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123 Gynaecology and Colposcopy NMH Annual Rep t | 2020 T he Global COVID-19 pandemic ensured that 2020 was an exceptional year for the colposcopy service at the NMH. The need to re-purpose available space to divide the hospital into COVID-19 and non-COVID-19 areas resulted in the cancellation of many gynaecological services including colposcopy. In addition, the CervicalCheck programme moved from a cytology based programme to the more sensitive Human Papilloma Virus (HPV) based programme in March 2020 before pausing screening between the end of March and July. The reduction in screening activity resulted in a marked reduction in referrals based on an abnormal screening result. Colposcopy service staff were redeployed to support the hospital's occupational health and contact tracing teams for four months with the result that capacity for colposcopy was reduced to a minimum during that time. Unprecedented levels of cancellations were followed by a backlog of 4000 appointments which needed to be dealt with when restrictions eased. This primarily affected women with follow up appointments as well as some new referrals with suspected low grade disease. Because of these Colposcopy pressures, delays in processing test results led to delays in communicating the results to women. Considerable credit is again due to the team for the dedicated response to these events. When the service was working normally women were seen from 8am to 7pm with clinics running five days per week using a combination of nurse and consultant led clinics. Follow up appointments fell again this year as HPV testing in colposcopy continued to facilitate earlier discharge for surveillance to the community. The mean age of the women attending the service was 36 years with a range between 19 and 84 years. Of the 1,164 new referrals, 938 women were referred because of an abnormal screening test which included a combination of abnormal cytology in the presence of an infection with high risk HPV. This represented a significant reduction compared with the 1,662 referred in 2019. The numbers of women referred to colposcopy for clinical reasons continued to surge but more efficient triage enabling the use of available local gynaecological services resulted in only 465 being given appointments to be seen at colposcopy. This redistribution of clinical