The interval between discovery of an abnormality on cervical cytology
screening, and colposcopy if that is what is indicated, is a time of
great worry for any woman.

It should therefore be minimised.

The net cost of actions to minimise such time intervals is likely to be
negative for both the NHS considered as a whole, and society considered
as a whole, therefore it is not improbable that such action will be
economically sound as well as morally sound.

Taking a process control view of the workflow involved should allow us
to do so.

The statistics of cervical cytology screening are by now well known (I
don't actually know them myself, but that is beside the point)

	<statistics of progression from smear to colposcopy>

Given the number of smears, n1, done in a time period, t1, and the
percentage of these which require colposcopy, p, and the time interval
which contains the action upon that  smear being taken and the result
being reported, t2, it is clear that in the time interval t2 the number
of colposcopy appointments required for new abnormal cervical smears is
given by

	p*n1

	<variation, Poisson or normal distribution descriptors>

It is intuitively obvious that for a population of sufficient size the
number of smear following colposcopies needed would be essentially
constant per time interval, provided no perturbing factors act upon the
input to th eprocess - the number of smears done per time interval.

It is also clear that given a knowledge of the rates and variation
involved it is possible to closely predict the requirement for new
colposcopy appointments in any interval t2 from the smears done in t1

It is also probable that a close idea could be obtained from the
requests made to general practices to moderate or increase their
activity in routine cervical cytology screening (see previous posting)
and an evolving model of the effect of such requests, of how many
appointments should be made available for colposcopy in a time period
commencing approximately 8 weeks in the future.

Reducing the agonising wait
----------------------------------
Therefore it is appropriate that such a number of appointments be
earmarked for women not as yet known to have an abnormal smear, and be
held open if they are not filled by such women, until a time
approximately one week before the appointment itself.

Responsibility
----------------
Managing this sort of complex process control is one of the functions
which professional managers, IE people with management training rather
than medical training, should be bringing to the Health Service.

To the best of my knowledge this has not in fact come about despite the
very large expansion in the managment class since 1989.

The reason, I suspect, is that instead of thoughtful engineers or
logisticians who would immediately understand (and perhaps pick out the
weaker points of)  this argument, we have arts graduates and
accountants, who far from not being thoughtless, have their thoughts
firmly in different directions and are unlikely to  build the material
or mental map of the process upon which these ideas depend.  Instead
they are likely to be quite creditably concerned with the interpersonal
relationships - assuring that everyone in the NHS works smoothly and
happily with everyone else - and less credibly but observably concerned
with their relative status in the pecking order within their own and
other Trusts and other health orgs.
The medical profession undoubtedly must shoulder some ofatch booking,
running  the blame as well, for persisting in old practices of batch
booking, filling clinic lists 8+ weeks in the future, declining to take
part in planning on the excuse that our responsibility is to individual
patients, and other instances of professional arrogance.

However, the medical profession has now been handed the chance to fix
things, introduce an overall management of processes rather than a
disconnected scramble, and this is one of the aims one should have in a
PCG.




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