Date published: 17 March, 2025
Date last updated: 17 March, 2025
Commissioning, Integrated care

Abortion commissioning guidance

1. About this document

This guidance applies to non-specialised abortion services commissioned by integrated care boards (ICBs) in England. It sets out expectations about how ICBs should commission these services while allowing them to be tailored to meet local need. The publication also includes practical advice about improving access and care.

This document is guidance to ICBs about the discharge of their commissioning functions issued under section 14Z51 of the NHS Act 2006, and ICBs accordingly have a statutory duty to have regard to the guidance. This publication is not a service specification and does not define standards of care.

This guidance has been developed with representatives from ICBs. It also draws on engagement with those with lived experience of accessing abortion services, as well as input from a range of stakeholders, including the Royal College of Obstetricians and Gynaecologists, the Faculty of Sexual and Reproductive Health, British Society of Abortion Care Providers, the British Pregnancy Advisory Service, MSI Reproductive Choices, the National Unplanned Pregnancy Advisory Service, the Local Government Association, the Association of Directors of Public Health, and the English HIV and Sexual Health Commissioners Group.

This guidance is published alongside a set of commissioning principles co-developed with those with lived experience of accessing abortion services. These commissioning principles both inform the recommendations in this guidance and provide a resource for commissioners as they take action locally to improve services for patients.

2. Introduction

Abortion care is an essential service. It is a common procedure, with the Office of National Statistics reporting that more than 1 in 4 conceptions resulted in an abortion in 2021 (where conception does not include miscarriages or illegal abortions).

Yet, the sector is facing significant challenges due to service pressures, market fragility and sector dynamics. Surgical capacity is not meeting patient needs. Patients are experiencing limitations on the choice of procedure and location, and there is uneven geographical distribution of provision. This is exacerbating inequalities in access, experience and outcomes and is significantly impacting patient care – and in some instances patient safety.

As such, this guidance asks ICBs – working with providers and their broader system partners – to take the following actions. 

1. Commissioning – take forward the 5 recommendations co-produced with system partners and informed by engagement with those with lived experience of accessing abortion services:

  • commission abortion services on a regional or sub-regional footprint where this makes sense for services, using a lead-ICB model where appropriate
  • use contracting models that provide resilience, collaboration, patient choice of procedure, location and anaesthetic, and a role for trusts
  • collaborate with providers to strategically plan services to meet patient needs and improve access
  • work with commissioners and providers of sexual and reproductive health and contraception services to support better patient experience and a more holistic local offer
  • use the recommended performance and quality metrics to support quality improvement and benchmarking

ICBs should also commission in line with the commissioning principles published alongside this guidance.

2. Funding – ensure that contractual payment arrangements are sustainable and follow guidance in the NHS Payment Scheme.

3. NHS capacity – given rising demand and time-sensitive nature of this service, systems should plan to ensure capacity in trusts and independent sector providers will bring waiting times in line with National Institute for Health and Care Excellence (NICE) 2 week standards over the medium term. Initially, ICBs should work with providers to stabilise trust capacity and work to increase surgical capacity in both trust and independent providers in the medium term.

This guidance should be read alongside:

The guidance is written for ICBs on a comply or explain basis; there is an expectation for ICBs to comply with the guidance or to document the reasons why they have departed from it. Further details on monitoring compliance is set out in section 3.

The challenges facing the sector and the context for this guidance – relating to service pressures, market fragility and sector dynamics, and the impact this has on patients – are outlined below. 

Service pressures

Demand for abortion services has risen by over 30% since 2016, and in 2022 alone, over 250,000 procedures were carried out: a 17% increase from 2021. While the implementation of remote early medical procedures has improved access to abortion wait times for surgical abortions (around 14% of procedures) are above the NICE standards of 2 weeks, and often 3 weeks or longer. For services as time pressured as these, prolonged waits can create greater clinical risk and risk of complications for patients.

This is accompanied by significant access challenges for surgical provision and onsite medical abortion, which in turn creates health inequalities in access and experience. Provision is not evenly distributed across the country, meaning some patients travel significant distances to access abortion services, particularly at later gestations.

Surgical capacity is insufficient in many areas and unable to meet need.

Market fragility and sector dynamics

The impact of service pressures is exacerbated by the provider and commissioning landscape. ICBs commission these services, with the independent sector delivering about 80% of provision, which is concentrated in 3 providers: MSI Reproductive Choices, the British Pregnancy Advisory Service, and the National Unplanned Pregnancy Advisory Service.

This model is fragile, and in the past 9 years, Care Quality Commission inspections have surfaced quality and leadership issues requiring national intervention and support at 2 of the main providers.

