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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)

  • 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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