Letter of Competence Subdermal Contraceptive Implants Techniques Removal Only (LoC SDI-RO)

Letter of Competence Subdermal Contraceptive Implants Techniques Removal Only (LoC SDI-RO) is open to doctors, nurses and midwives who have previously obtained the LoC SDI-IO or who work in deep implant clinics. 

Doctors must hold both registration and a licence to practice with the UK GMC and nurses and midwives must be on the UK NMC register (excluding RN Level 2).

This training programme has been designed to equip the learner with the evidence based knowledge, attitude and skills required to consult with a woman requesting contraception, and to appropriately remove a subdermal implant.  

The training involves both theoretical knowledge and practical training. We recommend that you start by reading the training requirements and the learning outcomes for the Letter of Competence in Subdermal Contraceptive Implant Techniques Insertion and Removal (LoC SDI-RO).

You may find our list of General Training terminology helpful to reference alongside these documents.

Entry Criteria

You must be registered with either the NMC or registered/licensed with the GMC to undertake this qualification. 

What/How do I study?

Completion of the Letter of Competence in Subdermal Implant Techniques can result in Associate Membership of FSRH. Associate membership includes the following benefits:

  • Access to 'My FSRH' a personalised area on our website which includes resources and personal details
  • Full online access to BMJ SRH - our quarterly peer-reviewed journal
  • Free webinars 
  • Regular e-bulletins with access to previous editions
  • Discounts to FSRH conferences
  • Access to our Members' Evidence Request

Read more about FSRH Membership here

The Letter of Competence in Subdermal Contraceptive Implant Techniques Removal only (LoC SDI-RO) is only open to clinicians working in deep implant services.

Entry Requirements

Click here for the learning outcomes. Details of the eligibility criteria and pathway are contained in the Training Requirements.

FSRH Diploma or LoCs - requirement for anaphylaxis training

The entry requirements for the DFSRH, LoC SDI (all options) and LoC IUT include the need for trainees to provide evidence that they are up to date with Basic Life Support and Anaphylaxis Training in accordance with their employer’s local policy. Trainees are encouraged to access local training where available. In the rare instances where this is unavailable, online updating which follows the UK Resuscitation Council standards may be deemed acceptable; there are a number of websites which offer e-learning for a fee. Trainers may choose to accept certificates of completion as suitable evidence. Doctors who register with doctors.net.uk can access free on-line learning through this website.


1. Pass Module 17 of the e-SRH and Read the Guidance on the 6 Principles of Care

Everybody must complete Module 17 of the e-SRH, which is hosted on the e-LfH website. This is an e-learning package, free to NHS professionals, which contains interactive learning modules on various topics. Each module lasts around 20 minutes.

or access you will need to register with e-Learning for Healthcare (e-LfH). This e-SRH is free to anyone holding an nhs.net email address. If you have previously registered on e-LfH site and have forgotten your details you can request a reset , or if you are having issues logging in you can contact e-LfH


At the time of application for your FSRH qualification, you need to confirm you have read the 6 principles of care as outlined in the “Guidance for those undertaking or recertifying FSRH qualifications whose personal beliefs conflict with the provision of abortion or any method of contraception” and agree to abide by them in practice. It is, therefore, important to have read this document prior to commencing training.

2. Purchase and Take the eKA (Electronic Knowledge Assessment)

The eKA is an online single best answer test that runs for 2 hours and must be completed in one sitting. It costs £75 per attempt.


If you do not hold a current FSRH Diploma, MFSRH or FFSRH, you must pass (or have recently passed) our online knowledge assessment (the ‘eKA in SRH’). Find out more about the eKA

If you hold a current FSRH Diploma, MFSRH or FFSRH, there is no need to take the eKA.


There are maximum timeframes allowed between completing the eligibility requirements and completing the Letter of Competence (LoC).

  • eKA pass and LoC application – 2 years

However, if you already hold one LoC from FSRH, this timeframe will increase to 5 years to allow you to submit your application for a second LoC.


At the end of the eKA you will see if you have passed or failed on the screen. You will not be told a score or given any other feedback aside from whether or not you have passed or failed.

You should save this webpage as a PDF by clicking the 'print' button and selecting a PDF writer instead of a printer. Please note that we do not issue certificates for the eKA as it is not a qualification. Therefore you will not see the eKA under ‘My Certificates’ or 'My Qualifications' in MyFSRH.