The number of abortions provided by NHS trusts and foundation trusts has been in decline, which has created challenges for training the surgical workforce. This has resulted in workforce shortages that impact the ability of both NHS and independent sector providers to meet growing demand.

It also impacts patient safety across the broader sector. A lack of NHS skills and capacity to provide abortion services means trusts may be unable to accept emergency transfers of patients and lack the required skill set to provide safe abortion and broader miscarriage management services. This can pose a significant risk to patients.

There is also evidence that providers have been funded below the level of core costs, particularly for surgical procedures.

Collectively, these challenges have resulted in national and regional fragility. There are local resilience issues in cases of acute service disruption or workforce shortages, and there is insufficient NHS capacity should providers fail or hand back contracts. Given the national footprint of providers, ICB commissioners are operating in a landscape where local decisions can significantly impact regional or national capacity and provision.

Impact on patients

Surgical capacity challenges, impeded choice of procedure and long travel distances considerably impact on patient experience.

Abortion services are used at what may be a challenging time. They may used by some of our most vulnerable patients, including those who have experienced crime, including rape, sexual assault, domestic abuse, coercion, modern slavery or sexual exploitation. Those living in areas of high deprivation are twice as likely to use abortion services.

Long waits and travel times exacerbate health inequalities by creating access challenges. These access challenges can lead to:

  • the negative physical and emotional impact of carrying unwanted or unviable pregnancies for an extended length of time
  • the risk of an unwanted pregnancy leading to a birth if the patient exceeds the legal limit
  • the increased clinical risk – including complications – at later gestations
  • unco-ordinated pathways to access other local services – including sexual and reproductive health care – for patients travelling outside their ICB or region for abortion services

Patients describe a lack of choice around:

  • procedure type
  • location of procedure (both where the clinic is situated, but also choice of an onsite or at home procedure)
  • options for anaesthetic and pain relief

The local offer and how to access services can also be unclear to patients both in terms of  available providers and upfront information on the procedures they can provide. Engagement undertaken with patients indicates that this lack of clarity and choice can significantly impact patient experience by placing limitations on whether patients can make meaningful decisions about their care, as they navigate the entirety of the pathway.

There are numerous situations where surgical procedures could provide improved patient experience, but option choice is currently constrained by a lack of surgical capacity. Access to surgical procedures may particularly benefit or be preferred by:

  • people who do not have a private, safe or comfortable space at home to undergo an early medical abortion
  • those with childcare or caring responsibilities who may prefer surgical care in a clinical setting rather than a procedure within the home
  • individuals who would appreciate the care and support of clinical settings
  • those who would prefer not to go through a medical abortion and see the products of conception
  • people who would prefer not to have their medical abortion on a labour ward
  • those who would prefer to keep their abortions confidential in clinic, for example, from parents, within a shared household or from potentially coercive partners​
  • people who prefer the predictability of surgical procedure and recovery times – as opposed to the risk of having a prolonged medical abortion over several days
  • those who have previously been negatively impacted by their experience of a medical abortion
  • those who want to reduce the likely need for any potential follow up care

As well as the impact of access issues and service pressures on the quality of care and patient experience, there are also reports from patients about how deviation from NICE standards can result in experiencing stigma at different stages of the pathway including in conversations about contraception and being shown scan images when unnecessary. Patients can also experience challenges with accessing other related health services following a procedure, particularly if the need arises some time after an abortion. This could range from contraception to bereavement services.

3. Recommendations for commissioning abortion services

Implementing the recommendations within this guidance will help to ensure that abortion service provision is accessible, sustainable and safe for patients. Given this and the pressing need for improvement, there is an expectation for ICBs to follow this guidance and implement its recommendations.

There may be instances where a recommendation is not considered best for a local population. In these cases, ICBs should document the reason for departure from this guidance. Where commissioning arrangements depart from recommendations, commissioners will need to evidence that, at a minimum, their model enacts as many recommendations as possible and achieves:

  • access to medical and surgical provision within NICE guidelines, including waiting times which meet the 2 week standard (links provided in appendix 2) and with a consideration of local health inequalities and population health needs
  • choice of procedure, location, anaesthetic and pain relief
  • travel distances that do not adversely impact patient experience or create risks of patient harm

NHS England also recognises that many of these recommendations may take time to embed, and there will be a period of transition to avoid disruption.

NHS England will ask ICBs for implementation progress updates, building on previous annual reporting by ICBs on commissioning and contracting arrangements for abortion. To facilitate this, we will provide a progress reporting template, which we will ask systems to complete in early 2026.

Completing the provided template will enable systems to demonstrate progress and help NHS England identify areas where further support may be needed. 

