Action Required: NHS Screening and GP Registration Process 

On behalf of NHS England

[Update: 13/03/2025:

NHS England has not provided lists of patients affected, but has contacted affect patients directly. NHS England has advised that practices do not need to do any proactive patient communication other than supporting with reactive queries and offering timely screening catch up.

The communication sent to practices asks GPs to check that ‘in flight’ and rejected registrations are resolved in GP Links. A rejected registration can be found in the GP Links workflow. Where resubmission is required, practices should obtain the additional information or edit the registration on the clinical system and resubmit through GP Links. If no patients are listed for resolution in GP Links, no further action is required. A step-by-step guide on how to do this will be available here shortly. Information about why a GP registration may be rejected is available here.]

Original communication 11/03/2025:

We are writing to ask you to take immediate action following an NHS England review of patient records. The review suggests that due to incomplete GP registrations, 5,261 people across the country have not been contacted to participate in one or more NHS screening programmes. This issue affects abdominal aortic aneurysm (AAA), cervical, breast and bowel cancer screening programmes. It does not affect diabetic eye screening or antenatal and newborn screening programmes.  

Issue overview: 

NHS England was contacted by a small number of people that were due for NHS screening but had not been invited. We have undertaken a thorough review and identified that GP registrations returned to some GP practices by Primary Care Support England (PCSE) for further information or review had not been completed or GP practices had not sent a GP links message to the Primary Care Registration Management System (PCRM).

This has meant that some GP registrations were incomplete, and the patient’s records have remained in an incomplete status for an extended period – also known as being ‘in-flight’. As a result, their information has not been transferred to NHS screening programme IT systems, and they have not been contacted for screening appointments. Annex A provides technical detail on the issue.

We have identified 5,261 people across 2,253 GP practices who are or were eligible to be screened and who we are contacting from today.

Actions taken by NHS England: 

• NHS England has identified the affected group. This week we will write to people affected with tailored letters to advise them of the issue and, according to records, the screening programmes that they are, or were, eligible for.  These letters will explain what will happen next and how they can now access screening. Letters will be sent on Monday 10th March and will start to be delivered in the following days, with the bulk of letters expected to arrive with those affected by Thursday 13th March. The different groups are set out at Annex B.
• NHS England will add the details of those eligible for screening to NHS screening programme IT systems, and the screening programmes will follow up with invite letters. In cases where patients are no longer eligible for screening due to their age, the letter will also provide information on ways they can access screening services if they should wish.
• Although NHS England is implementing a fix that ensures people affected, in this case, are now offered relevant screening, it remains the responsibility of the GP practice to ensure that any ‘in-flight’ registrations are completed and future registration information requests from PCSE are responded to quickly and registrations resubmitted through the practice’s clinical system. Further detail of the action required is set out below.
• While letters to those affected describe next steps for each programme including key contact points, a free general public helpline has been set up to support with any further queries. The helpline will be available from tomorrow (11 March): 0345 877 8962, Monday to Friday, 9am to 5pm.
• For any enquiries from clinicians/services, a central email has been set up: England.Inflight-GP-Registrations@nhs.net (please do not share this email address externally).

Action for Integrated Care Boards

• We are asking ICB leads to communicate with GP practices with affected people no later than tomorrow (Tuesday 11^th March) before letters are received by patients. To support this, we will send a list of the GP practices with affected patients, broken down by region/ICB area to ICB primary care and vaccination and screening leads (copied to ICB CEs). We will also send a template communication for ICBs to tailor and send to these GP practices.

Actions for GP practices: 

• GP practices with affected patients should respond to any follow-up queries their patients may have. 
• Please advise your administration staff of this issue. They may receive direct queries from affected patients.
• Every effort should be made to support catch-up screening opportunities. For example, women who have not been invited for cervical screening have been advised to contact their GP practice to make an appointment as soon as possible. Please ensure that all women who contact you are offered a timely appointment, including patients who are now above the eligible screening age. They have been advised they are able to access a cervical screen if they wish to do so. They should still be offered an appointment.
• GP practices must ensure that any incomplete registrations are completed in line with the process outlined in Annex A and future registration information requests from PCSE are responded to quickly and registrations resubmitted through the practice’s clinical system.

