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GPs to be quizzed about spirometry certification during CQC inspections

CQC inspectors are to start checking whether GPs and nurses are certified to carry out spirometry as part of routine inspections of practices’ competency, it has emerged.

New advice from the CQC on what practices can expect from inspections on spirometry explains that it is ‘best practice’ for GPs to be on the register – and that inspectors will consider this as evidence staff are competent at performing the test.

The CQC said being on the register was ‘only one way’ that practices could demonstrate staff were up to scratch. But the GPC lead on regulation warned the new advice showed that inspectors will start ‘causing problems’ for practices if they did not get their staff certified.

NHS England, in collaboration with other bodies including the UK Primary Care Respiratory Society, recently set up a new initiative to get GPs and practice nurses certified to continue performing spirometry, after claims that tests at many practices were not being done properly.

The system was set to be phased in over the next four years, to make sure the necessary resources and infrastructure were put in place for training and registration, after criticism from some GP experts who had warned the move was ‘over the top’ and could lead to practices dropping spirometry altogether.

NHS England has declined to explain how the system will be enforced and, despite the expected phase-in period, the CQC has now stated it will be checking whether GP practices are registered as part of their inspections. 

A new set of advice posted on the CQC website states: ‘It is best practice for those performing or interpreting diagnostic spirometry in general practice to be on the National Register. This demonstrates they have achieved the standard of practice set out by the Association for Respiratory Technology and Physiology (ARTP).’

It goes on to say that ‘CQC expects practices to be able to demonstrate: how they ensure spirometry equipment is cleaned and maintained… and that all staff who perform spirometry tests or interpret results are competent’.

And it adds: ‘They can demonstrate this if the staff are on the National Register.’

The CQC insisted this does not mean the CQC requires practices to have accreditation to show staff are competent.

A spokesperson said: ‘While they can demonstrate this if the staff are on the National Register, that is not the only way they can demonstrate it and we don’t require staff to be registered.’

But Dr Robert Morley, GPC policy lead on contracts and regulations, told Pulse that the move meant practices will come under pressure to be on the register.

Dr Morley said: ‘Regardless of what CQC has told you we can expect its inspectors to interpret this their own way and cause problems for practices that don’t have someone with this specific qualification.

‘This is quite typical of the tick-box “diplomatosis” that is strangling general practice; what it needs is a renaissance of sensible, professionally-led development opportunities, not the nonsense inflicted on it by CQC and every other Tom, Dick and Harry with a clip board.’

How will spirometry certification work?

Under the plans for national spirometry accreditation, first revealed in September last year, GPs and practice nurses will need to receive specialist training and certification by March 2021.

At the time, NHS England advice said GPs already experienced in spirometry would be able to choose if they need to attend training, but would need to undergo assessment by a specialist from the Association for Respiratory Technology and Physiology (ARTP) to be added to the National Register.

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 decision followed claims that testing was currently ‘sub-standard’ at many practices, but it was heavily criticised by some GP respiratory experts who warned that certification was ‘over the top’.

They warned it could end up forcing GPs to drop doing spirometry altogether and causing referrals to secondary care to rocket – especially as practices are currently required to check diagnoses of COPD using spirometry for QOF purposes.