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GPs will need certification to carry out spirometry by 2021

GPs will have to be certified and placed on a national register to be allowed to perform spirometry under a new scheme set to be implemented by NHS England over the next five years, GP respiratory leads have announced.

The certification scheme – set up with the help of the UK Primary Care Respiratory Society (PCRS-UK) and other expert groups – will mean GPs and practice nurses will have to demonstrate they can perform and interpret spirometry to standards set by the Association for Respiratory Technology and Physiology (ATRP) in order to continue carrying out the lung function tests.

Pulse revealed the scheme was in the pipeline three years ago, following concerns spirometry was ‘sub standard’ in some GP surgeries and leading to as many as two in five people potentially being misdiagnosed with COPD.

The idea raised hackles among some GP experts at the time, who warned certification was over the top and that the limited resources in primary care could even force GPs to stop doing the diagnostic tests.

But GP respiratory experts supporting the ATRP certification scheme told Pulse they believe these concerns have been addressed by planning a phased introduction that means it won’t come into full effect until 2021.

NHS England’s document outlining the scheme explains that GPs already experienced in spirometry can choose to undergo extra training if they need to, before undergoing an assessment by an 'ARTP approved assessor’.

Once certified, GPs will also need to show they are keeping up their competency every three years, with an observed assessment and submission of a ‘comprehensive portfolio’.

The portfolio will ‘include evidence of continued calibration, quality assurance and infection control procedures, evidence of quality spirometric measurements and where interpretation is required, an analysis of five spirometry traces provided by the ARTP to review for technical quality and interpretation’, the document states.

But it adds that ‘to allow sufficient time for the necessary training, assessment and certification infrastructure to be set up, it is proposed to phase the implementation of the recommendations over the four years 1 April – 31 March 2021’.

Dr Stephen Gaduzo, a GP in Stockport and former chair of PCRS-UK, who helped develop the programme said: ‘In many ways, this is formalising and standardising best practice. Healthcare staff are undertaking spirometry currently after taking a range of different training routes, and some may have had little or no formal training.

‘PCRS-UK welcomes this scheme as it will promote the performance and interpretation of spirometry to a consistent high standard by requiring staff to demonstrate their competence in order to join the national register.’

Dr Duncan Keeley, a GP in Oxfordshire who is on the PCRS-UK executive, told Pulse: ‘There are understandable concerns in the general practice community that there is a problem if every procedure done in primary care requires specific and repeated training and certification.

‘But I think there is a need for improvement in standards in spirometry [and] the document has got a long period over which it needs to be implemented, which I think that is very sensible given the current and ongoing financial constraints and the need for better training’

GPs are already required to make sure they perform spirometry to confirm COPD diagnoses under QOF, and are also coming under pressure to use the lung function tests more routinely in diagnosis of asthma.

Readers' comments (59)

  • In that case, it would be less hassle for the practice to refer to the respiratory team for spirometry rather than trying to do it in house.

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  • As we dont get paid for this extra hassle I would agree with the above refer to secondary care.I bet the certification will not be free!

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  • Spirometry is not core. Refer to respiratory. I dont need to be certified because i wont be doing them. Stop doing work for free!

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  • They're deluding themselves. There won't be any GP's in 2021 to certify .

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  • Don;t worry about this new outbreak of diplomatosis, there probably won't even BE an NHS by then, so it won't matter at all.

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  • Primary care is nearly on its knees and here we go with another top down box ticking exercise. Is this really the best way to tackle the problem-more "robust action plans" , "key stakeholders" , "quality driven processes" etc etc. As GP Reg @ 10 29 says why bother? NHSE just don't get it.

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  • BY 2012 THERE WILL BE NO GPs LEFT TO "CERTIFY".

    IN TRUTH, WE SHOULD BE "CERTIFIED" FOR CONTINUING TO WORK AS GPs.....

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  • Another daft idea. This is the problem with zealots. Funding won't be made available for all of this extra (and mostly pointless) micromanagement, GPs will stop offering spirometry and refer in, and costs will multiply tenfold (as they will all then need first outpatient appointments with consultants etc).
    Doesn't the NHS have more pressing things to deal with at this time? Can everyone messing about with (and spending money on) pet projects please just stop, and concentrate on trying to stop the NHS collapsing instead?

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  • Refer everyone. Problem sorted

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  • Excellent. I shall stop doing it then. Will free up lots of nurse appts for us. The CCG can set up a community clinic we can refer to to have it done and pt can come back with report telling me what it means as clearly I am too stupid to figure that out. Failing that the respiratory dept had better start recruiting as I'll be referring there.
    Sriously - what next ? ECG's / BP readings....

