Why was change needed?

Increasing demands for long-acting reversible contraception (LARC) within NHS Lothian had led to long waits for women requesting intrauterine contraception (IUC). As insertion of LARC to reduce unplanned pregnancy was viewed as a top priority, the Sexual and Reproductive Health (SRH) Service in Lothian wished to simplify access to this highly effective method of contraception. The aim was to improve the pathway to insertions, and reduce the number of visits required to the Chalmers Sexual Health Centre.

There is evidence to suggest that multiple visits for IUC insertion can create a barrier to uptake of the method.1 ,2

What needed changing?

In common with most other UK services, we traditionally insisted that women attend two appointments: the first for counselling about IUC followed by a second booked appointment for insertion of a device at a clinic dedicated to IUC insertion.

In an attempt to streamline this process, it was first agreed that the Chalmers Centre would insert IUC at all general SRH clinics; this would be at the morning, afternoon and evening drop-in and booked clinics rather than solely at dedicated IUC insertion clinics, as had previously been the case. Women requiring emergency intrauterine device (IUD) insertion are identified at triage and seen at same-day appointments.

In an effort to reduce waiting times, we then offered women the option of a telephone consultation as an alternative to attending in person for the clinic counselling appointment. Women booking an appointment for an IUC consultation for elective insertion were given a convenient time when they would be telephoned by a specialist nurse, and if they were suitable, they would then be given a …