Sample policy · Termination of pregnancy

Statutory notification policy (HSA1 and HSA4) (termination of pregnancy)

Statutory anchor: Regulation 20 (requirements relating to termination of pregnancies), Care Quality Commission (Registration) Regulations 2009 (SI 2009/3112), which carries the CQC notification duty for non-NHS termination providers. The clinical and certification framework is set by the Abortion Act 1967 (Form HSA1) and the Abortion Regulations 1991 (Form HSA4, notification to the Chief Medical Officer). The Abortion Act 1967, the Abortion Regulations 1991, and DHSC HSA guidance are the load-bearing primaries for this policy. · primary source

1. What the regulation says

the registered person must ensure that, unless two certificates of opinion have been received in respect of the service user ... no termination of pregnancy is carried out; and ... no fee is demanded or accepted from a service user. (Regulation 20(2))

The registered person must ensure that no termination of a pregnancy is undertaken after the 24th week of gestation. (Regulation 20(5))

the registered person must give notice in writing to the Commission of that information, within the period of 14 days beginning on the day on which the information is received. (Regulation 20(10))

The full text of the regulation is at https://www.legislation.gov.uk/uksi/2009/3112/regulation/20. The clinical and certification framework sits in the Abortion Act 1967 (https://www.legislation.gov.uk/ukpga/1967/87) and the Abortion Regulations 1991 (https://www.legislation.gov.uk/uksi/1991/499). Where this policy and the regulation diverge, the regulation wins.

2. Plain-English summary

This regulation applies to non-NHS providers carrying on the regulated activity of terminations. Two certificates of opinion must be received before any termination is carried out or any fee accepted; certificates must be filed with the medical record; no termination may be performed after 20 weeks unless suitably qualified staff and emergency procedures are in place; no termination at all after 24 weeks. A register of terminations must be kept, the total numbers must be recorded, each termination must be notified in writing to the Chief Medical Officer, and any death of a service user within 12 months that may be associated with a termination must be notified to CQC in writing within 14 days. This is distinct from HSCRA Regulation 20 (Duty of Candour), which is a different statutory instrument and a different obligation.

The Crime and Policing Act 2026 (section 241) removed the criminal liability of a woman in England and Wales acting in relation to her own pregnancy. It does not remove or alter the provider's obligations under the Abortion Act 1967, the Abortion Regulations 1991, the HSA1 and HSA4 process or the Care Quality Commission (Registration) Regulations 2009, which continue to apply in full.

3. 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.

4. Scope

This policy applies to:

Emergency terminations under section 1(4) follow the HSA2 control in section 11 and the Service's separate clinical-emergency procedure. They do not use the ordinary HSA1 route.

4.1 Roles and responsibilities

5. HSA1 certification workflow

For every non-emergency termination, the Service follows this workflow:

  1. Confirm the pathway: verify patient identity, gestation, place, legal route and whether HSA1, HSA2 or EMA1 applies.
  2. Form the opinions: two registered medical practitioners each review sufficient patient-specific information and form a good-faith opinion that at least one and the same section 1(1) ground is met.
  3. Complete before treatment: both practitioners complete, sign and date HSA1 before the termination starts. Pre-signing or retrospective HSA1 completion is prohibited.
  4. File the certificate: place HSA1 with the patient record and retain it for the required period.
  5. Prepare HSA4: after the termination, collect the current DHSC data fields and have the responsible practitioner verify the form.
  6. Submit and evidence: send HSA4 to the Chief Medical Officer within 14 days and retain the submission confirmation or postal evidence.
  7. Run the failsafe: reconcile every termination against HSA1 and HSA4 status, escalating incomplete records before the statutory deadline.

Under section 1(1) of the Abortion Act 1967, a termination requires authorisation by two registered medical practitioners (or, in an emergency, one, see section 11 below).

5.1 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.

5.2 Who can sign

Both signatories must be registered medical practitioners in good standing with the GMC. Each practitioner must consider the patient's individual circumstances and have enough information to form and defend their own good-faith opinion. The record identifies the patient-specific information each practitioner considered and whether they consulted or examined the patient. Staff must not add a blanket examination rule that is not stated in the live legislation or DHSC guidance.