3. Find a Trainer and undertake Practical Training - Removals

Trainees must first use a model arm to practice inserting and removing subdermal implants. This practice can take place as part of the Course of 5 for the FSRH Diploma, or in a separate training session.

The training then moves to live volunteers: you must complete as many supervised removals as necessary until your trainer is satisfied that you are competent.

Please note:
Your practical training must be completed through a Faculty-recognised General Training Programme – you can find a list of them on our 'Find a Trainer' page when you register or log into 'My FSRH'.

4. Download LoC SDI Record of Training

You must document all your practical training and obtain the signature of your trainer when you competently complete each stage. Please ensure all parts of your form are completed in full. If any part of your application is not complete or it does not meet the required standard, your application is likely to be delayed. Download a training record.

5. Submit your Record of Training

Once you and your Primary Trainer have completed all sections of your Record of Training Form, you may submit this form along with the supporting documents and LoC registration fee for a certificate award.


To do this, log into ‘My FSRH’ and then complete: 


1. Your LoC SDI training record / application form 
2. The online evaluation of your training experience – you can find links to this in ‘My FSRH’.  Your feedback will be shared with the FSRH's General Training Committee to help us improve our programmes.

Fast-track arrangements for experienced practitioners

If you are already experienced in subdermal contraceptive implant techniques and are currently providing subdermal implant contraception, you can fast-track your training by self-certifying. Read the training requirements by clicking the link at the top of this page.

Need an extension?
If you need an extension to the timeframe to complete the DFSRH training, please submit a request and we will aim to give you a decision within 10 working days.  Examples of reasons why you may need an extension include maternity/paternity leave, illness or other unforeseen circumstances.

Intellectual Property Rights
All intellectual property rights for any FSRH qualification including documents, materials and content belonging to and produced by the FSRH should not be used for purposes other than FSRH training. Should you wish to use any of the IPR for purposes other than FSRH training you must seek the FSRH’s approval in writing with your request via our copyright request form. We aim to respond to submissions of this nature within one working week. 

Recertification & Membership

If you hold Letters of Competence in Subdermal Contraceptive Implant Techniques – Removal Only (LoC SDI - RO), we require recertification every five years. This is to ensure that you have developed and maintained the knowledge, skills, attitude and behaviour needed to provide safe and effective sexual and reproductive health care (SRH).

As a member you can recertify free of charge, as this is a benefit included in your annual membership fee. However, you must have paid your membership fee continuously for the five years leading up to recertifying.

Experienced Practitioners - Please note, if you have undertaken training at another provider some time ago, and your initial qualification was not awarded by FSRH we are not able to recertify this for you.  However, there is a shortened pathway (less observed procedures) to achieving the Letter of competence in Subdermal Contraceptive Implant Techniques which takes into account past clinical experience . However, all parts of the programmes (including passing the eKA) need to be completed. 


How do I apply for my LoC SDI Recertification?

You can apply for recertification by filling in the online form.

Before filling in the online form, please have all the relevant information to hand before starting it, you will not be able to save it and then revisit it later, it must be completed in one sitting. You will also need a stable internet connection while completing the online forms:

Form for Recertifying Letter of Competence in Subdermal Implant Techniques (LoC SDI):

Please make sure to apply for recertification not more than six months before your recertification date and no later than six weeks afterwards.

To apply successfully for recertification, you need to demonstrate:

  • at least two credits of relevant CPD over the past five years 
  • completion of the relevant e-SRH module (for NHS professionals) or Faculty-approved distance learning (for non-NHS professionals) 
  • proof of basic life support and anaphylaxis training 
  • a log of IUT insertions 
  • a log of SDI insertions and/or removals

You can find more information on each of these requirements below. You can also find a calendar of CPD courses, meetings and events on this website.

Read some FAQs about Letters of Competence Recertification.

What are the CPD Requirements for my Letter of Competence recertification?

To recertify for either LoC IUT or LoC SDI, you need to collect at least two credits of CPD activity over the past five years. This activity must be relevant to IUT / SDI, and may be gained in the following ways.


  • Attendance at courses/meetings relevant to SDI
    Evidence: certificate of attendance, programme of meeting and brief reflection on how this will influence your future practice.
  • Reading of appropriate current peer reviewed publications e.g. JFPRHC, BMJ
    Evidence: reference of article, and brief reflection on how this will influence your future practice: 1 CPD credit per article
    Reading of FSRH CEU guidelines on subdermal contraceptive implant methods and completion of self-assessment questions Reading: 1 CPD credit and completion of self-assessment questions: 1 CPD credit. This may not be counted towards CPD if used to fulfil section 3.
    Evidence of reading: date read and brief reflection on how this will influence your future practice. Evidence of questions: mark sheet, date completed and brief reflection on how this will influence your future practice.

