This site is intended for health professionals only

At the heart of general practice since 1960

Should GP practices offer abortion?

MP Dr Evan Harris argues that restrictions preventing provision of abortion in general practice are unnecessary, outdated and deny women the chance for integrated care. But Dr Andrew Fergusson counters that expanding access to abortion would be precisely the wrong response to the rising numbers undertaken.

MP Dr Evan Harris argues that restrictions preventing provision of abortion in general practice are unnecessary, outdated and deny women the chance for integrated care. But Dr Andrew Fergusson counters that expanding access to abortion would be precisely the wrong response to the rising numbers undertaken.

Yes

The Abortion Act is now 40 years old, so it is not surprising that some of the restrictions put in place when abortion was first decriminalised are now out of date both scientifically and ethically.

One such example is the banning of abortion in all NHS premises other than a hospital. It is understandable that in the days of illegal and dangerous back-street abortions, only hospitals were approved as abortion providers.

But it is impossible to justify this restriction now – especially since the advent of early medical abortion, which can be provided by prescription and administration of drugs up to nine weeks' gestation.

Early surgical abortion can also safely be performed with local anaesthetic or conscious sedation, and is of a similar skill level to providing a woman with a contraceptive IUD.

There is no reason why early medical or early surgical abortion could not be offered by those GP surgeries and family planning clinics that wish to do so – assuming

they were contracted for the work, paid adequately and had suitable training

and back-up. Conscientiously objecting clinicians would be able to opt out of providing the service.

Research worldwide has shown that abortion services outside of secondary

care are safe, effective and acceptable to patients and doctors alike. Provision in the community would reduce delays, NHS costs and inconvenience for the women involved.

The need to permit abortions outside

of secondary care settings was already recognised in 1990 when the Government took the power to approve a ‘class of place' for early medical abortion – a power it has failed to use, by its own admission, for political rather than clinical reasons.

Integrated care

It would allow care to be provided closer to the patient. And GPs could provide integrated care – helping patients who

have inadequate contraception or repeat contraceptive failure and providing long-acting reversible contraception.

PCTs often fail to co-commission IUD provision with abortion services in hospitals, and everyone is interested in improving the take-up and effectiveness of contraception and reducing numbers of repeat abortions.

Many women who have a good relationship with their local GP practice would value the option of having their abortion care provided by a trusted local clinician rather than having to go straight to a hospital or private clinic.

Where abortion takes place, it is a consensus view among all except those opposed to all abortion that it should take place as early as possible in gestation, and that it should not involve unnecessarily invasive procedures or avoidable inpatient stays.

Nor should unnecessary statutory restrictions be allowed to stigmatise abortion services.

Access to secondary abortion services in some areas is still poor, particularly in rural areas. Women from north Wales actually have their abortions in Liverpool.

Women have to travel to hospital, possibly several times, and pay all costs. Although some PCTs perform nearly 80% of abortions in the first 10 weeks, in some – such as North Lincolnshire – it is only 40%.

You do not have to be a pro-abortion zealot to recognise that allowing GPs to choose to offer early abortion services and women the option of receiving abortion services in primary care is a sensible, evidence-based step.

Nobody is suggesting that all practices or all GPs would have to offer the service – it would be a matter for the partnership and for individual clinicians.

Our approach to healthcare has changed hugely over the past 40 years. It is time for the outdated provisions of the Abortion Act – which no longer reflect the requirements of patient safety and good medical practice – to be reformed.

It is neither ethical nor desirable to punish those who have made their own decision to choose abortion by unnecessarily restricting their access to it.

Dr Evan Harris is Liberal Democrat MP for Oxford West and Abingdon and a former hospital doctor

No

Of course GP practices could offer abortion, but they should not. Well over 200,000 abortions take place in Britain each year, with almost one in four pregnancies ending in abortion, and with one woman in three in England having an abortion in her lifetime.

There is a growing view that abortion is too easy, that too many see it as an alternative to contraception and that the numbers should come down.

Many doctors recognise that every time they consult with a woman with an unexpected and perhaps unwanted pregnancy, they have two patients before them: the woman and her unborn child.

GPs are increasingly reluctant to play a part in the provision of abortion – 19% believe it should be banned completely, 24% refuse to sign abortion referral forms and more than half want the upper limit for most abortions to be reduced from 24 weeks.

The pro-choice lobby has responded to the turning of the tide among GP opinion with a concerted attack on those who are sceptical about widening access.

Supporters of abortion need its reality to be trivialised. They therefore want what is effectively abortion on demand in the first trimester by abolishing the need for two doctors' signatures.

They want nurses and midwives to take over the entire responsibility, including prescribing for medical abortions and (later) performing surgical ones, and they want the second stage of medical abortions carried out on premises that are not currently licensed.

Supporters of abortion also want the Abortion Act extended to Northern Ireland against the wishes of its people and politicians and some want to prevent those with ethical concerns even from seeing women with crisis pregnancies.

Abortions would increase

Any of these measures risks increasing the total number of abortions, just when the number should be reduced.

Regarding premises, the Commons science and technology committee last October recommended that ‘Parliament pass regulations to enable women who chose to do so to take the second stage of early medical abortion at home'.

The Government responded: ‘We note the committee's recommendations. Under the Abortion Act 1967, an abortion (surgical and medical) can only be performed in a hospital vested in an NHS trust, PCT or foundation trust or in an approved independent sector place.

'Section 1(3A) of the Abortion Act 1967 also gives the Secretary of State the power to approve a class of place to perform medical abortion which could enable this method to be available in a wider range of healthcare settings.'

The Department of Health went on to reveal that it was funding two hospitals to run early medical abortion services in ‘non-traditional settings', in order to evaluate the effectiveness and safety of providing abortion in this way.

This particular proposal is essentially a discussion about safety, but medical abortion is not as safe as commonly assumed and it is not always effective.

Failed and incomplete abortions require surgery. In a recent review, complications involving hospitalisation were more than twice as likely following medical abortions than surgical ones: 1.5% after medical abortion as opposed to 0.6%.

The BMA, at last year's annual representative meeting, therefore voted against relaxing the rules on premises.

Perhaps GPs voting there also had in mind the consequences for other patients attending the surgery – perhaps for

an antenatal clinic or an infertility consultation – while in an adjacent room a woman was expelling a dead fetus. Perhaps they were concerned for the objections of their staff.

Perhaps too they were reminded of the profession's one-time commitment to the Hippocratic Oath: ‘I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive remedy.'

Perhaps GPs don't want killing on their premises.

Dr Andrew Fergusson is a former GP and head of communications for the Christian Medical Fellowship

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say