5.3 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 is recorded in the incident register and escalated to the Registered Manager and Medical Director for urgent legal, regulatory and professional advice.

5.4 Record-keeping

The completed HSA1 certificate is retained with the patient record for 3 years from the date of termination. The Service verifies that period against the live Abortion Regulations and DHSC approval guidance before adoption.

6. The HSA4 CMO notification

Regulation 4 of the Abortion Regulations 1991, as amended for England by the Abortion (Amendment) (England) Regulations 2002, requires the practitioner who terminated the pregnancy to notify the Chief Medical Officer within 14 days of the termination (the unamended 1991 wording said seven days; the 2002 amendment set 14 days for England). Current DHSC HSA4 guidance confirms the 14-day deadline.

6.1 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.

6.2 The 14-day clock

HSA4 must be completed and authorised within 14 days of the termination. For medical terminations, staff must follow the current DHSC HSA4 guidance on treatment dates, confirmation dates and form completion. This template must not override DHSC's live HSA4 guidance. The Service tracks every termination against this deadline from the day of the procedure forward; any notification approaching day 10 without submission triggers an internal escalation.

6.3 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.

6.4 Channel and submission evidence

DHSC strongly encourages electronic submission through the Abortion Notification System because it validates data and reduces disclosure and missing-data risk. Current DHSC guidance also permits submission by post using an official ordered form. Staff must not print or copy a paper HSA4. The record retains the electronic confirmation or secure postal evidence used by the Service.

6.5 Inaccuracy and corrections

If an HSA4 notification is submitted with a material inaccuracy, the practitioner and administrator follow the live DHSC correction route promptly. They retain the original submission evidence, corrected information, DHSC correspondence and reason for the amendment. The inaccuracy is also logged in the incident register for clinical-governance review.

7. Audit and assurance

The Service runs a monthly audit of HSA1 and HSA4 compliance:

Findings from these audits feed the quarterly clinical-governance meeting and the annual CQC self-assessment.

8. Internal escalation and statutory-breach response

A missing, retrospective, inaccurate or late statutory form is managed as follows:

  1. Inform the Registered Manager and Medical Director or Lead Clinician on the day the issue is identified.
  2. Protect the patient and record, preserve the audit trail and contact DHSC where correction or late-submission advice is required.
  3. Obtain urgent specialist advice on the applicable legal, CQC, commissioner, professional-regulator and patient-disclosure routes. Regulation 17 is a governance duty, not a generic CQC notification form.
  4. Record each threshold decision and its rationale, including why a notification or referral was made or not made.
  5. Add corrective actions to the improvement-action register and any continuing systemic risk to the risk register.

9. Patient-facing communication

Where a statutory breach affects a patient's care or record, the Service assesses open disclosure and the statutory duty of candour against the applicable harm threshold. Duty of candour is not triggered by the existence of a paperwork error alone. The decision, communication and rationale are recorded.

10. Training

All clinicians involved in HSA1 certification or HSA4 notification complete:

Training records are kept in the Verivius training matrix under the statutory_notification competency.

11. Emergency provision (section 1(4))

In an emergency, where the practitioner forms the opinion that the termination is immediately necessary to save life or prevent grave permanent injury, the section 1(4) route may apply without a second practitioner's signature. The practitioner completes HSA2 before the termination or, where that is not reasonably practicable, within 24 hours, and retains it for 3 years from the date of termination.

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.

11.1 Related policies and records

12. Review

This policy is reviewed at least annually and whenever the Abortion Act 1967, the Abortion Regulations 1991, or DHSC guidance materially changes.

13. Sources and further reading

This template is based on CQC's guidance for providers and managers, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and other topic-specific legislation and guidance listed below. It is a starting point for adaptation, not a substitute for legal, clinical, HR, safeguarding or specialist professional advice.

