During the day, we are easily reachable for concerns and complications via email and telephone. Care during ANW (out-of-hours) hours is provided by the GP out-of-hours centres. The GP out-of-hours centres have been informed about this, with a protocol that is being re-distributed by Ineen among the GP out-of-hours centres.
Abortion care is partly covered by the GP's \u2018additional services\u2019. Only the prescription of the combination of mifepristone + misoprostol falls under the Abortion and Sterilisation Act (Wafz), and requires additional training. Consultations in the context of abortion prior to and following the prescription of the abortion pill are covered by standard basic care.<\/p>\n\n\n\n
What do we offer?<\/strong><\/p>\n\n\n\n Home abortion provides online abortion care for unwanted pregnancies of less than 9 weeks gestation. We offer this service on weekdays between 8 am and 6 pm. We offer GPs and midwives:<\/p>\n\n\n\n How do we work?<\/strong><\/p>\n\n\n\n Following careful review of the application form by a member of staff, the form is re-assessed by the prescribing doctor when prescribing (four-eyes principle). If there are any questions, we will contact the pregnant individual for a telephone conversation, a brief email response, or for them to request an ultrasound, for example. This can then be submitted to us. Transfer letter to own GP<\/strong><\/p>\n\n\n\n The pregnant person then receives a message from us stating that the prescription has been sent to the designated pharmacy, and we will once again provide the link to the patient information leaflet developed by GPs and pharmacists. They will also receive a referral letter for their GP. The pregnant person can decide whether to forward this letter to their GP or not. This procedure is the same as that used by abortion clinics. <\/p>\n\n\n\n Aftercare<\/strong><\/p>\n\n\n\n On weekdays between 08:00 and 18:00, we can answer questions from those who have used the medication by telephone or email. Based on the prevalence of complications from medical abortion, we expect approximately 160 cases per year, distributed across 111 out-of-hours GP clinics.<\/p>\n\n\n\n For general practitioners who encounter a patient who has taken the abortion pill during their daily practice or out-of-hours service, it is important to know that the care is no different than for a patient experiencing a miscarriage, see NHG Standard Miscarriage<\/a><\/p>\n\n\n\n Patients who have attended an abortion clinic or consulted a fellow GP and have been prescribed the abortion pill can also come forward (to the day practice or) during out-of-hours services. Not all abortion clinics have arranged 24-hour care, so they refer patients to their GP for aftercare. <\/p>\n\n\n\n The most important information that the GP on duty needs to know has been sent to all GP out-of-hours centres as a protocol in autumn 2024 and is presented below. This advice comes from the Guideline on Unintended Pregnancy. <\/p>\n\n\n\n GP Out-of-Hours Protocol<\/strong><\/p>\n\n\n\n Every GP \u2013 regardless of whether they prescribe medication for a medical abortion themselves \u2013 can provide assistance in out-of-hours services for questions about, or complaints or complications arising from, a medical abortion. GPs have likely been doing this for a long time without realising it, as pregnant women who receive this medication via a gynaecologist or abortion clinic sometimes present with heavy bleeding, whether or not they disclose the reason. The complaints resulting from a medical abortion are similar to those of a (medically treated) miscarriage. The advice from the NHG Standard Miscarriage is therefore authoritative. The most important points are:<\/p>\n\n\n\n \u2022 If no bleeding occurs 6 hours after using misoprostol, the woman can insert four additional 200 microgram misoprostol tablets vaginally. We routinely prescribe a repeat prescription for misoprostol. Should the woman require additional misoprostol tablets, any GP may prescribe them. This falls under basic care.<\/p>\n\n\n\n \u2022 Advise an NSAID as a first choice for pain relief, for example, ibuprofen up to a maximum of 2400 mg\/day, supplemented with paracetamol at the maximum dosage. <\/p>\n\n\n\n \u2022 Be alert and invite a woman for a consultation if she has the following complaints: <\/p>\n\n\n\n \u2022 Refer to a gynaecologist in cases of persistent heavy bleeding (> 4 full sanitary pads\/hour for 2-3 hours) to rule out an incomplete abortion. <\/p>\n\n\n\n \u2022 Consider an ectopic pregnancy for unexplained pain, especially if there are risk factors. In case of suspected ectopic pregnancy, consult with the gynaecologist. <\/p>\n\n\n\n \u2022 Refer to a gynaecologist for persistent fever, especially in combination with abdominal pain and unpleasant discharge. This may indicate PID. The GP can treat PID themselves, or suspected PID, provided that ultrasound has ruled out any remaining products of conception in the uterus that could be causing the inflammation. <\/p>\n\n\n\n \u2022 Women who report a positive pregnancy test after an abortion can make an appointment with their GP during working hours on weekdays.<\/p>\n\n\n\n Evidence-based practice<\/strong><\/p>\n\n\n\n Online abortion care is as effective and safe as in-person care, a study shows Cochrane systematic review<\/a> from 2025. The American College of Obstetricians & Gynaecologists<\/a> (ACOG) has determined that the abortion pill is as safe as an NSAID and less deadly than an erectile dysfunction pill.<\/p>\n\n\n\n We operate according to the Guideline mentioned above, which was developed through collaboration between abortion specialists, gynaecologists, GP trainers, a lawyer, a representative of a women's organisation, and a pharmacist. Several of us contributed to this guideline and provide training on it to other GPs. We can be contacted during the day for concerns and complications via email and telephone. Care during out-of-hours (ANW) hours is provided by the GP practices. The GP practices have been informed about this with a protocol that is being redistributed to the GP practices by Ineen. Abortion care falls partly under the \u2018extra offerings\u2019 of the GP. ONLY prescribing the combination of mifepristone\u2026 <\/p>\n
We offer them:\u00a0<\/p>\n\n\n\n\n
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We will send the prescription to the pharmacy that the unintentionally pregnant person has provided. In addition to the prescription, the pharmacist will also receive a link to the The KNMP's abortus dossier<\/a> and to the Guideline for General Practitioners on Unintended Pregnancy<\/a>. By the end of 2024, all pharmacists will have been informed.<\/p>\n\n\n\n
After 4 weeks, we will email people again asking them to repeat the pregnancy test. For her contraceptive use, we will refer her to her GP.
Outside these hours, meaning evenings, nights, and weekends, any complications will be handled by an out-of-hours GP service. In this respect, we operate no differently to a regular GP practice. Likewise, a GP prescribing the abortion pill does not provide out-of-hours care themselves but can rely on the out-of-hours GP service. In autumn 2024, these services received instructions on how to handle questions and complaints following the use of the abortion pill. This falls under standard primary care. Prescribing a repeat prescription for misoprostol is also normal primary care.<\/p>\n\n\n\n\n
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In addition, we rely on the Directive Counselling when considering termination of pregnancy<\/a> of the Dutch Society of Abortionists, on the WHO Guideline<\/a> and the NICE Guideline<\/a>.<\/p>","protected":false},"excerpt":{"rendered":"