Delivery quality abortion care for patients with medical complexity and/or co-morbidities in England

Delivering quality abortion care for patients with medical complexity and / or comorbidities in England September 2026ISPs described challenges with referring to NHS hospitals including determining referral eligibility, obtaining information on the patient's health condition from general practitioners (GPs), lack of standardised referral systems and paperwork, lack of knowledge about networks, and difficulties identifying hospitals with available theatre slots.All these factors could delay care.NHS providers expressed differing views on ISP referral practices, with some perceiving referrals being overcautious at times.Conscientious objection and stigmatisation of both abortion and of certain health conditions or social circumstances could create additional barriers for delivery of care.Good relationships and trust across ISPs and the NHS facilitated greater understanding, surgical skill acquisition and maintenance, and effective working. Implementation Mechanisms: Independent Sector and NHS ProvidersImplementation Mechanisms: Regional Networks Work at hospital level determined the network model, set up training, created multi-disciplinary teams (MDTs), established referral processes, and ensured protected theatre slots.Delivery of care was operationalised differently, with two of the case-study regions using a hub-and-spoke model and the other an "informal clinical network".Networks remained fragile due to incomplete workforce development and some unwillingness to undertake abortion care training, either at all or at higher gestations.Services often relied on Independent Sector Providers (ISPs) to deliver training.Whole team training (including nurses and theatre staff) was seen as essential.Variation in referral mechanisms led to delays, duplication and inefficiencies.Variability in the frequency of theatre lists and reliance on one surgeon or anaesthetist resulted in further treatment delays when these staff were not available, with a pronounced impact for later-gestation care.Delivering quality abortion care for patients with medical complexity and / or co-morbidities in England