to follow up screening results for individual programmes, and how to make or change screening appointments.
| Programme | Action |
|---|---|
| AAA screening | Patient to contact local AAA screening service |
| Breast screening | Patient to contact local breast screening unit |
| Bowel cancer screening | Patient to call free programme helpline on 0800 707 60 60. This includes patients over the screening invitation age range, who wish to request a test kit. |
| Cervical screening | Results: GP to contact PCSE. Appointments: patient to contact GP practice or other screening provider. |
| Diabetic eye screening | Patient to contact local DES programme |
We have developed principles for the effective use of text messaging in screening and follow-up appointment reminders.
Programme contact details
The information below links to contact details for screening provider services.
| Programme | Contact details |
|---|---|
| AAA screening | Local AAA screening service contact details are available via NHS.UK |
| Bowel cancer screening | Free programme helpline: 0800 707 60 60 |
| Breast screening | Local breast screening unit details are available via NHS.UK |
| Diabetic eye screening | Local DES service contact details are available via NHS.UK |
Education and training
e-Learning for Healthcare (e-LfH) hosts a range of online education modules about screening. These include:
- All Our Health: population screening, a bite-sized session giving health and care professionals an overview of population screening
- the newborn and infant physical examination (NIPE) e-learning course
The Royal College of General Practitioners (RCGP) e-learning platform also has a course on NHS screening.
Cervical sample taker training
Guidance is available on training for cervical sample takers which outlines responsibilities and training requirements. A diagnostic chart for sample takers is available to order on a one per consultation room basis.
A cervical screening e-learning module for sample takers is available which meets the requirements of the mandatory 3 year update training.
NHS AAA screening programme
AAA screening checks for the presence of an undiagnosed AAA. An AAA will often cause few or no obvious symptoms. If an AAA is not detected early, then it may continue to increase in size and eventually rupture. A ruptured AAA is usually fatal.
Who is screened
Men receive a screening invitation by post when they are aged 64 or 65. All eligible people who are registered with a GP (as male) automatically receive an invitation by mail. Trans women (assigned male at birth) do not receive invitations if registered as female with their GP but are still eligible for screening.
Women, or men under 65 who think they are at higher risk (for example, due to family history of the condition), can talk to their GP about the possibility of having a scan outside the screening programme.
The screening test
AAA screening involves an ultrasound scan of the abdomen to measure the width of the aorta.
Screening results
There are 4 AAA screening results. These are:
- no aneurysm found (aorta is less than 3cm wide) – most men have this result
- small AAA (aorta is 3cm to 4.4cm wide) – just over 1% of men have this result
- medium AAA (aorta is 4.5cm to 5.4cm wide) – about 0.5% of men have this result
- large AAA (aorta is more than 5.4cm wide) – about 0.1% of individuals have this result
If no aneurysm is found no treatment is required and the man will not be invited for AAA screening again
If a small AAA is found no treatment is required and the man is invited back for screening every year. He is also given advice on how to stop an AAA getting bigger.
If a medium AAA is found no treatment is required and the man is invited back for screening every 3 months. He is also given advice on how to stop an AAA getting bigger.
If a large AAA is found the man is referred to a specialist surgeon within 2 weeks. Most men are advised to have surgery.
More information is available in the AAA screening programme overview.
NHS bowel cancer screening programme (BCSP)
Bowel cancer causes about 16,700 deaths in the UK each year.
Who is screened
People aged 60 to 74 are automatically invited to take part in bowel cancer screening every 2 years. People aged 75 and over can request screening every 2 years by phoning the free bowel cancer screening helpline on 0800 707 6060.
To the meet the commitment made in the NHS Plan the NHS is starting the roll out of age reduction for bowel cancer screening from May 2021, starting with people aged 56 years.
The screening test
Bowel cancer screening looks for blood in a stool sample. Those eligible receive a home test kit by post and return the collected sample for laboratory analysis.
The faecal occult blood test (FOBt) used in the programme is faecal immunochemical testing (FIT). It is a test used in both the bowel cancer screening programme and for symptomatic patients. FIT is an objective measure of haemoglobin per gram of faecal matter. The sensitivity level differs between screening and the symptomatic service. The sensitivity of the FIT test used in the NHS bowel cancer screening programme is lower than that currently recommended for use for symptomatic patients, so the level defining a positive result (people who require further investigations) in the screening programme is higher than for a symptomatic test.
Previously, some people aged 55 were invited for bowel scope screening. This is no longer offered due to the expansion of the age range in the bowel cancer screening FOBt programme.