3.1 Commissioning on larger footprints

Abortion services are currently not evenly distributed across the country, which impacts patient access to surgical sites and exacerbates health inequalities.

Depending on the local offer, patients may have to travel considerable distances to access surgical provision, particularly at later gestations. This could be mitigated by cross-ICB planning based on patient flows and alignment of surgical sites.  It is also beneficial for patients who wish to access abortion services out of area.

Additionally, abortion service contract values and commissioner capacity at an ICB footprint do not always support strategic decision-making or systematic engagement with providers and commissioners of related services. Given the majority of provision is concentrated in 3 providers they may struggle to manage high volumes of tenders, contracts and reporting requirements.

Recommendation 1

ICBs should collaborate to commission abortion services on a regional or sub-regional footprint where this makes sense for services, using the lead ICBs’ expertise, skills and capacity. The size of the footprint should reflect the needs and flows of patients.

What does this look like in practice?

This recommendation enables consideration of cross-ICB patient flows when designing services and choosing their location(s), ensuring equitable access for patients across the footprint. Please note several ICBs can collaboratively commission services under a single NHS Standard Contract. See s13 of the NHS Standard Contract technical guidance for more information.

This approach should:

  • reduce travel time and improve patient experience while ensuring the case numbers are sustainable
  • reduce unwarranted variation between ICBs, and encourage cross-ICB approaches to tackling local health inequalities in access, experience and outcomes
  • increase contract values and reduces the number of separate tenders and contract negotiations, which enables better use of limited commissioner and provider capacity
  • support an improved interface with regional specialised commissioning networks
  • align discussions about the role of trusts in provision of abortion care, supporting a blend of independent sector and NHS provision and helping improve patient choice of provider and treatment, as well as safety of transfers
  • assist strategic planning and decision-making to ensure trust capacity supports service sustainability and clinical training

Lead ICB arrangements should ensure commissioners with the greatest skill and expertise in improving the quality of abortion services are selected to oversee arrangements.

Commissioners should consider the arrangements and needs of individual ICBs as they commence plans to move into larger commissioning footprints. They should engage with all independent sector and NHS providers who deliver services in the proposed footprint to ensure that all existing provision is considered as part of new arrangements.

3.2 Contracting for resilience

Due to the current concentration of provision in a small number of providers, some contracting models can inadvertently exacerbate the fragility of these services and significantly impact local capacity and patient choice.

Certain models, particularly sole provider block contracts, can impact the resilience of the local market by limiting effective contingency measures in cases of acute disruption. They may also disincentivise NHS provision, either by not encouraging trusts to enter the market or by using a funding approach that does not reflect the cost of provision. Diminishing NHS provision also creates long-term challenges with surgical training and workforce levels, which further exacerbates surgical capacity challenges (and related patient safety issues) and a lack of choice for patients.

The length of contracts can also impact a provider’s ability to improve the quality of services. More extended contracting arrangements allow for investment in workforce and infrastructure.

Recommendation 2

ICBs should use contracting models that provide resilience, collaboration, patient choice and a role for trusts. ICBs should ensure patients are provided with timely, accurate information about treatment options, wait times, and the full range of clinic locations available locally. ICBs should consider longer-term contracting arrangements to build stability and longevity into local arrangements. Providers, in turn, should be encouraged to consider bidding offers that reflect this.

What does this look like in practice?

In implementing this recommendation, ICBs should consider different contracting options.

  • Any Qualified Provider frameworks provide greater choice of provider, risk-sharing and resilience. This requires a consideration of viable caseloads for providers and should be underpinned by provider collaboration and cross referral or central booking services to ensure informed patient choice. Without these provisions, there is a risk that Any Qualified Provider can destabilise services
  • Lead provider models, particularly between independent sector and NHS providers, can support collaboration, trust provision and robust pathways. These models involve the ICB(s) awarding an NHS Standard Contract to a single provider, which then sub-contracts some service provision to other providers. This is done using an appropriate form of sub-contract. More information is provided in General Condition 12 of the NHS Standard Contract and in s38 of the NHS Standard Contract Technical Guidance.
  • Alliance models, partnerships and joint bids can enable overarching agreement in which multiple providers agree to work collaboratively or bid together on separate parts of the same contract. This can also include arrangements to share resource, staff or premises.

These models should offer patients better choice of provider, type of procedure, and location, which are all important aspects of quality and accessible care. ICBs should avoid contracting with only 1 provider, as this can reduce choice of procedure, location and anaesthetic, as well as local resilience and risk-sharing.

