The DFSRH (Diploma of the Faculty of Sexual and Reproductive Healthcare) is the standard UK qualification for clinicians who want to provide contraception and sexual and reproductive healthcare in general practice or community settings. It is not a single exam but a four-part programme: an Independent Learning Portfolio, an Online Theory Assessment (OTA), five workplace-based clinical assessments, and a final Assessment Half Day. This guide covers each component, the 2026 fees, the syllabus the OTA actually tests, and how to prepare without wasting the two years you are given.
What it is and who sits it
The DFSRH is awarded by the FSRH and demonstrates competence to deliver contraception and non-specialist sexual and reproductive healthcare in primary or community care. It is taken by GPs, GP trainees, nurses and SAS doctors who provide, or plan to provide, contraceptive services. There is no single sit-down exam day that defines it — it is a portfolio of learning and assessment completed alongside clinical work, which is part of why people underestimate how long it takes to finish.
How the diploma is structured (the 2020 framework)
There are four components, and all must be completed within two years of formal acceptance onto the programme:
- Independent Learning Portfolio (ILP) — self-guided learning that runs across the programme. It is not a tick-box exercise: it asks for documented topic investigations, written case discussions, structured reflection and collated patient feedback, completed alongside your clinical work.
- Online Theory Assessment (OTA) — the knowledge gate. Fifty multiple-choice questions in one hour, taken online. One attempt is included in the diploma fee; resits cost £85 each. The OTA replaced the older eKA, and a previous eKA pass awarded within five years may exempt you.
- Five Summative Clinical Assessments (SCAs) — observed consultations in real clinical settings, each signed off by a registered FSRH trainer: taking a contraceptive history, counselling on method choice, managing or fitting a method, and handling a clinical scenario. The practical bottleneck is usually access to a trainer and to enough relevant patient contacts.
- Assessment Half Day (AHD) — the final summative assessment: a one-hour written paper (MCQs, diagram labelling and short answers) plus four VIVA/OSCE-style stations where examiners probe your reasoning and counselling rather than your recall. The fee is around £260, and it can be face-to-face or virtual depending on the provider.
What the OTA actually tests
The OTA goes deeper than people expect, and UKMEC is its spine. You need to distinguish UKMEC Category 3 — where risks usually outweigh benefits and a method is generally not recommended unless alternatives are unavailable — from Category 4, an unacceptable health risk where the method should not be used, because the exam tests exactly the borderline cases: migraine with aura and combined hormonal contraception, blood-pressure thresholds, the postpartum VTE window, current breast cancer and significant liver disease. The 2025 UKMEC is the current reference. Emergency contraception is similar: timing windows by method, the enzyme-inducer interaction that undermines ulipristal, the BMI and weight limits on levonorgestrel, and copper IUD eligibility all recur. Around these sit STI management — where BASHH is the primary source for most infections rather than NICE — early pregnancy, cervical screening, and prescribing for specific populations such as adolescents (Fraser and Gillick competence), postpartum and breastfeeding women, and older women with cumulative cardiovascular risk. FSRH guidance is primary, with NICE, UKHSA and BASHH alongside it.
2026 dates and fees
The OTA can be taken at any point in your DFSRH window once your application is approved; one attempt is included and resits are £85. The AHD costs around £260 and is booked through your provider. Because scheduling is provider-specific, confirm OTA access and AHD dates directly with your FSRH-approved provider. Last reviewed June 2026.
Pass rates
The FSRH does not routinely publish a headline DFSRH pass rate, and the OTA is a standard-set knowledge threshold rather than a ranked exam. In practice, candidates who struggle tend to do so on UKMEC depth and STI algorithms rather than on breadth of coverage.
How to prepare efficiently
Start with the FSRH e-SRH e-learning modules, which are free for UK healthcare professionals and give you the theoretical foundation. Then drill UKMEC until you can place any method–condition pair in the correct category and justify it, because that is where the OTA bites hardest. Practise applied questions under time pressure rather than re-reading notes, giving particular attention to STI management and emergency contraception eligibility. Finally, line up the clinical components early: the SCAs and AHD need a registered trainer and real patient contact, and the two-year window closes faster than most candidates plan for. A practical sequence is to clear the OTA early, since it is the most controllable component, while you build the ILP and arrange your SCAs, and to leave the AHD until your clinical confidence is solid.
Where iatroX fits
iatroX offers one of the largest DFSRH banks available, with more than 860 questions, and it is on iatroX's subscription (£29/month or £99/year). It is built around five things: a Socratic tutor that works back through the reasoning behind a wrong answer instead of handing you the solution; questions mapped meticulously to the DFSRH learning outcomes; spaced repetition that returns missed material at widening intervals; adaptive sequencing that surfaces related weak areas, such as UKMEC Category 3 versus 4 distinctions; and a mobile app for iOS and Android, useful between clinics and on placement. For a standalone alternative, PasSRH offers more than 800 dedicated questions.
A few common questions
Is the DFSRH one exam? No — it has four components: the ILP, the OTA, five SCAs and the AHD.
Is the OTA hard? It is a 50-question, one-hour knowledge test; the difficulty lies in UKMEC depth and STI algorithms, not in volume.
How long do I have? Two years from acceptance to complete all four components.
Is iatroX's DFSRH bank free? Not in full — the bank is on iatroX's subscription (£29/month or £99/year), with free sample questions to try first.