The challenge: a new cost for essential training

After the merger and recommissioning of sexual health services across Nottinghamshire, members at Nottingham University Hospitals NHS Trust (NUH) were told they’d need to pay for the College of Sexual & Reproductive Healthcare’s (CoSRH) Letter of Competence (LoC)—a qualification required for procedures like fitting coils and implants.

The costs weren’t insignificant:

• CoSRH membership: £134 per year
• LoC: £111 (with membership) / £475 (without)

Initially, they were told this was a condition of employment. But instead of quietly accepting it, they began asking questions.

Members take the lead

Working with myself and RCN Officer Kully Hans, members quickly mobilised. Together, we began researching the LoC, its status as a qualification, and how other Trusts handled the cost, and what we found was revealing:

• The LoC is not a professional requirement to carry out clinical duties.
• According to CoSRH’s own guidance, the LOC is a certificate of standards, not a mandatory qualification.
• NUH had previously funded the training—this shift was new and unexplained.

There were also noticed inconsistencies across the region. While some Trusts had always passed the cost onto staff, others, including NUH, had covered it until recently.

Demanding answers

Armed with this evidence, members drafted a collective letter to management. They asked:

1. Who made the decision to shift the cost onto staff?
2. Is the LoC a contractual requirement?
3. Why was there no follow-up after management promised to escalate the issue?

Their persistence paid off.

The breakthrough

Two weeks later, NUH responded. They confirmed that the LoC was a requirement under the new service contract with the local authority. But more importantly, they committed to:

"...fund the cost of the initial training and yearly CoSRH membership."

A victory for collective action

This outcome wasn’t handed down—it was won through the determination and unity of RCN members. By gathering evidence, challenging inconsistencies, and standing together, they saved hundreds of pounds in training costs and reinforced a vital principle: employers must fund essential clinical training.

Take action: your voice matters

This win shows what’s possible when members come together. If you’re facing similar issues in your workplace—whether it’s training costs, unclear policies, or unfair practices—don’t stay silent. Start asking questions, gather evidence, and connect with your fellow members.

Speak up. Organise. Act.

Carmel Bagness, RCN Professional Lead for Midwifery and Women's Health, says: "This is all part of activist membership of the RCN, where members and staff collaborate and work together for a positive result. Your voice is powerful - together we are stronger and we can make change happen."