Letter of Competence Subdermal Contraceptive Implants Techniques Insertion and Removal (LoC SDI-IR)

This training programme is aimed at Doctors, Nurses, Midwives and Physician Associates already working in general practice and community sexual health services who want to develop the necessary knowledge, attitude and skills to support women seeking contraception. It will enable them to provide and remove subdermal implants competently, and manage any complications or side-effects that may occur.


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


FSRH also offers these two options for this qualification:

What/How do I study?

You can ensure you fulfill all the entry requirements for the Letter of Competence in Subdermal Contraceptive Implant Techniques (LoC SDI-IR) to allow a successful application. Successful applicants must meet the following entry requirements: 

The entry requirements for the Letter of Competence in Subdermal Contraceptive Implant Techniques

Successful applicants must:

  • Be registered with a UK or Irish medical professional regulatory body and have a license to practice if that is required by your regulator.

We recognise the following regulatory bodies: 

  • The General Medical Council (UK)
  • Irish Medical Council
  • The Nursing & Midwifery Council (UK)
  • Nursing & Midwifery Board of Ireland
  • General Pharmaceutical Council (UK)
  • The Pharmaceutical Society of Ireland
  • Physician Associate Managed Voluntary Register (UK)
  • Health and Care Professions Council (UK)



Read more information about entry requirements and the next steps towards achieving your qualification:

1. Complete Module 17 of the e-SRH

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).

Click view button at top right hand corner of e-Learning for Healthcare website to see a list of all modules and you will need to login first in order to be able to see contents of the modules.

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


2. Purchase and take the OTA (Online Theory Assessment)

You are now able to purchase our Online Theory Assessment (OTA) which has replaced the previous eKA (the electronic knowledge assessment).

A pass in the eKA or OTA is required as a pre-requisite to our FSRH Letters of Competence including our LoC SDI-IR and LoC IUT.   

How to purchase and take the OTA

To do this, register (if you don’t have an FSRH website account) and then log into ‘My FSRH’ and scroll down to the ‘FSRH Training Hub’ section and click ‘Browse Courses’. This will take you through the Training Hub.

Select ‘Online Theory Assessment OTA (for LoCs only)’.


Do I need to take the OTA?

  • If you do not hold a current FSRH Diploma, MFSRH or FFSRH, you must pass the OTA (or have recently passed the eKA or OTA). Find out more about the OTA. 
  • If you hold a current FSRH Diploma, MFSRH or FFSRH, there is no need to take the OTA.
  • If you have previously passed the eKA as part of another qualification which has been awarded within five years of starting the new qualification, you will not be required to take the OTA.
  • If you have previously passed the eKA (without achieving another FSRH qualification) within two years of starting the new qualification, you will not be required to take the OTA. If you have any question regarding this, please read through our FAQs or Contact us for help.  

3. Find a Training Programme to Undertake Practical Training

Your practical training must be completed through a Faculty-recognised General Training Programme. You can find a list of these on our Find a Training Programme map. You can select your chosen qualification/s and search by postcode, or town / city name, up to a radius of 250 miles. 

Once you have identified your nearest programme, get in touch with the contact listed on the map to find out more.

 Our video shows you how to use the Find a Training Programme Map. 

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 scroll down to the ‘FSRH Training Hub’ tile and click ‘Browse Courses’.

Select ‘Letter of Competence in Subdermal Implant Insertion & Removal (LoC SDI-IR Application)’ and click ‘Go to Course’.

On this page, you’ll be able to

  • Download a LoC SDI-IR Training Record Form
  • Complete the online evaluation of your training experience. Your feedback will be shared with the FSRH’s General Training Committee to help us improve our programmes.
  • Click orange button ‘Submit your training record and pay fee here’ to submit your documents and pay the fee.


Once you have submitted the required documentation and paid the fee, a member of our team will review your application. We will contact you by email within 10 working days from this submission.


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.



If you hold Letters of Competence in Subdermal Contraceptive Implant Techniques (LoC SDI), 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.

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

If it is 10 years or more since your qualification was awarded or last recertified, you will need to retake the full training programme for your qualification. For Letters of Competence, this may be via the experienced practitioner route, if appropriate.