ICBs should ensure that contracting arrangements include trust provision wherever possible. Trust provision is required to:

  • help increase surgical capacity, improve resilience and ensure and expand the availability of safe, viable and high-quality abortion and miscarriage services
  • deliver certain services that cannot be provided in the independent sector (for example, due to complexity or clinical risk)
  • support the training of the current and future workforce

As trusts respond to NHS England’s expectation that they build their abortion services, it is therefore expected that trusts will be among the providers of abortion services to all ICBs.

To realise the benefits of patient choice of procedure and location, reduced travel and waits, it is important that commissioners require providers to give patients timely, accurate information about treatment options, wait times, including the range of clinic locations and other providers available. This can  be achieved either through central booking services or as a requirement of provider contracts to inform patients of the full range and location of clinics that are available to them locally (including those run by other providers).

ICBs should ensure that there are arrangements to transfer patients between providers based on patient choice, which should be informed by proximity, accessibility and wait times. Over larger geographies or where commissioners are not assured patients would otherwise have easy access to information on the full range of services and options available, central booking services are particularly valuable. ICBs should therefore consider establishing them where they don’t already exist.

These services do not fall under the legislative and NHS Constitution right to choose provider, so procurements and contracting arrangements should be developed with this in mind.

ICBs and sub-contracting trusts must award these contracts in accordance with the requirements of the Provider Selection Regime using the appropriate process. 1 or more contracts can be awarded under the other processes.  However, framework agreements can only be established under the Competitive Process.

3.3 Collaborating for capacity

Commissioners play an important role in the strategic planning of services. However, there is variation in how commissioners work with one another and providers to address quality and operational issues when they arise. This is particularly the case in planning capacity to meet need, ensuring service continuity, and establishing clinics to meet the access needs of local populations.

Some systems report issues with sustainable caseloads for existing or new surgical services following the introduction of telemedicine. This is unlikely to mean there is no longer as great a need for surgical procedures. Instead, latent need has likely been supressed, as high surgical wait and travel times have diverted service users into telemedical and medical services with significantly shorter waiting times. 

Past contracting arrangements, which funded surgical procedures below cost, have also likely contributed to insufficient surgical growth.

Recommendation 3

Given rising demand and time-sensitive nature of this service, systems should plan to ensure capacity in trusts and the independent sector will bring waiting times in line with NICE 2 week standards over the medium term. ICBs should ensure collaboration between providers to improve patient access, proactively manage capacity, establish links between related pathways, support the establishment of clinics in optimal locations, support the delivery of training, and ensure service continuity and resilience.

What does this look like in practice?

Commissioners are uniquely placed to work with providers and the wider system to tackle quality and operational issues. Commissioners should collaborate with providers in the following priority areas.

  • Commissioners and providers should work together to strategically plan for capacity to meet patient need in line with NICE guidelines and quality standards. Initially, ICBs should work with providers to stabilise trust capacity and work to increase surgical capacity in both trust and independent providers in the medium term.
  • Commissioners should ensure arrangements and pathways for non-specialised abortion services include links into abortion services for patients with complex co-morbidities. ICBs should consider how they can facilitate pathways and networks regionally, between specialised and non-specialised providers. Commissioners should ensure that they have clear pathways and contracting arrangements in place for abortions required due to foetal anomaly and appropriate links between abortion services and Early Pregnancy Units.
  • They should ensure optimal clinical locations in a way that reduces patient travel times, meets local population health needs and inequalities in access, while maintaining sufficient caseloads to ensure service viability. This involves:
    • working strategically with providers to plan clinic locations to improve patient access and reduce travel. This may include providing some sites that do not cover the whole pathway but improve access and minimise travel for patients
    • identifying potential new premises for independent sector provider clinics, including, for example NHS sites (acute or primary care providers) where there is capacity
    • co-ordinating approaches to patient group directions (PGDs) across the ICBs being serviced by a clinic (given these need to be agreed with every commissioner)
  • They should lead work to increase training in non-NHS settings, which improves access to clinical training in abortion care for all professional groups . As part of this, ICBs should work with both independent sector and NHS providers to identify training needs of their workforce and facilitate partnerships to improve access to clinical training across both sectors.
  • Commissioners should encourage collaboration between providers to share capacity and available resources to minimise patient wait times and optimise the use of clinic space and workforce. As a priority, ICBs should ensure collaboration and capacity sharing between providers where wait times exceed NICE 2 week standards. Commissioners should also improve access by supporting clinicians to work in more than 1 provider (including more than 1 trust) and facilitating smooth transfers based on patient choice of method, location, wait time or where there is a change in anticipated procedure. Such collaboration on the part of providers would be consistent with Provider Licence Conditions IC1 and IC2.
  • ICBs (including lead ICBs) should collaborate with one another, particularly in instances of acute service disruption or where patients require a transfer to an out-of-area provider.
  • They should work with system partners to ensure abortion services commissioned by the ICB are accessible for all those who need them, including where relevant, patients in prison.
  • They should work with independent sector providers to ensure they have the following plans and processes in place:
    • business continuity plans (including for patient records)
    • patient transfer agreements with trusts
    • the implementation and systematic use of the Learning from Patient Safety Events (LFPSE) service, which provides commissioners with timely information on safety events to improve service quality
    • patient safety incident response plan and policy, which describes how the provider (with support from ICB as required) will respond to patient safety incidents for the purpose of learning and improvement. This should include processes for ensuring equitable engagement and support for those affected by patient safety incidents
    • infrastructure to support sharing of patient records between the independent sector and NHS providers (if patients consent)
    • robust safeguarding processes

