Improving the quality of Diagnostic Spirometry in adults: new National Register launched

Today sees the publication of a competency assessment framework for diagnostic spirometry. Key to this is the launch of the new The National Register of healthcare professionals certified to perform and/or interpret diagnostic spirometry in adults.

In 2014 , the All Party Parliamentary Group (APPG) Report on inquiry into Respiratory Deaths 2014 looked at why premature mortality from respiratory disease remained so high and how death rates could be improved. The framework – which responds directly to the recommendations made by the APPG – has been co-produced by a stakeholder group comprising Association for Respiratory Technology & Physiology (ARTP), Association of Respiratory Nurse Specialists, Asthma UK, British Lung Foundation, British Thoracic Society, Education for Health, and Primary Care Respiratory Society UK (PCRS-UK). NHS England has endorsed the document.

Monica Fletcher, Chair of the Stakeholder Group and Chief Executive of Education for Health, explained “The document sets out the framework for implementing the APPG recommendations: a common curriculum; quality assured training, assessment of healthcare professionals to clearly defined standards and the establishment of The National Register.

“This will ensure that everyone – patients, individual healthcare professionals and commissioners – is clear about the standards required.

Professor Mike Morgan, National Clinical Director Respiratory, NHS England, added “Diagnostic spirometry is provided many settings; general practice and community services as well as secondary care and workplace surveillance. Whatever the local service model, whoever performs and/or interprets spirometry should be certified as competent and follow the ARTP standards.”

The document describes:

  • how healthcare professionals performing and/or interpreting diagnostic spirometry should be trained, assessed and certified
  • the 3 levels of competency
  • the routes available to gain initial certification
  • the Experienced Practitioner Scheme, which recognises prior experience and competence
  • how to join the National Register
  • the process of recertification

The new arrangements will be phased in over 4 years up to 31March 2021 to allow sufficient time for the necessary training, assessment and certification infrastructure to be set up.

An independent National Spirometry Quality Scrutiny Board will be established to oversee the quality assurance process.

Professor Sue Hill, Chief Scientific Officer, NHS England, said: “Any diagnostic test that influences the eventual diagnosis and treatment that a patient receives needs to be performed to recognised standards by competent professionals. This competency assessment framework builds on The Guide to Performing Quality Assured Diagnostic Spirometry published in 2013. We are currently working on an overarching guide to help CCGs in commissioning quality assured diagnostic spirometry. ”

Professor Nigel Sparrow, Senior National GP Advisor and Responsible Officer of the Care Quality Commission, said “In our inspections of general practice, we need to assured that the staff have the knowledge, skills and competences required for their role. I hope the register and accreditation system will be an extremely useful way of helping them demonstrate this. Spirometry needs to be done to the required standard to ensure that patients are both diagnosed and monitored safely and effectively. This includes, not only the technical skills to do spirometry but also the knowledge and understanding required to interpret results. “

Dr Stephen Gaduzo, GP in Stockport and Chair of Primary Care Respiratory Society UK commented: “This document recognises the difference between performing the test, interpreting the findings to provide a report, and the separate clinical skills involved in making a diagnosis using the patient’s history and examination. The role (and skill) of the generalist is therefore not eroded but enhanced by the accuracy of the information provided by the test.

Patients with respiratory symptoms deserve an accurate diagnosis in order to receive the correct treatment. If it leads to raised standards, more accurate diagnosis, and ultimately improved care and better clinical outcomes, we will have succeeded.”

Dr Matthew Hodson, Chair of ARNS said “We welcome this frame for diagnostic spirometry. It will enable nurses and other healthcare professionals to ensure that they access the most appropriate guidance to improve patient care”

Improving the quality of diagnostic spirometry will support accurate and timely clinical diagnosis, as well as improving the long term monitoring of the one in five people in the UK affected by respiratory disease.

The National Institute of Health and Care Excellence (NICE) is due to publish revised guidelines on asthma diagnosis in spring 2017.

Read the full Framework Spirometry Framework

Read the information leaflet spirometry leaflet


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