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  • What a load of nonsense.Clearly if people don't know how to interpret the results then there are questions to be raised but yet again a self-interest group of our "GP colleagues" make a suggestion that impinges on us all.Locally we have a LCS for spirometry- I query why others are doing this unfunded work??!!
    I like other posts say will stop doing this and refer to Respiratory department at acute trust and suggest PCRS members reflect on thatand their impact on the cost to NHS of such actions.

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  • We are just about to sign up to a LCS involving spirometry which is still underfunded, but a start. If they increase governance requirements around it i can guess what the partners will say in the future. One reason we are signing up is the CCG has no plan B. If we stop doing the work the only ones to suffer will be patients.

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  • GPs are not required to perform spirometry, they need to ensure spirometry is performed. This will lead to a wholesale referral to out-patients

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  • PM @ 1134- why on earth sign up to something that is underfunded? you can't claim gift aid on this sort of charity work.

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  • I find it a waste of time anyway. Sending COPD for patients for annual spiro is a waste of resources. You can tell looking at them if they are worse or not. Serial peak flows are pretty good for new asthma. It should be removed from QOF. Why not do the same for minor ops/joint injections/ECGs/syringing/pessaries/vaccines/travel advice/diabetic foot checks ........

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  • Or what exactly?

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  • At least it means that the service will have to be commissioned.

    We will organise for someone to be trained if the enhanced service is significant enough.
    If not we will organise for it to be done elsewhere.

    Either way we will stop doing it for free.

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  • Once they start paying, then they can insist on certification, otherwise they can copulate whilst on their travels

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  • I agree with all the above - the people pushing this really inhabit a different world it appears. Our HCA generally does most of our spirometry or practice nurse both of whom are holders of certificates to do so. I'm sure most GP 's never do and I cannot envisage ever doing an 'emergency' spirometry....ever. I wish these so-called experts would go back into their ivory towers and never come out again as they just create needless work and devalue primary care.

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  • And how much will GP's have to pay the ARTP for accreditation? If provided by NHSE to raise standards I'm all in favour but if it is another cost to practices then I can see a rise in referrals.

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  • Not enough red tape yet. NHSE will next want you to be on 'National register' - (where did that come from?)- for doing rectal examinations and even auscultations.
    National register hmmm.... sounds more ominous than a 'GPs to the flames' register - another Werwolf plan?

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  • Refer to respiratory team for enhanced breathing tests. Job done. Good thing I don't wear a cardigan.
    Item of service payment is a different conversation.
    We could bring ccg crashing down with more debt and hospitals even more unable to deliver opd assessment. I am trying to make my job sustainable. Joining transform.

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  • Am I wrong, but is not the recording and interpretation of spirometer included in the MRCGP curriculum and as such I have been trained and assessed already? Just a thought. Maybe I should go on a course on blood pressure recording or ECG interpretation next.

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  • Made me laugh that "...concerns have been addressed by planning a phased introduction that means it won’t come into full effect until 2021." So, concerns are addressed merely by putting it into the future?

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  • Sanjeev Juneja | GP Partner23 Sep 2016 12:45pm
    I think this already exists. The national register for being rectally examined by NHSE is called the GMC register. Now kindly bend over.

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  • Really don't know why I bothered doing a degree in medicine. It is pretty much worthless, or will be soon. Sad that it's other GPs contributing to these decisions.

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  • and let me guess who will have to pay for the course and certification etc etc......

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  • Absolutely awful. I do not have much to add except that I agree to all of the above comments, especially Sanjeev Juneja's comment about P.R. examinations. I presume GPs will be attending Medical School next, and having to pay for it. So why don't GPs do something about this nonsense,? Because of blackmail. The micromanagers mantra, is do this or else you do not get paid. Maybe they need a P.R. exam using several fingers.

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  • Yup, fine, as above. Not GP work, no interest in doing so refer all.

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  • How about using a stethoscope? we need training in that too.

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  • This is long overdue and I am writing to the Minister to urge that all GPs should also have special training in taking a pulse and signing a Med 3. I have devised a training course lasting 3 full days each with mandatory reassessment every 3 months.
    The assessors will be paid £ 3oo per hour and the GP will pay only £200 for each certificate. Failure to mail a copy to every patient on the list will incur a fine.
    We must keep up our standards especially as there are so few of us still working.
    I will volunteer as an assessor full time and thus another GP will be lost to actually seeing patients as opposed to carrying out all these bloody silly checks!

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  • Sessional/Locum GP23 Sep 2016 4:22pm

    you failed to add that it should be part of appraisal/re-validation and requirement of good medical practice and enforced by GMC/RCGP. you also need a few politicians on your company board and then you will be good to go.

    suggested additional certification for;

    breathing - how can we assess if patient's are breathing if we haven't been assessed ourselves?

    urinating - again often overlooked is the fact that we take a history re: urinary symptoms but have we ever been trained or properly assessed and certified on this?

    i wish i was joking but i'm sure eventually some 'special' adviser i.e. a prof or lord or lady will come up with this at some point. i despair.

