"Appalling" appointment letters have been blamed for contributing to a drop in women having cervical cancer tests.
The screening rate in Newcastle has reduced from 75.8% nine years ago to 70.4%, according to a council report.
Healthwatch chief executive Steph Edusei told city councillors in Newcastle the tone of letters was off-putting and "cold".
"I have had a letter recently, they're appalling and don't encourage you to have your screening," Ms Edusei said.
Ms Edusei added: "They sound really cold, there is no 'thank you' at the end, and nothing about why they [screenings] are so important.
"They're just 'you have an appointment, get it done'."
Public Health England said it offers advice to health bosses on how to improve screening uptake.
The report to councillors said the rate of screenings in the Newcastle Gateshead Clinical Commissioning Group (CCG) area was below the England average of 71.7%.
The decline was most evident among younger women and the "level of variation" between GP practices was of "concern", the Local Democracy Reporting Service said.
Only eight surgeries met the 80% threshold target in the last nine years. according to the report.
Screening for cervical cancer is estimated to save 5,000 lives a year in the UK.
The CCG is running a No Fear, Have a Smear poster campaign to encourage women to book a smear test.