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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)

  • 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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