More information is available in the bowel cancer screening programme overview.
NHS breast screening programme (BSP)
About one in 8 women are diagnosed with breast cancer in their lifetime. There are about 12,000 breast cancer deaths in the UK every year. The NHS BSP saves around 1,300 lives each year.
Who is screened
In England breast screening is offered every 3 years to women from the age of 50 up until their 71st birthday. A separate screening programme operates for women who are at very high risk of developing breast cancer.
All eligible people who are registered with a GP (as female) automatically receive an invitation. Trans men (assigned female at birth) and trans women (assigned male at birth) who have received female hormone therapy do not receive invitations if registered as male with their GP but are still eligible for screening if they have any breast tissue.
GPs should contact their local NHS breast screening programme to ensure their trans patients are correctly invited for screening.
Women aged 71 and over can request screening every 3 years by contacting their local NHS breast screening programme to make an appointment.
The screening test
Breast screening uses x-rays (mammograms) to check for signs of cancer. The mammographer who carries out the mammogram is always a female.
More information available in the breast screening programme overview.
NHS cervical screening programme (CSP)
Cervical screening helps prevent cervical cancer. It saves thousands of lives each year in the UK. In England, cervical screening currently prevents 70% of cervical cancer deaths. If everyone attended screening regularly, 83% of deaths could be prevented.
Cervical screening tests for human papillomavirus (HPV), which is associated with the development of more than 99% of cervical cancers. If HPV is detected the cervical cells are examined for the presence of precancerous (or cancerous) cervical cells. The aim is to identify precancerous cells in order to treat them and prevent progression to cervical cancer.
There are about 850 cervical cancer deaths in the UK every year.
Who is screened
All women and people with a cervix aged between 24 and a half and 64. People aged 24 and a half to 49 are invited every 3 years. People aged 50 to 64 are invited every 5 years.
All eligible people who are registered with a GP (as female) automatically receive an invitation by mail. Trans men (assigned female at birth) do not receive invitations if registered as male with their GP but are still eligible for screening if they have a cervix. If a GP practice does not offer cervical screening they should contact their local NHS cervical screening provider to ensure their trans patients are correctly invited for screening.
In some parts of England, local sexual health clinics may also offer cervical screening.
Cervical screening is not recommended for anyone under 25 years old who has not been invited.
Cervical screening is not appropriate for symptomatic patients.
The screening test
Cervical screening looks for HPV. If HPV is found a cytology test is used as a triage to check for any abnormal cells.
Screening results
The screening results are:
- HPV negative – most individuals have this result
- HPV positive and no abnormal cells seen on cytology
- HPV positive and abnormal cells (any grade) seen on cytology
- inadequate result
If the result is HPV negative no treatment is required. Individuals are invited for cervical screening again in 3 or 5 years according to their age.
If the result is HPV positive and no abnormal cells no treatment is required. A follow up screen is arranged for 12 months’ time to see if the immune system has cleared the virus. If not, the individual is referred to colposcopy.
If the result is HPV positive and abnormal cells (any grade), the individual is referred to colposcopy.
An inadequate result may be due to a technical problem, for example if the laboratory cannot get an HPV test result from the sample or cannot see if abnormal cells are present or not. Following an inadequate test cervical screening should be repeated in 3 months’ time.
HPV self-sampling
HPV self-sampling would allow women to take a test in the comfort of their own home. Updates on the self-sampling national evaluation are posted via the PHE Screening blog.
More information is available in the cervical screening programme overview.
Cervical screening guidance specifically for primary care is under development and will be available here when published.
NHS diabetic eye screening (DES) programme
Diabetic eye screening checks for signs of diabetic retinopathy, a condition caused by diabetes that damages the small blood vessels in the retina. In the early stages of disease, diabetic retinopathy is often asymptomatic. If left undiagnosed and untreated diabetic retinopathy can cause blindness.
GPs are responsible for correctly coding individuals with diabetes on their IT systems. It is important this coding is accurate to ensure individuals are correctly invited by their local DES programme.
Who is screened
Individuals with diabetes aged 12 years and over are invited at least every 12 months. The programme is planning to introduce a 2-year interval for individuals with no eye disease identified at their previous 2 screens.
Pregnant women who have diabetes and individuals who have diabetic retinopathy, but do not yet require treatment, are offered extra screening tests because their risk of sight loss is greater.
The screening test
Dilating eye-drops are administered and retinal images taken.