3.4 Aligning sexual and reproductive health and abortion services

Patients’ experience of navigating abortion and sexual and reproductive health (SRH) pathways can be hampered by a lack of clarity about the local offer and fragmentation between these services. The choice of contraceptive method offered to patients at appropriate points in their abortion pathway varies, as does the level of signposting to alternative access points.

Additionally, commissioners and providers across SRH and abortion services may not always consistently engage with one another to understand mutual access and capacity challenges and seek joint solutions.

Recommendation 4

ICBs should collaborate with local systems partners, including commissioners and providers of SRH services and contraception, to support better patient experience and a more holistic local offer recognising the interdependency of services. There is not an expectation for these services to be formally co-commissioned or integrated. ICBs should also consider opportunities for improving access to abortion services through women’s health hubs.

What does this look like in practice?

ICBs have an important role in:

The SRH offer needs to be clear to patients. In addition to commissioning contraception provision within abortion services, ICBs should:

  • ensure that the full range of local contraception options (available through SRH and primary care services) are clearly signposted by abortion providers
  • explore ways to support collaboration between services to provide seamless pathways and choice for patients
  • consider opportunities for improving access to abortion services through women’s health hubs, which have the potential to bring many services closer to home and streamline pathways of care. Some or all elements of the abortion care pathway can be built into a women’s health hub model

ICBs should also explore ways to use intelligence from local metrics (see appendix 1) and population health needs assessments to support collaborative work between SRH and abortion commissioners, particularly for tackling health inequalities in access, experience and outcomes. This specifically includes the Joint Strategic Needs Assessment or local Public Health Sexual and Reproductive Health Needs Assessments, as well as intelligence and data on the Pharmacy Contraception Service, which is included in SHAPE.

This intelligence can be used to support joint work between abortion commissioners and providers on post-abortion contraception. It can also be built into ICB tender processes to support early conversations on the interface between abortion and SRH as part of abortion service design.

To improve coordination and alignment, there are opportunities for ICBs to work proactively with local authorities to establish networks of commissioners and providers of SRH and abortion services to discuss and review pathways, population health needs and challenges with services. These could be at a multi-ICB footprint (as per the commissioning footprint chosen by ICBs in a particular geography) or at an ICB footprint (with key challenges and opportunities fed back to the lead ICB in the multi-ICB arrangement).

3.5 Standardising performance and quality metrics

Currently, each abortion provider reports to each commissioner on quality performance and contract requirements subject to the ICB’s requested format and methodology. The information requested can be complex and fragmented.

This can burden providers and impede the ability to benchmark quality across ICBs or effectively monitor issues at a multi-ICB or national level.  There is also notable variation in quality and patient experience metrics being collected or requested by commissioners.

Recommendation 5

ICBs and providers should use standardised quality and performance metrics (included in appendix 1). These have been developed in collaboration with ICBs and providers, building on existing metrics and work on metric standardisation.

What does this look like in practice?

A standardised approach to the collection of quality and performance information from abortion providers will simplify reporting for providers and enable better quality information flows to commissioners. This will support quality improvement and benchmarking across systems locally and nationally.

The metrics in appendix 1 should be incorporated into Schedule 6A (Reporting Requirements) of the NHS Standard Contract. These metrics do not cover safeguarding reporting, which will continue to require separate reporting and assurance locally. The metrics are primarily intended for independent providers, however, ICBs may also want to work with trusts to explore their potential for use with NHS providers.

Quality and performance metrics are 1 element of assurance that patients receive high-quality care. ICBs should also work with providers to ensure the approach to quality oversight is appropriate and effective. This includes quality and clinical leads in providers having sufficient engagement with commissioners on quality issues.

