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

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.

Recent legislative changes may affect the criminal-law position for women in England and Wales who end their own pregnancies. Providers must verify the current primary legislation before publishing any patient-facing wording. This does not alter the provider's obligations under the Abortion Act 1967, the Abortion Regulations 1991, the HSA1/HSA4 process or the CQC Registration Regulations unless primary legislation says so.

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:

• 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.

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

• Registered Manager: owns the statutory-notification failsafe, investigates any missing or late form and makes sure corrective actions close.
• Medical Director or Lead Clinician: approves the clinical certification procedure, advises on uncertainty and reviews breaches or repeated data-quality errors.
• Each certifying registered medical practitioner: forms and records their own good-faith, patient-specific opinion and signs only when at least one and the same statutory ground is met.
• Practitioner taking responsibility for the termination: remains accountable for the accuracy and timely submission of HSA4, even where administration is delegated.
• Notification administrator: prepares and tracks forms, checks required fields, retains submission evidence and escalates approaching or missed deadlines. They do not form clinical opinions or sign on a practitioner's behalf.
• Information-governance lead: approves secure access, transfer, retention and correction arrangements for highly sensitive notification data.

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 requires the practitioner who terminated the pregnancy to notify the Chief Medical Officer within 14 days of the termination.

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:

• 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.

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:

• Induction training on the Abortion Act 1967 statutory grounds and signatory requirements.
• Annual refresher on the HSA4 portal submission process plus 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.

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

• Termination consent and reflection policy
• Termination medication safety policy
• Termination clinical governance and complications policy
• Termination patient confidentiality and data protection policy
• Incident reporting, investigation and learning policy
• Duty of candour policy
• HSA1, HSA2, EMA1 and HSA4 tracker with submission evidence
• Incident, risk and improvement-action records for every exception

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.

• 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, abortion notification forms and live guidance: https://www.gov.uk/government/publications/abortion-notification-forms-for-england-and-wales
• Department of Health and Social Care, procedures for approval of independent-sector places: https://www.gov.uk/government/publications/update-to-procedures-for-the-approval-of-independent-sector-places-published/procedures-for-the-approval-of-independent-sector-places-for-termination-of-pregnancy-abortion-in-england
• 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
• Care Quality Commission (Registration) Regulations 2009, Regulation 20 (requirements relating to termination of pregnancies): https://www.legislation.gov.uk/uksi/2009/3112/regulation/20
• CQC: Care Quality Commission (Registration) Regulations 2009 (statutory notifications, including notification of termination of pregnancy)
• DHSC HSA forms guidance
• RCOG and NICE abortion care guidance (complications and clinical governance)
• Recent changes to the criminal law on ending one's own pregnancy in England and Wales (verify against current primary legislation before publishing patient-facing wording; provider obligations under the Abortion Act 1967, the Abortion Regulations 1991, HSA1/HSA4 and the CQC Registration Regulations are unchanged unless primary legislation says otherwise)

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

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.