Archived: BPAS - Tottenham

Updated 2 November 2016

Termination of pregnancy (TOP) refers to the treatment of termination of pregnancy (abortion) by surgical or medical methods. British Pregnancy Advisory Service (BPAS) Tottenham is part of the provider group BPAS. The service at BPAS Tottenham is located within a sexual health clinic in a GP surgery leased by BPAS on a sessional basis, and is provided under a contract with local clinical commissioning groups (CCGs) for NHS patients mainly from Haringey, Enfield, Barnet and Walthamstow, and also accepts private patients.

BPAS Tottenham provides a range of termination of pregnancy services. They include: pregnancy testing, unplanned pregnancy counselling/consultation, EMA up to 10 weeks of pregnancy, abortion aftercare, sexually transmitted infection testing, and contraceptive advice and contraception supply. The services are provided under contract with local clinical commissioning groups for NHS patients and also accept private patients.

Updated 2 November 2016

Is the service safe?

• Authorisation for the supply and administration of medicines under patient group directions (PGDs) was not carried out or documented in line with national or local guidelines.
• Incidents, including those with a potential to cause harm to patients or staff, were not always reported.
• Staff did not receive prompt feedback from incidents to reduce the risk of recurrence.
• The approach to anticipating managing day-to-day risks to people who used the service was reactive rather than pro-active, and tended to be led at a regional or corporate level. This meant that opportunities to prevent or minimise harm could be missed.
• National specifications for infection prevention and control were not adhered to. In particular, requirements for cleaning schedules, and checklists; and clear separation of clean and dirty activities and equipment.
• There were reliable systems, processes and practices in place to keep people safeguarded from abuse.
• There was a specialist placement team to source appointments within the NHS for patients who were not suitable for treatment at BPAS on medical grounds.
• Medicines were safely ordered, supplied, and stored in accordance with manufacturers’ instructions, and administered only when they had been prescribed for a named client.
• Records were securely stored, well maintained and completed with clear dates, times and designation of the person documenting.
• Safety and maintenance checks were generally carried out on equipment in accordance with local and national requirements.
• There were sufficient numbers of suitably trained staff available to care for patients.
• Arrangements were in place to manage emergencies and transfer patients to another health care provider where needed and were known to all staff.

Is the service effective?

• Care took account of national best practice guidelines.
• The exception was the use of simultaneous administration of abortifacient drugs for early medical abortion (EMA), which is outside of current Royal College of Obstetrician and Gynaecologist (RCOG) guidance. However; we saw that a structured governance system was in place and had been followed to introduce this treatment option.
• The complication rate for simultaneous administration was approximately double that for medical abortion treatment when medicines were administered separately.

• Policies were accessible for all staff and were kept up to date.
• Patients were offered pain relief, preventative antibiotic treatments and post-abortion contraceptives.
• Staff had an annual appraisal.
• Counselling staff participated in group counselling supervision.
• The BPAS Aftercare Line, a telephone service, was accessible to patients 24 hours a day and for seven days a week.

Is the service caring?

• Staff were caring and compassionate and treated patients with dignity, understanding, and respect.
• Patients gave consistently positive feedback and described the staff as ‘kind, warm, and professional’.
• During the initial assessment, nurses and midwives explained to patients all the available methods for termination of pregnancy that were appropriate and safe. Staff considered gestational age and other clinical needs whilst suggesting these options.
• Patients considering termination of pregnancy had access to pre and post termination counselling, with no time limits attached, but were not obliged to use the counselling service.

Is the service responsive?

• Patients could book appointments through the BPAS telephone booking service which was open 24 hours a day throughout the year. This also enabled patients to choose the location and time they attended.
• Patients were able to attend other local BPAS clinics for treatment if Tottenham was closed.
• BPAS Tottenham did not offer surgical treatment. Patients who chose this option would be referred to treatment at one of two BPAS treatment units in London.
• There was a fast track appointment system for patients with a higher gestational age or complex needs.
• A professional interpreter service was available to enable staff to communicate with patients whose first language was not English.
• Patients were provided with information to help them to make decisions.

Is the service well-led ?

• There were effective governance arrangements to manage risk and quality. However, local risks were not always identified or acted upon by people with the authority to do so.
• Staff felt supported by the treatment unit and regional managers, and considered the leadership and visibility of senior managers was good.

• The culture within the service was caring, non-judgemental and supportive to patients.

• Staff spoke positively about the high quality care and services they provided for patients and were proud to work for BPAS.