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Notes: Objective— To audit various aspects of colposcopy practice throughout the United Kingdom on behalf of BSCCP.Design— A postal questionnaire was circulated to those responsible for colposcopy services in all districts in the United Kingdom in 1988, followed by a smaller survey of 40 clinics in 1990 to detect any trends.Main outcome measures— Information was sought on colposcopy workload, referral criteria, treatment method and follow-up, waiting times, staffing and training.Results— There was a 71% response to the national survey of 1988 practice which alone accounted for 80 000 new referrals for colposcopy. Cytological criteria for colposcopy referral were generally liberal. In 1988 laser ablation was the single most popular method, and waiting times for colposcopy varied, with 79% of patients being seen within 8 weeks of referral. Colposcopy clinies run by non-gynaecologists, mainly genito-urinary physicians, were reported by 32% of districts. Half the respondents did not have accurate statistics, only 17% being computerized, and dissatisfaction with clerical support was widespread. Resources are required to improve administration and data collection. The principal findings from the 1990 data subset were a 10% reduction for new patient referrals compared with 1988 and the use of diathermy loop excision by one-third as their preferred treatment.Conclusions— This audit of colposcopy has provided useful information as well as a means of monitoring trends in colposcopy activity in the future.

Notes: This study investigated the 5-year follow-up status of women with cervical smears showing borderline nuclear changes (BNC) or mild dyskaryosis and the effect of koilocytosis on the outcome. Thirteen per cent of women with cervical smears showing BNC had high-grade cervical intraepithelial neoplasia (CIN). In contrast, 28% of women with cervical smears showing mild dyskaryosis had high-grade CIN. The presence of koilocytosis (24% for borderline smears and 34% for mild dyskaryotic smears) did not appear to influence the risk of developing high-grade CIN. Our results suggest that the simultaneous implementation of the British Society for Clinical Cytology proposed terminology and the colposcopy guidelines from the British Society for Colposcopy and Cervical Pathology could have an impact on colposcopy services.

Notes: The success of the Cervical Screening Programme (CSP) is due in part to its management being underpinned by Quality Assurance. These measures ensure uniform standards across the country. Since 1992 Colposcopy Guidelines have been in place; these were updated in 1997 and have just been redefined. It is entirely consistent with the National CSP that colposcopy is governed by Guidelines.The aim of clinical practice guidelines is to raise the standard of care and improve outcomes. The objectives are, therefore:〈list xml:id="l1" style="custom"〉a) to develop evidence based guidelines;b) to ensure the guidelines are widely adopted.The credibility of guidelines is crucial to their adoption and this depends far more on the demonstration of an evidence base than that the authors are ‘experts’. Development by a professional group or body who are seen as having a legitimate role is very important as is involvement of all ‘stakeholders’ in ensuring acceptability.In terms of their nature, guidelines should be valid i.e. they will achieve what they are intended to achieve, and they should be robust i.e. they will work when implemented by different individuals in different settings. Colposcopy lends itself well to guidelines because it is largely a routine practice, but substandard care can have serious consequences.In previous years there has been a set of Guidelines for Practice/〉/〉 and a set of Quality Standards/〉. On this occasion these two components have been put together in a simple publication.It needs to be borne in mine that the new guidelines were being developed in the context of a number of potential changes which could interact with each other and impact on the Guidelines. These include: 〈inlineGraphic alt="inline image" href="urn:x-wiley:09565507:CYT086_5:CYT_086_fu1" location="image_n/CYT_086_fu1.gif"/〉 The process for the development of the Guidelines included an Editor, an editorial group, and a group of contributors to produce a draft set of evidence based guidelines across 18 areas. New areas covered included HIV +ve women, immuno suppressed women, and working practice.The draft has been available for comment for several months and amendments have been made. Clearly there are areas where evidence is lacking and where different views are expressed. The most contentious area not surprisingly is in the topic of managing mild dyskaryosis; controversy in this has persisted for many years.The quality standards are either attainable or within attainment and are a driver for rising standards. These programme practice guidelines and standards have earned UK colposcopy international respect. They provide a benchmark for QA assessment and will continue to require amendment as new developments come into being.