ICBs may require “compliance” assurance reporting to ensure operational standards, national quality requirements and educational quality standards are met.

Alongside this, ICBs should adopt an approach that is underpinned by soft intelligence and collaboration to explore improvement opportunities. Mechanisms should be in place to support information and intelligence sharing between trusts and ICBs in relation to abortion services, including about transfer pathways and follow-up care provided to patients after an abortion. ICBs should also consider how they can share intelligence with system partners, including local authorities, to support strategic planning and improvement across the system.

Where quality issues are identified, ICBs should ensure they appropriately use the established forums to improve quality, including System Quality Groups and Regional Quality Groups, as well as provisions in the NHS Standard Contract (see s39 and s47 of the NHS Standard Contract Technical Guidance).

Appendix 1: Performance and quality metrics

Note – metrics significant for ensuring national resilience, sustainability and access are marked with an asterisk (*).

Access to abortion services

1. Procedure type and gestation*

Definition – number and % patients treated split by:

  • total treated from relevant ICB
  • telemedical abortion (<10 weeks)
  • medical abortions by gestational age (<10 weeks, 10 to 13+6 weeks, 14 to 19+6 weeks, 20 to 23+6 weeks, 24+ weeks)
  • surgical abortions by gestational age (<10 weeks, 10 to 13+6 weeks, 14 to 19+6 weeks, 20 to 23+6 weeks, 24+ weeks)

Measurement:

  • denominator – total number of patients treated
  • numerator – total number of each type and gestation or procedure provided
  • qualitative commentary if relevant – consider segmentation by demographics (metric 24)
  • please note it is suggested that telemedical abortion is reported where there is no face-to-face or in-person contact with services (including collection of medicines as in person contact)

2. Self-referral

Definition – evidence patients can self-refer into services.

Measurement:

  • denominator – total number of patients treated
  • numerator – total number of patients self-referred

3. Out of area travel*

Definition – number and % of patients travelling out of a) ICB and b) NHS region for treatment, broken down by type of procedure (medical or surgical and gestational bands).

Measurement:

  • denominator – total number of patients treated
  • numerator – total number of patients treated out of a) ICB and b) region
  • supported by qualitative reporting

4. Translation services

Definition – % of patients requiring translation services who receive translation services.

Measurement:

  • denominator – number of patients requiring translation services
  • numerator – number of patients receiving translation services

Choice of abortion procedure

5. Service choice*

5.1 Definition – number and % of patients provided with information on the full range of services locally, including clinic locations and other providers (where there is more than 1 provider).

Measurement:

  • denominator – total number of patients accessing services
  • numerator – number of patients provided with information on the full range of services locally
  • qualitative reporting on processes

5.2 Definition – evidence of referral pathways to alternative clinics and providers to enable patient choice.

Measurement:

  • qualitative reporting on process in place

5.3 Definition – % of patients who had an abortion with a record of their choice of telemedical, medical or surgical abortion and anaesthetic (including general anaesthetic) split by gestational band.

Measurement:

  • denominator – the number of patients who had an abortion
  • numerator – the number in the denominator with a record of their choice of medical or surgical abortion and anaesthetic

Waiting times for an abortion

6. Referral to clinical assessment wait time

6.1 Definition – number and % of assessments within 7 calendar days of referral for a) medical and b) surgical abortion by gestational age.
Measurement:

  • denominator – total number of assessments provided
  • numerator – total number of assessments within 7 calendar days of referral

6.2 Definition – median and mean days between referral and assessment for a) medical and b) surgical abortion by gestational age bands.

Measurement:

  • median and mean (denominator – number of patients; numerator – total days waited between referral and assessment) split by procedure type and gestational age band

7. Assessment to treatment wait times

7.1 Definition – number and % of treatments within 7 calendar days of assessment for a) medical and b) surgical abortion by gestational age bands (where patients decide to proceed with treatment).

Measurement:

  • denominator – total number of treatments provided
  • numerator – total number of treatment within 1 week of assessment
  • please note: for early medical abortion, when medication not taken in clinic, use from time prescription signed, with supporting information on processes for timely distribution

7.2 Definition – median and mean days between assessment and treatment for a) medical and b) surgical abortion by gestational age.

Measurement:

  • median and mean days (denominator – number of patients; numerator – total days waited between assessment and treatment), split by medical or surgical and by gestational age band

8. Referral to treatment wait times*

8.1 Definition – number and % of abortions provided within 14 calendar days of initial approach for a) medical and b) surgical abortion by gestational age.

Measurement:

  • denominator – total number of treatments provided by type
  • numerator – abortions provided within 14 days of initial approach

8.2 Definition – median and mean days between referral and treatment for a) medical and b) surgical abortion by gestational age.