14. When to seek further advice

Seek specialist advice where the issue involves serious harm, safeguarding, deprivation of liberty, restraint, children, professional misconduct, controlled drugs, radiation, termination of pregnancy, infection outbreak, water safety, employment dismissal, DBS barring referral, or regulatory enforcement.

15. Document control

Version Date Author Changes
v1 2026-06-10 Verivius (sample) Conformed existing draft to the Verivius policy standard; added regulation quote, plain-English summary, source pack, and document control. Original operational sections preserved.
v1.1 2026-07-19 Verivius (sample) Corrected the emergency certificate and escalation routes, then added named accountability, a failsafe workflow and linked records.

This sample policy template was issued by Verivius. It is a template, not a substitute for legal advice or the provider's own policy-development process. Where this template and live law or regulator guidance diverge, the live source wins.

Awaiting final verification

The HSA4 deadline is confirmed at 14 days for England. The complete HSA1, HSA2, HSA4 and CQC Regulation 20 framework must be confirmed for your service by a named abortion-law or clinical reviewer.

What good looks like here

Written from an ex-CQC inspector's chair, but the point is safe, well-led care your team can stand behind. Each row shows what strong evidence looks like, what thin evidence looks like, and where the expectation comes from.

In a termination service the statutory forms are not administrative overhead sitting alongside the care: the two-practitioner HSA1, completed and signed before treatment, is the thing that makes the procedure lawful, and a certificate produced afterwards to tidy the file does not cure a termination that went ahead without it. The notifications that follow, to the Chief Medical Officer for every termination and to CQC where a person's death may be connected to one, are legal duties in their own right, and each sits in a different instrument with a different trigger, so it is easy for a busy service to believe it has 'reported' when only one of several duties has actually been met. The evidence trail protects the person twice over: before treatment it shows two clinicians formed a good-faith, patient-specific opinion and that gestation and legal route were confirmed rather than assumed, and afterwards it makes sure a rare death or serious complication cannot be quietly absorbed into a full list. A missing HSA1 or a late HSA4 is a statutory breach, not an audit observation, which is why an inspector treats the completeness and timing of these records as load-bearing, and why the same failsafe that catches a slipped notification is what keeps the service lawful between visits.

  1. Every termination the service carries out rests on two registered medical practitioners' good-faith, patient-specific opinions that are recorded and signed before treatment begins, not a certificate completed afterwards to catch up with a procedure that has already happened.

    Strong evidence: A sampled HSA1 for the month showing both signatories are registered medical practitioners in good standing, at least one and the same statutory ground recorded, the patient-specific information each practitioner considered, and a signature date that falls before the procedure date.

    Weak evidence: An HSA1 signed or dated after the procedure, a pre-signed blank certificate kept ready, one practitioner's opinion standing in for two, or a ground ticked with nothing to show either clinician weighed this person rather than applying a house rule.

    A legal duty. This comes from legislation that applies to your service, so meeting it is not optional. The exact provision is cited beneath the badge.

    Abortion Act 1967, s.1(1); Abortion Regulations 1991, reg 3(1)(a) and reg 3(2) (certificate of opinion, on Form HSA1, given before the commencement of the treatment)

  2. Every termination is notified to the Chief Medical Officer as its own separate event within the statutory period, with a failsafe that reconciles each procedure against its notification, so a form is never left unsent because the person had already been discharged and the record moved on.

    Strong evidence: The HSA1, HSA2, EMA1 and HSA4 tracker showing each termination for the month cross-checked against its HSA4 submission, the electronic Abortion Notification System confirmation or secure postal evidence retained, and the responsible practitioner named as the notifying practitioner even where an administrator submitted on their behalf.

    Weak evidence: Terminations sitting on the clinical log with no matching HSA4 evidence, submission confirmations that were never kept, several procedures to one person collapsed into a single notification, or a tracker that lists what is due but shows nobody reconciling it before the deadline passes.

    A legal duty. This comes from legislation that applies to your service, so meeting it is not optional. The exact provision is cited beneath the badge.