  • Peer observation: For LoC IR you can claim 1 CPD credit for observing a peer perform an insertion or removal and giving feedback afterwards, 1 CPD credit for being observed performing an insertion or removal by a peer and discussing feedback afterwards.

  • For LoC IO you can claim 1 CPD credit for observing a peer perform an insertion and giving feedback afterwards, 1 CPD credit for being observed performing an insertion by a peer and discussing feedback afterwards.

  • For LoC RO you can claim 1 CPD credit for observing a peer perform a removal and giving feedback afterwards, 1 CPD credit for being observed performing a removal by a peer and discussing feedback afterwards.The observer/person being observed must hold a current LoC SDI. Evidence: date and name of observer/person being observed and brief outline of what you learned from this, either as an observer or from being observed)
  • Audit of SDI – personal or local

Evidence: date, summary of audit, brief description of your role in audit: 1 CPD credit

What evidence of CPD do I need to submit?

You do not always need evidence of CPD activity when you are applying for recertification. However, the General Training Committee audits 10% of all applications and reserves the right to ask for supporting documentation for all your activity. 


What other requirements and resources are there for my ongoing CPD?

If you are an NHS professional, you must also complete e-SRH module 18 (for LoC IUT) or e-SRH module 17 (for LoC SDI) during the two years before your recertification date.

To access the e-SRH learning modules, please register with e-Learning for Healthcare (e-LfH).

If you are not an NHS professional, you may instead complete Faculty-approved distance learning e.g. the latest CEU IUT / CEU SDI guidance and self-assessment questions.

You should also be up-to-date with basic life support and anaphylaxis training in accordance with your employer’s policy.

Finally, please submit a log covering a consecutive 12 month period that started no more than 24 months before your recertification date. 

  • For LoC IUT, this log should show 12 insertions, showing at least two different types of IUT method in conscious women. 
  • For LoC SDI Insertion and Removal (LoC SDI-IR), the log should show 6 procedures including at least one insertion and one removal.
  • For LoC SDI Insertion only (LoC SDI-IO), for individuals who work in an abortion or maternity services, the log will need to show a minimum of 6 insertions.
  • For LoC SDI Removal only (LoC SDI-RO), for individuals who work in deep implant services, the log will need to show a minimum of 6 removals.

Women's Health Library

Bringing together national guidance, resources produced and accredited by the RCGP, and resources from the Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Sexual and Reproductive Healthcare (FSRH), the Women's Health Library is a resource relevant to GPs and other primary healthcare professionals.

The Library is divided into four sections for ease of use with the free resources clearly marked:

  • Maternal Health
  • Sexual and Reproductive Health
  • Pre-Menopause
  • Peri/Post Menopause

Access the library here

I'm late for my recertification, what should I do?

If you apply for recertification more than six weeks after your recertification date, you must: 

1. gain the necessary CPD credits and the Basic Life Support and anaphylaxis training outlined above
2. complete the relevant e-SRH module no more than 12 months before your recertification application date  (as opposed to within 24 months of recertification date) 
3. provide a log (described above) covering a consecutive 12 month period within 24 months of your recertification application date (as opposed to recertification date)
4. stop training or supervising anybody working towards an LoC.

If you are absent for more than a year and wish to apply for an extension on your recertification date,  please fill in our extension request form and we will get back to you shortly

I'm a lapsed FSRH member and I want to recertify my qualification, what should I do?

FSRH Council believes that membership of the FSRH – and therefore access to the latest clinical guidance, standards, Journal, CPD questions and regular updates – is an important part of the membership and recertification process. The rules surrounding back payment of subscriptions were tightened up in 2015 by FSRH Council. 

Recertification is free to current FSRH members.  Recertification is one of our member benefits and supports you professionally in a number of ways.

It helps you to:

  • demonstrate the learning outcomes achieved from your qualification(s) have been maintained
  • show you have the knowledge, skills, attitudes and behaviour needed to provide safe and effective sexual and reproductive health care (SRH)
  • meet the requirements of commissioners, who often require clinicians to have certified qualifications

If your membership has lapsed and you would like to re-join FSRH past the 31 March cut-off date for the current membership year or after one or more years, you will be required to pay back your 'missing' years to ensure you have continuous membership which is required for recertifying your primary qualification.