Measurement:

  • median and mean days (denominator – number of patients; numerator – total days waited between referral and treatment) split by medical or surgical and by gestational age band

9. Appointments cancelled on the day by provider

Definition – number and % of appointments cancelled on the day by provider as a result of list cancellations.

Measurement:

  • denominator – total number of appointments provided
  • numerator – total number of appointments cancelled on the day by the provider – exclude cancellations for clinical reasons
  • reporting on lists cancelled and reasons for cancellation

Transfers and onward referrals

10. Transfers to local NHS trusts

10.1 Definition – number of transfers made to and received by local trusts, related to procedure a) complications or b) clinical need.
Measurement:

  • number of provider’s patients transferred to local trusts relating to complications or clinical need and qualitative details and outcomes
  • include complications from telemedical care that result in transfers
  • include qualitative reporting on cases where patients refused care

10.2 Definition – number of emergency and blue light transfers to NHS trusts.

Measurement:

  • number of emergency transfers for provider’s patients
  • qualitative details and outcomes
  • include emergency transfers required following telemedical care
  • separately, where known, include qualitative details of patients admitted as emergencies to trusts without referral by the provider (for example, as walk-ins or GP referrals)

11. Out of area transfers

11.1 Definition – number and % of patients transferred out of the local area due to a) complications or b) clinical need.

Measurement:

  • denominator – total number of patients treated
  • numerator – total number of transfers out of area due to a) complications or b) clinical need
  • supported by qualitative details and outcomes information where appropriate

11.2 Definition – evidence of regular review of transfer pathways between providers.

Measurement:

  • qualitative evidence, including information on agreed pathways

Patient safety

See also SC33 of the NHS Standard Contract

12. Incident recording

12.1 Definition – evidence of developing and maintaining processes for recording patient safety incidents for the purpose of learning and improvement.

Measurement:

  • qualitative reporting supplemented with quantitative data demonstrating recording as required
  • include incidents post-discharge where possible
  • include national and local information

12.2 Definition – evidence of developing and maintaining processes for monitoring incident data quality, including use of the Learn From Patient Safety Events service.

Measurement:

  • qualitative reporting supplemented with quantitative data demonstrating output of quality monitoring work
  • include national and local information

12.3 Definition – evidence of developing and maintaining processes to use insight gained from recording and responding to patient safety incidents to inform service improvement.
Measurement:

  • qualitative reporting supplemented with quantitative data from improvement efforts where available

12.4 Definition – evidence of developing and maintaining processes for responding to patient safety incidents using a systems-based method.

Measurement:

  • qualitative reporting, including national and local information

12.5 Definition – evidence of developing and maintaining processes to support the a) application and b) review of a patient safety incident response plan (PSIRP).

Measurement:

  • qualitative reporting, including national and local information

12.6 Definition – number and % complications with narrative breakdown where appropriate. Consider: haemorrhage, sepsis, cervical tear, uterine perforation, genital tract or pelvic infection, embolism, ectopic related, continued pregnancy, other (to align with Hospital Episode Statistics or Abortion Notification System reporting of complications; for more information see complications from abortions in England: comparison of Abortion Notification System data and Hospital Episode Statistics 2017 to 2021).

Measurement:

  • denominator – total number of abortions provided
    numerator – number of complications in each category
  • include incidents post-discharge and national and local information

13. National Patient Safety Alerts (NaTPSA)

Definition – evidence of developing and maintaining processes to effectively manage and implement actions from NatPSAs; evidence implementation of NatPSAs is coordinated by an exec lead (or equivalent).

Measurement:

  • denominator – total number of relevant NaTPSAs
  • numerator – number of relevant alerts implemented in timescales
    qualitative reporting if relevant

14. Duty of candour

Definition – details of any thresholds that have been breached and breaches in respect of the duty of candour that have occurred.

Measurement:

  • number of times thresholds breached and qualitative details

15. Follow up

Definition –  % of patients receiving follow up support within 21 days of procedure (including support accessed via patient-initiated contact to an aftercare line). 

