1. Purpose
This policy sets out how the Service obtains the statutory two-practitioner authorisation under the Abortion Act 1967 (Form HSA1) and notifies the Chief Medical Officer of each termination under the Abortion Regulations 1991 (Form HSA4).
It is the most regulator-load-bearing policy in the Service. A missing HSA1 or a late HSA4 is a statutory breach, not an audit observation.
2. Sources to verify before adoption
- Abortion Act 1967 (as amended): https://www.legislation.gov.uk/ukpga/1967/87
- Abortion Regulations 1991 (S.I. 1991/499): https://www.legislation.gov.uk/uksi/1991/499
- Department of Health and Social Care, "Guidance for completing the abortion notification form HSA4": https://www.gov.uk/government/publications/abortion-notification-forms-for-england-and-wales
- HSA4 online notification system: https://www.hsa4.dhsc.gov.uk
- Care Quality Commission, regulatory requirements for termination of pregnancy services: https://www.cqc.org.uk
- GMC, Good Medical Practice 2024 (effective 30 January 2024): https://www.gmc-uk.org/professional-standards/good-medical-practice-2024
3. Scope
This policy applies to:
- All terminations performed by the Service, whether medical or surgical, in England and Wales.
- Both NHS-funded and self-funded pathways.
- All clinicians involved in the HSA1 certification process and the HSA4 notification process.
- Administrative staff supporting the notification workflow.
This policy does NOT apply to terminations performed under the emergency provision in s.1(4) of the Abortion Act 1967 — those are covered by a separate clinical-emergency policy.
4. The HSA1 two-practitioner certificate
Under section 1(1) of the Abortion Act 1967, a termination requires authorisation by two registered medical practitioners (or, in an emergency, one — see §10 below).
4.1 Statutory grounds
Both practitioners must form an opinion in good faith that the termination is justified under one or more of the grounds in section 1(1). The current grounds (verbatim text in the Act; verify before patient-facing copy) are commonly referred to as grounds A through G.
4.2 Who can sign
Both signatories must be registered medical practitioners in good standing with the GMC. Both must have considered the patient's circumstances. One of them must have personally examined the patient where clinically practicable; the second may rely on the first practitioner's examination and the case notes where this is documented.
4.3 When the certificate must be signed
The HSA1 certificate must be signed BEFORE the termination is performed. Retrospective signing of HSA1 is a statutory breach. Any incident where the certificate was signed after the procedure was performed is reported under [statutory_notification_breach] in the Verivius incidents register and triggers escalation to the registered manager + the GMC fitness-to-practise consideration.
4.4 Record-keeping
The completed HSA1 certificate is retained in the patient record. The Abortion Regulations 1991 set the statutory retention period; verify the current period against the regulations before adoption.
5. The HSA4 CMO notification
Regulation 4 of the Abortion Regulations 1991 requires the practitioner who terminated the pregnancy to notify the Chief Medical Officer within 14 days of the termination.
5.1 What must be notified
Each termination, regardless of patient circumstance or outcome, is notified separately. Multiple terminations to one patient over time are separate notifiable events.
5.2 The 14-day clock
The clock starts on the day the termination is completed (for medical terminations, the day the second dose of misoprostol is administered or the day the products of conception are confirmed expelled, per current DHSC guidance). The Service tracks every termination against this clock from the day of the procedure forward; any notification approaching day 10 without submission triggers an internal escalation.
5.3 Who submits
The practitioner who terminated the pregnancy is named as the notifying practitioner on the HSA4 form. Where the practitioner has delegated submission to an administrator (as is operationally common), the practitioner remains accountable for accuracy.
5.4 Channel
HSA4 notifications are submitted via the DHSC online portal at https://www.hsa4.dhsc.gov.uk. Paper submissions are accepted only by prior arrangement.
5.5 Inaccuracy and corrections
If an HSA4 notification is submitted with a material inaccuracy (gestational age, statutory ground, patient identifying information, treatment modality), a corrected submission is made via the portal as soon as the inaccuracy is identified. The original notification is NOT withdrawn; the correction is layered. The inaccuracy is also logged in the Verivius incidents register under [hsa4_notification_inaccurate] for clinical-governance review.
6. Audit and assurance
The Service runs a monthly audit of HSA1 and HSA4 compliance:
- HSA1 audit: sample of completed certificates for the month, checking signatory eligibility, statutory ground recorded, examination evidence, signature date relative to procedure date. Target: 100% compliance; any retrospective certificate is a critical finding.
- HSA4 audit: every termination performed in the month cross-checked against the HSA4 portal submission record. Target: 100% submitted within 14 days; any submission past day 14 is a critical finding.
Findings from these audits feed the quarterly clinical-governance meeting and the annual CQC self-assessment.
7. Internal escalation
A statutory breach (missing or late HSA1 or HSA4) is escalated to:
- The Service's registered manager, on the day the breach is identified.
- The medical director (if the Service has one) or the lead clinician within 24 hours.
- The CQC under Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, via the standard notifiable-incident pathway, where the threshold for notification is met.
- The GMC, where a registered medical practitioner's conduct or practice is materially implicated.
8. Patient-facing communication
Where a statutory breach affects a patient's care or record, Duty of Candour applies. The patient is informed in accordance with the Service's Duty of Candour policy, including written notification within the timescales in Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
9. Training
All clinicians involved in HSA1 certification or HSA4 notification complete:
- Induction training on the Abortion Act 1967 statutory grounds and signatory requirements.
- Annual refresher on the HSA4 portal submission process + the 14-day deadline.
- Update training within four weeks of any DHSC guidance change.
Training records are kept in the Verivius training matrix under the statutory_notification competency.
10. Emergency provision (section 1(4))
In an emergency, where the practitioner forms the opinion that the termination is immediately necessary to save the life of, or to prevent grave permanent injury to, the patient, the termination may be performed without the second practitioner's signature. The HSA1 is then completed retrospectively by the operating practitioner alone, citing the emergency ground.
The HSA4 notification still applies and is submitted within 14 days as normal.
Emergency-ground terminations are reviewed at the next clinical-governance meeting; any pattern of repeated emergency-ground use without clinical justification is a critical finding.
11. Review
This policy is reviewed at least annually and whenever the Abortion Act 1967, the Abortion Regulations 1991, or DHSC guidance materially changes.