For screening providers

• Please advise your staff of this issue, especially those who come into direct contact with patients as part of the screening journey. It is important that staff are aware of this issue and can answer any questions.
• For AAA screening, patient letters advise those no longer eligible to contact their local AAA screening service if they want to be screened and signposts to www.nhs.uk/find-aaa-screening and our general helpline.
• For bowel screening, the IT system will make sure that impacted people are invited. For those now over the eligible age, patient letters highlight that they can still request a home test kit via the NHS bowel cancer screening helpline.
• For breast screening, for people aged 71 and six months or over, patient letters advise they can still have breast screening every 3 years by contacting their local breast screening service to ask for an appointment. People aged up to 71 years and 6 months will be offered an invitation. Breast screening offices will see these as an auto-batch, and these individuals should be selected and an invitation sent within 4 weeks.   
• For cervical screening laboratories, please check screening history carefully to avoid rejecting a sample from an individual who may no longer be eligible for the programme but has come forward because of receiving a letter about this issue.
• As part of incident management, a clinical advisory group is urgently considering the most appropriate harm assessment next steps. On initial review it’s likely that this will take the form of a phased clinical review that covers people that have not been invited for a screening programme for which they’re eligible, are still alive and have since been diagnosed with a relevant cancer; and those that are diagnosed as having a relevant cancer as part of taking part in screening. Each of these phases will require the input of treating centres and screening providers and we will provide further guidance to support this process soon.

Ongoing monitoring

It is the responsibility of GP practices to ensure patients’ registrations are fully completed, however NHS England has put in exceptional measures to ensure that those who remain incomplete are added to NHS screening IT systems as quickly as possible, allowing timely invitations to screening. NHS England is putting in place business as usual monitoring and escalation mechanisms.

Clinical review process 

We are considering the next steps in terms of harm assessment and clinical review. As set out above it’s likely this process will be conducted in several sequenced phases and will need to involve treating centres and screening providers. An initial review of cancer and death registry data indicates that there are some patients for which a harm assessment would be appropriate to conduct. We will write to those patients that are still alive, at the same time as sending out the letters to those that we think have been delayed. We will commit to sharing the outcomes of any review that is conducted, should individuals wish to know. Further information will be made available soon.

Communications support

To reduce any anxiety, it is important that anyone affected receives a full explanation and follow up advice directly from the NHS. Outside this direct contact with patients, please treat this information sensitively. To support conversations with patients, we have included questions and answers in Annex C.

System queries can be sent to England.Inflight-GP-Registrations@nhs.net

If you do receive any media enquiries, please direct them to the NHS England press office: www.england.nhs.uk/contact-us/media/

NHS England will also brief national stakeholders in case they receive any queries.

Complaints or feedback

Complaints and feedback should be signposted to the NHS England complaints team:

• By post to: NHS England, PO Box 16738, Redditch, B97 9PT ​
• By email to: england.contactus@nhs.net, stating ‘For the attention of the complaints team’ in the subject line. ​

By telephone: 0300 311 22 33 Opening hours are 9am to 4.30pm Monday to Friday, except Wednesdays when opening is at the later time of 9.30am. Closed on bank holidays. ​

Yours sincerely, 

Steve Russell, National Director for Vaccination and Screening and Chief Delivery Officer 

Dr Claire Fuller, Medical Director for Primary Care, Professional Standards and Performers Lists

Annex A – How the issue occurred: 

The patients affected have been identified due to incomplete GP registrations. At the time of registration, the following steps should occur: 

1. The GP practice sends a message to the Patient Demographic Service (PDS) via a patient lookup, initiating the registration process. The registration is logged but remains ‘in-flight’ until PDS receives an approved GP links message from Primary Care Registration Management system (PCRM). 
2. The GP practice sends a GP links message to PCRM to complete the patient’s registration. 
3. There are two possible outcomes: 
   • the registration is approved automatically by PCRM or by Primary Care Support England (PCSE) processing the registration. This generates an approval message to PDS, or
   • PCSE rejects the application and provides a reason for rejection to the GP practice for remediation and resubmission. 