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 £400 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 (2021)

Amount Payable


Diplomate £111

2 years (2020 and 2021) - £222 

3 years (2019, 2020 and 2021) - £333

4 years (2018, 2019, 2020 and 2021) - £444 

5 years (2017, 2018, 2019, 2020 and 2021)- £555

Associate £94

2 years (2020 and 2021) - £188

3 years (2019, 2020 and 2021) - £282

4 years (2018, 2019, 2020 and 2021) - £376

5 years (2017, 2018, 2019, 2020 and 2021)- £470

Member/Fellow £235

2 years (2020 and 2021) - £470

3 years (2019, 2020 and 2021) - £705

4 years (2018, 2019, 2020 and 2021) - £940

5 years (2017, 2018, 2019, 2020 and 2021) - £1175

If you think you might qualify for a reduced subscription on your back fees, please Contact us to find out how to claim. 


Contact Us 

If you need any more help with recertification, please read through our FAQs on the Contact us page.

How to Apply

To start your application process for the Letter of Competence in Subdermal Implants Insertion and Removal, 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. 

Register here 

Log in here


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

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



Option 1: Associate Membership

Member rate per LoC application: £174 (Associate annual membership £94 + LoC registration £80) - for LoC applications between 1 Jan – 30 Jun
Member rate per LoC application: £127 (Associate annual membership £47 + LoC registration £80) - for LoC applications between 1 Jun – 31 Dec

Option 2: Non-member rate

The non-member rate per LoC application is £400, this fee will cover you for next 5 years.


Associated Fees and Costs for the Letter of Competence

*Join us as a member to benefit from a reduced LoC application fee and free of charge recertification every 5 years

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 £80 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 £94 (for initial LoC applications between 1 Jan – 30 June) or a reduced half-year subscription in your first year of membership of £47 (for LoC applications made between 1 July – 31 December).

The subsequent full annual Associate membership fee is due on 1 January 2022 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.

Online Theory Assessment (OTA)

£75 (per attempt)-Payable to FSRH

Clinical Training (Costs are set locally)

Between £300-£400 depending on location and provider

Letter of Competence Registration fee - Current FSRH Members (Associate, Members, Fellows and current holds of the FSRH Diploma)


Non-FSRH members

£80-Payable to FSRH


£400-Payable to FSRH

Total (approximate)

FSRH Members


Non-FSRH Members


£507 (approximate - depending on clinical training costs)


£882 approximately


Is your trust/employer paying by invoice?

If your trust/employer 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. 

Contact Us

Contact Us

If you have questions regarding applying for the Letters of Competence, please read through our FAQs available on the Contact us page. 



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

Experienced Practitioners Pathway

You may apply for this Letter of Competence via the Experienced Practitioner Route: 

  • If your initial Letter of Competence (LoC) qualification was not registered with or awarded by FSRH
  • If you attained a local LoC certification and now wish to register or recertify it with FSRH
  • If you have not recertified FSRH LoC for more than 10 years, but have been fitting/removing implants for last 12 months

For all above scenarios, you may be eligible to undertake a shortened pathway which takes into account past clinical experience. The FSRH’s General Training Committee requires that, in order to obtain FSRH certification, this training would need to be completed. 

The General Training Committee is unable to offer exemptions to its published criteria. However, experienced practitioners can complete a shortened pathway in respect to the clinical component but all other parts of the programme, included the OTA pass, would need to be completed.

The training involves both theoretical knowledge and practical training.

Theoretical knowledge includes e-SRH theory learning and scenario-based discussions with your trainer.

The experienced practitioner must demonstrate competence in insertion and removal on a model arm before competence is assessed in live patients.

The candidate must provide details and dates of previous relevant training or experience. A log of previous procedures must also be provided. For LoC SDI this log must show six self-certified procedures within the last 12 months to include one insertion and one removal.

The primary trainer must observe at least one insertion and one removal performed competently in a conscious patient. 
We recommend that all theory learning be undertaken before live training with women. 


Please follow the steps on What/How do I study? tab and complete relevant sections of LoC SDI Record of Training form if you are applying via experienced practitioner pathway.


Associate Membership

Completion of our Letter of Competence qualification can result in Associate Membership of FSRH and includes the following Membership benefits. Your membership subscription is payable annually and your membership runs from 1 January to 31 December each year.

  • 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
  • Free five-yearly recertification of your qualification