    Abortion Regulations 1991, reg 4 (practitioner's notice to the Chief Medical Officer); Care Quality Commission (Registration) Regulations 2009 (SI 2009/3112), reg 20(9) (registered person's duty to ensure notice to the Chief Medical Officer of each termination)

  3. The death of a person that may be connected to a termination is notified to CQC in writing in its own right, kept separate from the Chief Medical Officer notification, the duty of candour owed to the person and their family, and any safeguarding referral, because none of those duties discharges another.

    Strong evidence: A record of any such death showing written notice to CQC within the period the regulation sets, logged distinctly from the HSA4 notification, the duty-of-candour decision and any onward referral, each with its own trigger and recorded rationale.

    Weak evidence: A death folded into the HSA4 process and treated as already notified, a duty-of-candour conversation logged as though it had satisfied the CQC duty, or a governance note that reads 'reported' without showing which of the separate duties was actually met.

    A legal duty. This comes from legislation that applies to your service, so meeting it is not optional. The exact provision is cited beneath the badge.

    Care Quality Commission (Registration) Regulations 2009 (SI 2009/3112), reg 20(10) (death of a service user within 12 months that may be associated with the termination, notice in writing to the Commission)

  4. No termination proceeds beyond the statutory gestational limit, and a termination at the higher gestation the regulation flags is only carried out where the suitably qualified staffing and emergency arrangements the regulation requires are in place; gestation, place and legal route are confirmed and recorded before treatment, not reconstructed afterwards.

    Strong evidence: The pathway record for each case confirming identity, gestation, place, legal route and the correct form before treatment, and the register showing every termination fell within the statutory limits with the higher-gestation conditions evidenced wherever they applied.

    Weak evidence: Gestation or legal route written up after the event, a higher-gestation case with nothing to show the required staffing or emergency arrangements were in place, or a pathway step that exists as a policy paragraph but leaves no per-case record.

    A legal duty. This comes from legislation that applies to your service, so meeting it is not optional. The exact provision is cited beneath the badge.

    Care Quality Commission (Registration) Regulations 2009 (SI 2009/3112), reg 20(5) (upper gestational limit), with reg 20(4) for the higher-gestation suitably qualified staffing and emergency arrangements

  5. The single-practitioner emergency route is used only where a clinician judges in good faith that ending the pregnancy is immediately necessary to save the person's life or prevent grave permanent injury, is certificated as the regulations require and retained, and every use is reviewed so the emergency ground never becomes a routine shortcut around the two-practitioner rule.

    Strong evidence: Each emergency-ground termination showing the HSA2 certificate completed and retained, the clinical justification for the section 1(4) ground recorded against this person's picture, and a clinical-governance review of the pattern of emergency-ground use.

    Weak evidence: Emergency-ground terminations with no HSA2 on file, a justification that reads as a generic phrase rather than this person's clinical circumstances, or a run of emergency-ground cases that never reaches a governance review.

    A legal duty. This comes from legislation that applies to your service, so meeting it is not optional. The exact provision is cited beneath the badge.

    Abortion Act 1967, s.1(4); Abortion Regulations 1991, reg 3(1)(b) and reg 3(3) (emergency certificate of opinion, on Form HSA2, before treatment or within 24 hours where that is not reasonably practicable)

  6. A missing, late, retrospective or inaccurate statutory form is handled as a statutory breach that is escalated, corrected at source and learned from, not logged as an audit observation and left, and the reconciliation that catches it runs on a set cadence rather than only when someone asks to see it.

    Strong evidence: The completed HSA1 and HSA4 audit for the period with any exception traced into the incident register, escalation to the Registered Manager and Medical Director, contact with DHSC where correction or late-submission advice was needed, and a corrective action that closed with evidence.

    Weak evidence: Audit tick-sheets marked fully compliant with no sample size or named findings, a late or retrospective form noted once and never escalated, or an exception recorded with no rationale for which external duties were and were not triggered. The monthly cadence is a Verivius default, not a statutory interval.

    Our recommended baseline. Not a legal or regulatory requirement, but a sensible standard we suggest where the rules leave the detail to you. Adapt it to your service.

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Last verified 20 July 2026

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Last reviewed 19 July 2026