More information is available in the diabetic eye screening programme overview.
DES guidance specifically for primary care is under development and will be available here when published.
NHS sickle cell and thalassaemia (SCT) screening
Sickle cell disease (SCD) is the most common genetic condition in England. It can lead to life‐threatening acute and chronic restricted blood flow to organs.
People with the inherited condition thalassaemia produce either no or too little haemoglobin. They need a blood transfusion every 2 to 5 weeks, as well as injections and medicines throughout their lives.
GPs have a significant role in supporting the SCT screening programme by providing pre-conception counselling and referring pregnant women who are known carriers to midwifery services before 10 weeks.
Who is screened (antenatal)
SCT screening should be offered as early as possible before 10 weeks of pregnancy. Thalassaemia screening is offered to all pregnant women. Sickle cell disease (SCD) screening is offered to all pregnant women in high prevalence areas. In low prevalence areas, the family origin questionnaire (FOQ) is used to determine if the pregnant woman is likely to be a carrier for SCD or other haemoglobin disorder. A list of high and low prevalence areas in England is available.
All biological fathers are offered screening where antenatal screening shows the mother is a genetic carrier.
There are special circumstances where additional investigations may be required.
Who is screened (newborn)
All newborn babies are offered sickle cell screening as part of the NHS newborn blood spot screening programme, usually when they are 5 days old.
Screening test
A blood test in early pregnancy. The baby is tested for SCD at 5 days old as part of the newborn blood spot screen.
More information is available in the SCT screening programme overview.
NHS infectious diseases in pregnancy screening (IDPS) programme
Screening for HIV, hepatitis B and syphilis is recommended for all pregnant women as early detection and intervention can significantly reduce the risk of vertical transmission to the baby during pregnancy, birth or through breastfeeding.
GPs and practice staff can support the IDPS programme by:
- facilitating prompt registration for mothers and babies, especially those with adverse social circumstances
- including infection status and any relevant social or clinical information when referring women known to be living with HIV and hepatitis B for maternity care
- encouraging engagement with treatment for those who screen positive for an infection
- reinforcing ‘negative now’ messaging and supporting access to repeat testing for infections for women who disclose risk factors during pregnancy
- ensuring infants born to women with an infection have received appropriate follow-up, including hepatitis B immunisation schedule and 12 month serology (ideally by DBS)
- checking measles, mumps and rubella (MMR) immunisation history for women post-delivery or planning a pregnancy
Who is screened
Screening is offered and recommended to all pregnant women in every pregnancy, regardless of any previous results or treatment.
The screening test
A blood test undertaken as early as possible in the first trimester or as soon as a woman presents for antenatal care. Results are communicated directly to the antenatal screening team by the laboratory within 8 working days. Positive screening results are managed by the screening team.
More information is available in the IDPS programme overview.
IDPS guidance specifically for primary care is under development and will be available here when published.
NHS fetal anomaly screening programme (FASP)
Screening to assess the chance of a baby having Down’s syndrome, Edwards’ syndrome or Patau’s syndrome and 11 physical conditions is offered to all eligible pregnant women in England.
GPs and GP practices should ensure women have timely access to midwifery services so they can be supported to make personal, informed choices about their screening options.
Who is screened
All eligible pregnant women in England are offered screening as part of their usual antenatal care.
The combined test is offered at around 11 to 14 weeks of pregnancy for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome.
The quadruple test is offered at around 14 to 20 weeks of pregnancy for Down’s syndrome only.
The 20 week screening scan is offered at around 18 to 21 weeks of pregnancy.
The screening test
A blood test. The combined test is the test of choice for both singleton and twin pregnancies. It is offered in the first trimester to assess the chance of the baby having Down’s syndrome, Edwards’ syndrome or Patau’s syndrome.
The quadruple test is offered in the second trimester if the combined test cannot be performed. It assesses the chance of the baby having Down’s syndrome only.
From 1 June 2021 women who receive a higher chance result from a combined or quadruple test will be offered the option of non-invasive prenatal testing (NIPT), alongside no further testing or prenatal diagnosis (PND). This applies to women pregnant with singletons or twins.
The 20 week screening scan is an ultrasound scan and screens for 11 physical conditions, including Edward’s syndrome and Patau’s syndrome for women who book too late for the combined screen.
Care pathways are available for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome screening and the 20 week screening scan.
The FASP handbook brings together all the guidelines and recommendations relating to the NHS FASP.
More information is available in the FASP overview.