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  • All doctors should be assessed for relevant competences before being allowed to practise at a level expected of them.

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  • Ha ha - almost got me - its 23rd September day - the day they play the silly healthcare joke.

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  • I read the article then checked the date and laughed so hard- then I realised it isn't the 1st April. What is general practice coming to?

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  • Fookinell !

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  • Vinci Ho

    You see
    Typically , the argument is politically correct .Like what I said in the other article about NICE having a go on GPs not diagnosing enough melanoma by 2 weeks rule , one must look at the reality situation before 'driving up the standard '. You don't even have enough GPs and practice nurses to do bread and butter stuff everyday.Yes , the knowledge on how to perform and more importantly ,interpret Spirometry is variable amongst us,GPs. But really we did not ask for it in the first place . The ultimate consequence is everybody just refers to secondary care for spirometry unless you have a GP with extended interest allocated to each locality of a group of practices . Obviously , we will then be penalised for referring too many !
    Depending on how complex the training requirements are to obtain this certificate, this ,kind of ,paves the road of PACS and MCP . Only the super or mega- practice can have certified GPs or specialists for Spirometry.
    As I said , the difference between being down to earth and up there above the ground.......

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  • Presumably our hospital Respiratory colleagues will also have to leap through the same pointless hoops?
    Perhaps our Consultant cardiology colleagues should be asked to undertake regular training in the interpretation of ECGs?
    Madness. Where has the trust in professionals gone?

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  • What is the point in studying for decades and racking thousands in debt when nobody trusts you to perform at the end of it?

    No time for this certification, accreditation, revalidation and other suck bollocks. Just refer.

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  • What about ECG's or using a patellar hammer or a stetoscope or an opthalmoscope or taking a history
    Let's have certificates for all these
    You can damage patients just as much with wrongly using or doing any of these
    God give me strength

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  • Of course the people who implimented this know the situation. They will only be doing it to fast forwards the demise of the NHS according to Hunt's wishes.

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  • 1:37 PM: Misconception! NHSE does not have GMC in it's pocket. A PM from a neighboring Practice tried that trick 3 years ago by supporting a complaint against me to the GMC but she had to bend over as GMC dropped the complaint but she lost her job:)
    Bending over is not what GPs are good at. We are told to be resilient but believe me we are as resilient as resilience can get.

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  • Shouldn't the headline read " GPs will stop doing Spirometry and referring ALL respiratory problems to secondary for ALL treatment and management in 2021"?

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  • I personally think this is a great idea. I was actually just contemplating ways in which arbitrary and meaningless bureaucracy could be increased in general practice. Then as if by magic, I discovered that someone had beaten me to it. And this idea is almost as good as my idea that all general practitioners should have a weekly swallow assessment to check that they are safe to eat their lunch without choking.

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  • Sweet as ... going to need a larger office for all my certificates. Looking forward to the training and certification (with portfolio and continuing reflection) on "opening the consulting room door". Or maybe just refer before then?

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  • Just another dodgy way of trying to make money of skint GP Practices and it is astounding to think, its our GP colleagues area a party to this. Look in the mirror and hang your heads in shame.

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  • The practice nurse does it. She's trained,with a certificate. Interpretation is taken care of by the attached computer which checks with previous tests, or with stored general states. Job done. Now, about NHSE coming out of the stone-age and into the General Medical World...

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  • For various logistical reasons I do personally do COPD checks and spirometry in some patients. This week I was teaching a colleague how to do it. I did two adequate blows myself and had a headache and felt faint. She did the same with the same result. Can you blame me for being half hearted and only getting one brief puff at times rather than inflicting this unpleasant test properly on well ex-smokers who have been clinically stable for a decade. The test is only for box-ticking, not clinical management, in well over 40% of patients and that is one reason we don't bother to do it well, even although we could.

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  • certification is sensible as we need to have some evidence of quality standards being reached. we need to do this for patient's sake as they need to be confident that their GP can tick the boxes set by the state. hopefully more areas will be covered as kindly suggested by colleagues such as ECG, taking pulse, taking urine samples etc. soon we will have lots of lovely boxes to tick to demonstrate that we are conforming to the states' requirement. Soon we will be controlled to such a degree that it will make North Korea look lax. hopefully, all these tick boxes will cheer up our CQC head as I feel sorry for him crying all the time over the state of General Practice.

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  • Dear All,

    Certification for spirometry, you could train a monkey to do it in a day.
    We've been doing it for 10+ years with desktop computerised analytic spirometers. In barn door cases it helps confirm what you know and can see, in the borderline cases its about as useful as these experts, it might be it might not, what we resort to is individualised patient centred outcome based chronic disease management, i.e. try this and report back.
    What utter rubbish.
    Regards
    Paul Cundy

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