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Improving access to abortion services: a local model - contraception-esc.com

Improving access to abortion services: a local model

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.

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