NHS newborn and infant physical examination (NIPE) screening programme
The NHS NIPE screening programme aims to reduce morbidity and mortality by identifying, and referring for clinical assessment, children born with congenital abnormalities of the eyes, heart, hips, and testes.
The NIPE screening programme offers newborn screening to all babies born in England for:
- congenital cataracts
- congenital heart conditions
- developmental dysplasia of the hip (DDH)
- undescended testes
GPs (or qualified practitioner) undertaking the NIPE infant screening examination at 6 to 8 weeks should ensure all screen positive babies are appropriately referred and followed up in line with national guidance.
Please see the NIPE programme handbook for further information.
Who is screened
Newborn babies within 72 hours of birth and infants between 6 and 8 weeks of age.
The screening test
Physical examinations.
More information is available in the NIPE screening programme overview.
NHS newborn blood spot (NBS) screening programme
The NBS screening programme enables early identification, referral and treatment of babies with 9 rare but serious conditions. These are:
- sickle cell disease (SCD)
- cystic fibrosis (CF)
- congenital hypothyroidism (CHT)
- phenylketonuria (PKU)
- medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
- maple syrup urine disease (MSUD)
- isovaleric acidaemia (IVA)
- glutaric aciduria type 1 (GA1)
- homocystinuria (HCU)
The NHS recommends NBS screening because it can improve health and prevent severe disability or even death.
GPs should ensure all children under one year of age registered at their practice are offered NBS screening.
Who is screened
All babies, usually when they are 5 days old. If not done at 5 days screening can be offered up to, but not including, the baby’s first birthday. This excludes testing for cystic fibrosis (CF), which is unreliable after 8 weeks of age.
Babies who are new to the country or are yet to have a blood spot test are eligible for testing up to a year old.
During pregnancy parents should be asked if there is a family history of any of the 9 NBS conditions. If there is, then the health team should create a care plan which could involve an additional early blood spot sample.
Screening babies for severe combined immunodeficiency (SCID) will be evaluated in the NHS from September 2021. The SCID evaluation will cover around two-thirds of the newborn population of England and is reliant on changes to the BCG vaccination programme across the whole of England.
The screening test
A blood spot test, also known as the heel prick test.
More information is available in the NBS screening programme overview.
NHS newborn hearing screening programme (NHSP)
The NHSP aims to identify permanent moderate, severe and profound deafness and hearing impairment in newborn babies. About 1 to 2 in a 1,000 babies are born with a permanent deafness in one of both ears. This increases to one in 100 babies who have spent more than 48 hours continuously in a neonatal intensive care unit. In England, an average of 1,400 babies a year (approximately 27 a week) are diagnosed with a permanent deafness. Most of these babies are born to families with no history of hearing loss.
GPs should be notified of babies who have been referred to audiology from the NHS NHSP and should encourage follow-up appointment attendances.
Who is screened
The hearing screen should be offered before the baby is 4 weeks old, but it can be done up to 3 months of age. The local NHSP service should be informed of babies up to the age of 3 months, including those new to the country, whose parents wish them to have an initial hearing screen.
The screening test
The screen always involves the automated otoacoustic emission (AOAE) test, where gentle clicking sounds are played into the baby’s ear via a small soft-tipped earpiece. The AOAE tests cochlea function. It takes just a few minutes and requires the baby to be settled or asleep.
Some babies require a second test, the automated auditory brainstem response (AABR) test. This involves placing 3 small sensors on the baby’s head, neck and shoulder and playing the clicking sounds via headphones. The AABR test detects responses from the hearing nerves. It takes between 5 and 15 minutes and also requires the baby to be settled or asleep.
If the screening test results do not show a clear response in one or both of the baby’s ears, a referral for audiological assessment is made within 4 weeks. If a permanent deafness is diagnosed, further tests to find a possible cause may be required. These tests need to be performed within the first few weeks of birth.
If a baby has a clear response in both ears from the screen, they are unlikely to have a permanent deafness. However, as newborn hearing screening does not pick up all types of hearing loss and children can develop hearing loss it is important referrals are made to audiology if there are any professional or parental hearing concerns.
More information is available in the NHSP overview.
Confidentiality and use of data
We provide information about confidentiality and use of patient identifiable data in the screening programmes.
Updates to this page
Published 23 October 2018Last updated 25 January 2024 + show all updates
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PHE Screening helpdesk details removed
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PHE screening helpdesk email has been updated to the NHSE email address.
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Updated information for primary care services.
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First published.