Basic investigations should be carried out according to the local care pathway but as a minimum should include:

• Clinical examination to confirm gestational age

The following may be performed in primary care, or after referral to secondary care, as per local protocol:

• Chlamydia screening
• Blood group and save

Advise the patient regarding the cervical screening programme and arrange screening if appropriate (this should not delay pregnancy termination)

There are three strategies for dealing with STIs and the choice between these approaches depends on local protocol and the prevalence of infections:

• A screen and treat strategy (treat those women found to have an infection with an appropriate antibiotic)
• Routine antibiotic prophylaxis for all women
• A combination of screen and prophylaxis:
  • this allows prophylaxis in all cases but also enables partner notification and screening for other STIs

Offer support and counselling

In order to give valid informed consent to termination, the patient should be fully informed about the options available and be given further support and counselling as appropriate to her needs:

• Assess the patient's situation and feelings about termination
• Explore options available, e.g. continuing pregnancy, adoption
• If necessary, allow time to make a decision, although the clinician must respect the fact that the woman may already have made her decision, in which case the referral should not be delayed
• Inform the woman that she can change her mind until the actual procedure
• Explain the procedure and what to expect, discuss after care and contraception
• Reassure the woman that there is no association between a single abortion and an increased risk of psychological sequelae unless there are pre-existing risk factors
• Inform the woman about the process for informing of a positive sexual transmitted infection (STI) screen

When giving the woman the information and counselling:

• Counselling should be unbiased and non-judgemental
• If an interpreter/signer for the deaf is used, they must be an independent person and not a family member
• Written information should be provided that is impartial, easy to understand and translated if necessary
• Emphasise confidentiality

Offer the patient time to consider their decision, and arrange a review appointment if the patient wishes:

• Respect the fact that the woman may already have made her decision, in which case the referral should not be delayed

If the woman does want more time to consider the decision, with the woman's agreement consider:

• Booking an appointment with an abortion provider for assessment and information, with no need to book a date for the procedure, as abortions that are performed earlier are safer

If Patient less than 100% sure to proceed with termination of pregnancy

• Refer to specialist counsellor if indicated and continue with pregnancy, make appointment with the midwife in Primary Care

Referral Instructions

Making a referral to TOP clinic

There are two providers of TOP clinics for those in the Exeter and North Devon catchment. Referral information for both are below.

Royal Devon University Healthcare NHS Foundation Trust with branches in Exeter and North Devon

• Exeter clinic is based in Wonford and referral should be made by contacting: 01392 406503 . You will be asked to send a referral letter and include the HSA1 form.
• North Devon clinic is based in NDDH and referral should be made by contacting: 01271 322577. You will be asked to send the referral form found through the formulary and include the HSA1 form. If the patient requires a counselling service please contact Petter Day Unit, NDDH - 01271 322722

MSI Reproductive Choices UK services.

• Patients can self-refer to MSI Reproductive Choices UK . If they are registered with a GP locally, they will not be charged. The advantage of going to MSI Reproductive Choices UK is that they can often get seen quite quickly as the service is mainly telemedicine. For more information, visit their website MSI Reproductive Choices UK or call 0345 300 8090.

The Devon Sexual Health website has lots of useful information related to termination of pregnancy. You can find out more about how to access services and support, as well as information about treatment options.

This guideline has been signed off on behalf of NHS Devon.

Publication date: August 2018

Updated: September 2023