You can easily do this by contacting us by phone on 020 7724 5534 or by email to info@fsrh.org. We can take payment by phone using a debit or credit card, it will take a few minutes to do this for you.

You can also pay for a one-off recertification for Letters of Competence qualification. This is £368 per LoC. This option is not available for Diploma recertification. You can pay your Diploma membership back fees by telephone on the above number.

Read more about the recertfication requirements of our qualifications here

How much will I be paying if I'm a Member re-joining FSRH after a break of two or more years?

Membership Category

& Annual Fee amount (2020)

Amount Payable


Diplomate £108

2 years (2019 and 2020) - £216 

3 years (2018, 2019 and 2020) - £324 

4 years (2016, 2017, 2018 and 2019) - £432

5 years (2016, 2017, 2018, 2019 and 2020)- £540 

Associate £92

2 years (2019 and 2020) - £184

3 years (2018, 2019 and 2020) - £276

4 years (2017, 2018, 2019 and 2020) - £368

5 years (2016, 2017, 2018, 2019 and 2020)- £460

Member/Fellow £228

2 years (2019 and 2020) - £456

3 years (2018, 2019 and 2020) - £663

4 years (2017, 2018, 2019 and 2020) - £912

5 years (2016, 2017, 2018, 2019 and 2020) - £1140

If you think you might qualify for a reduced subscription on your back fees, please contact the FSRH office on 020 7724 5534 or by email at info@fsrh.org to find out how to claim. Or, you can fill in our form here to claim your reduced subscription on previous year's fees.


Contact Us 

If you need any more help with recertifcation, please contact us by calling us on either: +44(0)20 7724 5620 or +44(0)20 77245647 or by emailing kwells@fsrh.org or iahmad@fsrh.org.

How to Apply

To start your application process for the Letter of Competence in Subdermal Implants Removal Only, please click on the register button (if you do not already have a 'My FSRH' website account). Registration on this website is free, you will not be required to make any payment until you are ready to apply for your qualification.

If you already have a log in for 'My FSRH', please click on login and then navigate to 'Take a qualification/recertify' behind log in. 

FSRH Register here  Log in to 'My FSRH'

Not sure how to register on our website? Watch our video for some help.

(You'll need sound or earphones on your device) 


Associated Fees and Costs for the Letter of Competence Subdermal Implants Removal Only (LoC SDI-RO)

*Join us as a member to benefit from a reduced application fee

You can apply to become an Associate member when completing your LoC training application online as part of the final step. This will allow you to qualify for the reduced member rate of £63 for each LoC application fee as well as giving you full access to all our membership benefits. 

The cost of full Associate membership annually is £92 (for initial LoC applications between 1 Jan – 30 June) or a reduced half-year subscription in your first year of membership of £46 (for LoC applications made between 1 July – 31 December).

The subsequent full annual Associate membership fee is due on 1 January 2020 and then the following years of your membership.

As an Associate member your recertification of your qualification is free of charge every 5 years, if you have retained and paid for your annual Associate membership each year. Recertification enables you to demonstrate you have retained the skills and knowledge required for your qualification. This evidence can be used in appraisals and for revalidation.

Electronic Knowledge Assessment (eKA)

£75 (per attempt) - Payable to FSRH

Clinical Training (Costs are set locally)

Between £300-£400 depending on location and provider

Current FSRH Members (Associate, Members, Fellows and current holds of the FSRH Diploma)


Non-FSRH members

£63 - Payable to FSRH


£368 - Payable to FSRH

Total (approximate)

FSRH Members


Non-FSRH Members


£488 (approximate - depending on clinical training costs)


£850 approximately

Is your trust paying by invoice?

If your trust is making payment by invoice, we will need the following information in order to raise a purchase order: invoice address (accounts payable), a purchase order number (only if your trust requires one), and a finance/accounts payable email address. Please note, your trust can opt to pay for several individuals in a bulk payment if required. 

Please share this information with our Finance Manager, at finance@fsrh.org to raise the invoice or you can fill in our form online with all the information to raise the invoice.

Start your qualification now, by clicking on 'How to Apply' which will enable you to register for a free account on the FSRH website, no fees are payable until you are ready to start your application process.

Contact Us

Contact Us

If you have questions regarding applying for the Letters of Competence including e-KA queries, please contact the Education Development Officer, Iftikhar by phone on: +44(0)20 7724 5647 or by email to iahmad@fsrh.org.



Check our FAQs here to find out some common questions and answers about our  Letters of Competence qualifications.