Improving access to abortion services: a local model

E.J. Oloto

Contraception, Sexual & Reproductive Health Services, University Hospitals of Leicester NHS Trust, Leicester, UK

Local difficulties: Access to local services was poorly co-ordinated with considerable frustration and inconvenience to GPs, users and staff providing the service. There was very limited support for ultrasound scan services. There was also a limited choice of methods as only 23% of pregnancy terminations were carried out medically. About 26% of cases in one hospital were repeat outpatient visits. This was primarily said to be due to the difficulty in assessing the duration of pregnancy in the absence of an ultrasound scan machine. There were different, and sometimes complicated, paperwork for termination of pregnancy (TOP) services in the local hospitals. Staffing was problematic due to conscientious objection particularly by junior doctors. The net result was that the ‘first contact to procedure’ interval was in excess of the required target of 3 weeks (National sexual health strategy) and that 60% of cases referred to and 44% of those treated by the private sector were 12 weeks and under (local service level agreement is for cases above 12 weeks).

Aim: To put a comprehensive system in place to facilitate early access to and choice for abortion services in the local population. Improvements required: These would include establishment of a community based centralised referral system for the efficient coordination of the appointments at the various clinics, theatres and wards; harmonisation of the paperwork and protocols for TOP services in the region; purchase of at least one portable ultrasound scan machine to facilitate early dating of pregnancy; expansion of existing service to reduce the number referred out of the region with significant reduction in cost to Primary Care Trusts (PCTs) and inconvenience to the clients; effective contraceptive backup in clinics, wards and theatres; staff training in basic ultrasound scanning; additional training in general and specialised contraception; recruitment of clerical, nursing and medical staff; and establishment of a robust database for TOP services for the purposes of audit and monitoring of local and national targets.

Outcome measures: Overall improvement in access and choice for clients; efficient use of time by GPs and other health professionals; and in staff morale and job satisfaction. A GP or other health professionals would either ring, fax or email details to designated numbers rather than ringing round various services for an appointment. An ultrasound scan machine, used in-house, would eliminate the need for repeat outpatient visits and increase the option of a medical TOP. Provision of regular information to PCTs and other stakeholders about TOP services and how targets are being addressed. Contraceptive backup and further training for staff would hopefully reduce the number of unplanned and unwanted pregnancy.

Results: The new system was set up in July 2003 and the first year experience would be presented. Also to be presented is the result of the questionnaires being sent to GPs and other health professionals to evaluate the impact of the changes.