4. Step 3a must be completed for the registration to be finalised. 

If step 2 is not completed, the patient’s registration remains ‘in-flight’. Similarly, if step 3b occurs and the GP practice does not address the rejection and resubmit the application, the registration will remain incomplete. 

Incomplete (‘in-flight’) registrations do not flow through to NHS screening programme IT systems, as the screening programmes require approved registrations before invitations can be issued. Other NHS England programmes only require step 1 (PDS registration) to be completed, so are not impacted by this issue.

Annex B – groups of people affected

Annex C – Q&As to support any public queries

How did this happen? 

NHS England was contacted by a small number of patients due to delays in receiving screening invites. NHS England then quickly carried out a thorough review to understand why. This highlighted that when people register with a GP surgery, if the registration process isn’t completed by GP practices the patient details won’t flow through to adult NHS screening systems to allow the systems to invite eligible people for screening (apart from diabetic eye screening, which is on different system).  

Those affected are in the process of being added into relevant screening programmes. Monitoring is ongoing to ensure that this doesn’t occur in the future.

NHS England is contacting those affected to explain what has happened, apologise and outline next steps on accessing screening.

Which screening programmes are affected? 

People in the process of registering with their GP may not have been invited to abdominal aortic aneurysm (AAA) screening, cervical screening, breast screening and bowel cancer screening programmes. Diabetic eye screening is not affected or antenatal or newborn screening programmes.  

Has this only affected screening programmes? 

Yes, this registration issue is specific to national adult screening programmes. 

Why has this only been picked up now? Has the issue been fixed now?  

A small number of people contacted NHS England as they had not been invited to be screened. NHS England carried out a thorough review when this was brought to our attention and anyone affected is now being added to NHS screening IT systems.  

Is this across the whole country? 

Yes – it impacts all of England. 

How are you contacting people and what solutions are you putting in place? 

NHS England is directly contacting those affected to say sorry and explain what has happened. We have confirmed that the issue with their GP registration has been fixed, and explained how they can now access the relevant screening in a timely way. 

What about people that are no longer eligible for screening but were missed – will they be able to get screened? 

Yes, anyone in this group that is no longer eligible for screening will be able to have their screening if they choose to opt-in. Details of how to do this are set out in the letters that have been sent to those affected.

How confident are you that you have identified all those who have been affected?  

NHS England has carried out a thorough review to identify those affected, which has involved robust quality assurance checks. 

How quickly will I get my screening? 

We have contacted people affected to let them know they will receive contact from the breast and bowel screening programmes if they are eligible within 4 weeks. For cervical screening, women can contact their GP surgery now for an appointment and for those no longer in an eligible age group, we have explained how they can still access screening.  

AAA screening is offered to all men during the year they turn 65. Anyone affected, can book a screening appointment by contacting their local AAA screening service. Contact details are at www.nhs.uk/find-aaa-screening

I have not been sent a letter from the NHS about this issue but believe I have been missed for screening. What should I do?

You must be registered with a GP and live in England to be invited. Your GP surgery gives us your contact information. If your GP surgery has all these details but you believe you may have been missed for screening, you can contact the NHS England dedicated helpline on 0345 877 8962.

I have received a letter to my address but the addressee does not live here. What should I do?

The envelope in which the letter was sent includes a return to sender option. 

I do not want to be contacted by screening programmes. How do I opt-out?

It is your choice whether or not to have screening. If you decide that screening is not for you and you don’t want any more invitations, you can opt out. Withdrawing yourself means you will not get invited for that type of screening in the future.

Opting out is something to think through very carefully. It could mean that if you have the condition being screened for in the future, early signs might be missed. You may want to discuss any questions or concerns with your GP or someone from the local screening programme.

Instructions about how to opt out of different screening types are provided at www.gov.uk/screening-opt-out