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New spirometry training requirement ‘not covered under GMS’, says GPC

GPs do not need to undertake new NHS England training requirements to perform spirometry in their practices, according to the BMA's GP Committee.

A statement from the GPC has clarified that despite spirometry appearing as an ‘item within QOF’, it is not part of General Medical Services, leaving local commissioners responsible for defining what training requirements are needed.

The clarification comes after NHS England released new 'training standards' for spirometry in 2016, which the GPC claims 'will make the provision of spirometry more onerous'.

However, NHS England told Pulse that all healthcare professionals have a duty to ensure they are appropriately trained and qualified to carry out their work.

In a statement on the BMA website, the GPC said: 'The fact that spirometry appears as an item within QOF does not define it as part of general medical services.

'In many areas spirometry is delivered through a local enhanced service, and in these areas the commissioners have the right to define what training requirements are needed for the provider to fulfil the contract.'

The GPC added that where practices are not specifically commissioned for spirometry but still wish to provide the service, the responsibility for ensuring that staff are appropriately trained rests with the practice partners, 'who will need to be aware of the recommendations of NHS England'.

Guidance from the BMA has previously said that while 'there are no mandatory requirements for performing spirometry', the CQC 'expects practices to be able to demonstrate that all staff who perform spirometry tests or interpret results are competent',

The latest statement added that the CQC could look for 'equivalence' between the NHS England training recommendations and training provided by GPs for their staff.

GP partner and Kent LMC chairman Dr Gaurav Gupta, who is also a GPC member, told Pulse: 'GP practices are well placed to undertake procedures like spirometry in the community for our patients but this work should be adequately funded and supported by the CCGs.'

Pulse first revealed in 2013 that GPs would have to undergo specialist training in order to continue using spirometry in their practices, as part of new rules being developed for NHS England.

It was later announced that GPs will have to be certified and placed on a national register by 2021.

An NHS England spokesperson said: 'NHS England recognises the historic local variations that exist in how spirometry services are commissioned and this means local commissioners are best placed to determine if any cases of non-provision are a contractual matter or not.'

They added all healthcare professionals have a duty to ensure they are appropriately trained and qualified to carry out their work as keeping skills up to date is an important professional responsibility.

This comes after NICE asthma guidelines released in November recommended that spirometry and forced exhaled nitric oxide testing are used by GPs where available, alongside the usual clinical assessment of symptoms, as it will make diagnosis more accurate and treatment more effective.

Readers' comments (8)

  • Quality assured spirometry is a key part of both COPD and asthma management - specially for the diagnosis. After all we are making a long term condition diagnosis with all its implications - hence the stricter requirements on training/accreditation and calibration. After all we wouldn't want to be diagnosed with diabetes based on a faulty glucometer reading.
    However this higher standards also require significant time for training and extra time during consultations - and the CCG's need to quickly rcognise this. If GP practices decline to do in-house spirometry and start to refer to secondary/community care we will loose a valuable asset. Lets hope this does not happen with forward planning.

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  • if they want it they can pay for it. otherwise refer to have it done. if you do it for free and pay for it yourself you are helping to destroy general practice further. I cannot afford all this extra training requirements for this, larc, minor surgery, FeNo machines, any other employer would provide this or as a business you negotiate the extras in your costs in your contracts. we are not considered as employees or separate businesses and our contracts are fixed for us. this model only works when any extra costs are added in. as they have been added in with a reduction in payments for the past 10 years its a loss making exercise. we are under no obligation to provide the service so don't. it make get palmed out to a private provider but the monies involved in providing it with regulation does not cover the costs - the government would have to pay far more to get a private provider to do it. as it is I am not going to redo the course to interpret spirometry even though I have been doing it for nearly 20 years. I will refer. I have more serious concerns to worry about.

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  • Another example of where management of the NHS thoroughly gets in the way of service delivery. There need to be clear, nationally-defined levels of competence, which will therefore *always* have to be taken into account by those who devise targets.
    When will NHS managers get round to understanding that these organisational aspects *have* to be created holistically, taking into account the time needed to acquire the expertise, its cost, the benefits it will give, etc etc? Currently there is far too much of the 'Oh yes, we'll need to impose standards...' without anyone appearing to think about the wider implications. This is not what good healthcare management is about.

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  • Good Health care management in the NHS is an oxymoron I think.

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  • Vinci Ho

    (1) If the government wants quality and standard maintained, there has to be no buts on the argument that more investment of resources must be here in general practice; the Expertise (of spirometry in this case)to be developed and maintained by these trainings NHSE is talking about , protected Time for GP practices to do spirometry in line with the requirements, Manpower and of course , Funding .
    (2) Otherwise , the reality right now is we refer to secondary care for spirometry to assist the diagnosis of COPD , at least , in my local areas . The ongoing measurement of FEV1 will have to be referred to secondary care as well if the rules become totally inflexible. The ball is in the courtyard of the government and NHSE . General practice cannot take any more burden with this current level of resources. Full stop.
    (3) Fine , they can consider providing resources through networks of practices , super/mega practices , federation, whatever . (We already know from NAO report last week even Simon Stevens’ baby vanguard sites , either MCP or PACS could not deliver what they set out to do for efficiency savings because most resources allocated to them ended up in filling the deficit holes in secondary care). It is no rocket science, if you want primary care to save your arse , cough up the resources . After all , it is increasingly evident that this weak government needs us (GPs) more than it needs us.

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  • Vinci Ho

    Correction
    ...... more than we need it.

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  • This thinking also applies to an fbc. I have accreditation. It is called the mrcgp.

    When will this end!

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  • doctordog.

    MRCGP an accreditation for interpretation of FBC.
    I didn’t know that.

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