Recommendations for the Co-Delivery of Intrauterine Devices for All Contraceptive or Non-Contraceptive Indications

Joint briefing calls for a single commissioning model for IUDs across all indications

The English HIV and Sexual Health Commissioners Group (EHSHCG), the Primary Care Women’s Health Society (PCWHS), the College the College of Sexual and Reproductive Healthcare (CoSRH) and the Advisory Group on Contraception (AGC) have published a joint briefing addressing the commissioning of intrauterine devices (IUDs) for gynaecological indications alongside their contraceptive use.

Two surveys conducted by PCWHS among primary care providers and by EHSHCG among Local Authority commissioners, found that despite DHSC updating its commissioning guidance in January 2025, responsibility for non-contraceptive IUD provision remains unclear in many areas. This has resulted in inconsistent funding, Local Authorities absorbing costs disproportionate to their commissioning remit, and women being redirected between services before accessing appropriate care.

The briefing sets out six recommendations for change which include:

1. Clarify national commissioning responsibilities and accountability for LARC Services
2. Develop a single commissioning model for IUD across all indications
3. Establish a system-wide IUD tariff
4. Provide clear assurance to Primary Care on data collection and payment
5. Use data to inform future commissioning and workforce planning
6. Strengthen system leadership and accountability

Addressing these issues has implications beyond commissioning administration. Community-based IUD provision is more cost-effective than delivery in secondary care, reduces unnecessary referrals, and supports timelier access to care. The recommendations are intended to support delivery of the Women’s Health Strategy and the ambitions of the NHS 10-Year Plan by reducing unwarranted variation and improving equity of access regardless of clinical indication or geography.

Rob Bacon – EHSHCG Representative (East of England) said,

“Our findings show the excellent work already taking place across Local Authorities, primary care and sexual and reproductive health services to improve access to intra-uterine devices (IUDs). However, without greater clarity and consistency in commissioning arrangements, and a shared understanding of responsibilities across the system, progress will remain limited. These recommendations highlight the work that still needs to be done to address longstanding complexities and develop equitable and sustainable pathways for women accessing IUD care.”

The Primary Care Women’s Health Society said,

“PCWHS is pleased to support this collaborative briefing and its call for urgent, long-overdue change. We hope its recommendations reach the right decision-makers and prompt meaningful action. We believe women deserve accessible, responsive and joined-up services that put their needs first, remove barriers, and provide appropriate support, whether they require an IUD for contraceptive or non-contraceptive reasons.”

Dr Zara Haider, President of the College of Sexual and Reproductive Healthcare, said,

“If a woman needs an IUD, for any reason, she should be able to access it close to home and in a timely manner. Being bounced between services while expecting her to wait for care is unacceptable. Achieving these recommendations will be critical to delivering this ambition and we would welcome working with Government and wider stakeholders on this issue.”

The Advisory Group on Contraception (AGC) said,

“The Advisory Group on Contraception is pleased to endorse this paper, which reinforces the need for a more consistent approach to commissioning LARC across both contraceptive and gynaecological care. Women should be able to access the contraception they need, without commissioning arrangements determining where or whether that care is available.

We therefore welcome the briefing’s focus and practical recommendations on greater clarity, collaboration and accountability across the system, which will be important in supporting more consistent and equitable access to contraception across the life course.”