Clarity and compliance: Delivering abortion services within the law

The GMC’s role is making sure women seeking an abortion are given a good standard of care and that doctors understand what is expected of them, says Chief Executive Niall Dickson.

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The General Medical Council is a creature of statute – an organisation established by Parliament to set and promote the standards doctors must meet – and, where necessary to take appropriate action to ensure patients are protected.

When it comes to the highly contentious area of abortion, the GMC does not and should not have a view – that is a matter for Parliament and for society in general. The GMC’s role is confined to making sure its own guidance and doctors’ practice is within the law, that women seeking an abortion are given a good standard of care and that doctors understand what is expected of them.

In 2012, the Care Quality Commission (CQC), the systems regulator for health and social care in England conducted an investigation of nearly 250 clinics offering abortion services. During those inspections, they found, among doctors, that the practice of pre-signing (HSA1) forms had become widespread. This meant that, in effect, a single doctor – rather than the two required by the Abortion Act – was able to take the decision to perform a termination.

Our initial response involved working closely with the CQC and the police to identify the doctors involved in this practice, which runs counter both to the law and the standards we expect from doctors. As a result, nearly 70 doctors were identified.

We continued to work closely with the police, sharing information and intelligence, and as we often do, we placed our own investigation on hold while their work continued.

The Crown Prosecution Service, based on the evidence available to them, and following the police investigation, subsequently decided a prosecution of these doctors would not be in the public interest.

We then had to complete our own investigation and decide what action to take. It was clear that the practice of pre-signing forms had become commonplace – and undoubtedly was not restricted to the 67 doctors who happened to be identified in the CQC inspections. Here was an example of a poor practice which had emerged over a number of years, at least in part as a response to changes in the way clinical care is given. As with much abortion practice, a great deal has changed over the past 47 years. Nevertheless, the practice was contrary to the Abortion Act and it was wrong.

Our response was to demand assurances from every one of those doctors that they would stop pre-signing forms. We also made it abundantly clear that there would be consequences if they ignored our guidance in this area. This is a very serious matter and we will take action if any doctor is found to be ignoring the law in this way.

That intervention together with advice from the Royal College of Obstetrics and Gynaecology and a letter from the Chief Medical Officer had the desired effect – a second set of inspections by the CQC found that the practice has ceased. Our clear stance, with others’, has made a significant impact.

It is worth noting that these cases are very different from the allegations that two doctors offered abortions based on the gender of the foetus. Again it is true that the Crown Prosecution Service decided not to prosecute these doctors, but we have made it clear that we will not be bound by that decision. Both doctors are currently banned from any involvement with abortion services while our investigation continues.

It is important for everyone concerned that there is clarity in this area of medical practice as far as is possible. That is why we are working with the Department of Health who are developing further guidance on good practice to support doctors – and inform patients – in this area.

This is a highly controversial aspect of medical practice and much has changed since the current law was passed. Dealing with that must be a matter for Parliament and society.

However, just because the law seems out of step does not mean it can be ignored, and we will continue to make sure that doctors understand what is expected from them in delivering good care.

3 responses to “Clarity and compliance: Delivering abortion services within the law

  1. What exactly does presigning forms mean? Signing without the patient’s details being filled in or without knowing the patient?

  2. I am proud to be a GMC registered Doctor and to be working with standards set by the Council, in the interest of both the patient and the Doctor.

  3. Yes, this practice had become common place and infact it was almost expected by the abortion service providers that HSA 1 form is pre-signed. It is unfortunate that GMC had to first issue cautions before reiterating the Guidance in Good Practice. UK doctors are trying their best to provide best care for their patients under difficult circumstances(increased demand, expectations, and reduced funding and reducing staffing levels). It is unfair to make the doctors look like criminals all the time. GMC sometimes need to also recognize the amount of work doctors are putting in to improve patient care.
    My American physician friends are amazed that we see 40- 50 patients a day, are so under funded, are heavily criticized by almost everyone, and we still bale to provide a world class service.
    All i want to say is that doctors also deserve respect and not being made scapegoats for everything that is going on wrong in NHS

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