Measurement: 

  • denominator – total number of abortions 
  • numerator – number of patients receiving follow up support
  • where relevant, qualitative commentary on outcomes from follow-ups

Patient experience

See also NHS Standard Contract  and SC12

16. Patient satisfaction

16.1 Definition – satisfaction score in surveys or number of patients who would recommend services to friends or family.

Measurement:

  • average satisfaction score out of 10 or
  • denominator – total number of survey responses
  • numerator – number satisfied with abortion care (rated good or excellent) or services users likely or highly likely to recommend the services in accordance with Friend and Family Test
  • qualitative reporting on themes from feedback

16.2 Definition – number and % response rate to satisfaction surveys.

Measurement:

  • denominator – total number of patients treated
  • numerator – total number responding to satisfaction survey

16.3 Definition – % of patients satisfied with ease of access to services

Measurement:

  • denominator – total number of patients assessed for abortion
  • numerator – total number of patients satisfied with ease of access

17. Complaints

17.1 Definition – complaint rate, taking into account verbal and written complaints requiring a response.

Measurement:

  • denominator – total number of patients treated
  • numerator – number of complaints received

17.2 Definition – evidence of complaints monitoring, learning and action.

Measurement:

  • evidence of comprehensive approach to complaints monitoring reporting, including numbers of complaints received and qualitative analysis of key themes, learning and actions taken

Contraception, sexual health and support after an abortion

All metrics in this section are for information not target setting.

18. Contraception

18.1 Definition – number and % of patients taking up offer of contraceptive counselling
Measurement:

  • denominator – total number of patients treated
  • numerator – total number taking up contraceptive counselling

18.2 Definition – number and % patients receiving a) any contraception b) LARC.

Measurement:

  • denominator – total number of patients treated
  • numerator – total number receiving a) any contraception b) LARC

19. Sexual health

19.1 Definition – % offered testing for a) HIV b) chlamydia, syphilis and gonorrhoea (consider hepatitis B and C).

Measurement:

  • denominator – total number of patients treated
  • numerator – total number offered testing by sexually transmitted infection (STI)

19.2 Definition – % receiving testing for a) HIV b) chlamydia, syphilis, gonorrhoea (consider hepatitis B and C), as well as rates of positive test results.

Measurement:

  • denominator – total number of patients treated
  • numerators – total number receiving testing, as well as positive test rate (by STI)

20. Support after an abortion

Definition – number and % of patients taking up offer of post-abortion counselling.

Measurement:

  • denominator – the number of patients who had an abortion
  • numerator – the number in the denominator taking up offer of post-abortion counselling

Workforce and training

Please note that reporting on workforce may be required less frequently than other metrics, for example, annually. Staffing requirements are covered in GC12 of the NHS Standard Contract.

21. Staffing

Definition:

  • staff sickness absence rates
  • staff turnover rates
  • vacancy rates by staff group
  • agency usage (WTE) by staff group
  • bank usage (WTE) by staff group
  • appraisal rates (%)
  • professional registration and revalidation data
  • mandatory training rate
  • safer staffing (where relevant)
  • clinical supervision rates
  • staff survey results, including staff experience and friends and family tests
  • number of staff trained in long-acting reversible contraception (LARC)

Measurement:

  • denominator – total number of relevant staff
  • numerator – indicator specific staff numbers
  • provide benchmarking or narrative and exception reporting to support data
  • provide local information contextualised with regional or national information

22. Workforce sustainability

Definition – evidence of developing and maintaining processes to ensure workforce sustainability.

Measurement:

  • number of surgeons providing abortion
  • accompanied by qualitative reporting on clinical training provision, succession planning (where relevant) and implementation of the Education Quality Framework

23. Safeguarding training and supervision

Definition:

  • % staff with level 1, 2, and 3 adult’s safeguarding training
  • % staff with level 1, 2, and 3 children’s safeguarding training
  • % staff who are requiring safeguarding supervision receiving supervision, typically at 3 monthly intervals
  • % staff with Prevent, Mental Capacity Act (MCA), Deprivation of Liberty (DOLS), Female Genital Mutilation (FGM), beginner and intermediate domestic abuse training

Measurement:

  • denominator – total number of relevant staff
  • numerator – number of staff with each training type or receiving supervision

Supporting information

Supporting information is included to provide an indication of patient characteristics only. Targets should not be set for any metrics relating to patient demographics.

Please note reporting on demographics may be required less frequently than other metrics, for example, quarterly. This data relies on self-reporting and some characteristics may not be reported by patients or there may be inaccuracies in patient reporting.

24. Patient demographics

Definition – total number of patients treated by:

  • parity
  • number of previous terminations within the previous 12 months
  • age (under 16, 16 to 17, 18 to 24, 25 to 34, 35 to 44, 45 and over)
  • patient disability information (for example, learning disability and difficulty, long-standing illness, mental health condition, physical impairment, sensory impairment)
  • sexual orientation
  • gender identity
  • religion
  • ethnicity
  • to consider – deprivation based on indices of multiple deprivation (IMD rank and decile) where available

Measurement:

  • number for each category

Publication reference: PRN01724i

Date published: 17 March, 2025
Date last updated: 17 March, 2025