Why do we need a National register – the current system seems to work fine?
There is currently a range of different levels of training and competence amongst the people doing spirometry. We expect that introducing the scheme will raise the quality of diagnosis of respiratory disease because it will ensure that all practitioners involved in spirometry have their skills assessed and are certified as competent. A National register will enable transparency within the NHS and to the public about the competence of healthcare professionals.
Where did the need for a National register come from?
NHS England has led the initiative to improve the quality of diagnosis in respiratory care by working with the respiratory community to produce two documents over the last 5 years. They hope to raise the standard of performing and interpreting spirometry with the new certification scheme.
- A guide to performing quality assured diagnostic spirometry
In 2013 NHSE published a document setting out the standards to which spirometry must be performed and interpreted. This step-by-step guide shows clinicians how to ensure that diagnostic spirometry performed in primary care and other settings is quality assured and provides valid results for patients. It details how spirometry should be performed, the interpretation and reporting of results and methods for quality assurance. The guide also illustrates common technical errors and offers top tips for reporting spirometry results.
- Improving the quality of diagnostic spirometry in adults: the National Register of certified professionals and operators
This 2016 document builds on ‘The Guide to Performing Quality Assured Diagnostic Spirometry’ and sets out a competency assessment framework. It describes the process by which healthcare professionals and operators can become certified as competent and join the National register, thus demonstrating that they have achieved the standards established by the Association for Respiratory Technology & Physiology (ARTP) for the performance and interpretation of spirometry measurements. It is expected that from March 31 2021, those healthcare professionals performing and/or interpreting spirometry will be on the National register.
What about the other nations? Why is this only England?
NHS England led the work that led to the publication in 2013 of ‘the Guide to performing quality assured diagnostic spirometry’. They have been closely involved in the development of this assessment and certification process too. However Wales has been working on skilling up their primary care staff on spirometry and is ahead of England. But technically, the this scheme only applies to healthcare practitioners working in England. There is nothing to stop HCPs in the other three nations from going through the assessment process to join the National register.
I am already on the ARTP register – after going on a spirometry training course a couple of years ago. How will this certification scheme affect me?
- You will be notified about when you need to undergo recertification – which will take place every three years. If you perform spirometry, you will be required to submit a short portfolio which includes calibration records and evidence of spirometry traces. You will have 3 months to put the portfolio together. There is no practical component for recertification.
- If you are involved in interpreting spirometry, you will be sent some traces to interpret.
- You can go on a refresher course before you undergo recertification if you wish to.
What do I have to do in order to re-certify to remain on The National Register?
You will be contacted directly that the time has come to undergo recertification. This is usually in the six months leading up to the third anniversary of your most recent (re)certification. You will be given full instructions about what is required. It will be very similar to the assessment process for people who are not yet on the National register.
I am a GP who diagnoses respiratory conditions after colleagues have undertaken spirometry and interpreted it. Do I need to attend any training or go on the register?
No – the certification scheme only covers people performing and/or interpreting spirometry. As you are considering the results of spirometry alongside other investigations e.g. full history, examination, then you do not need to join the National register.
I have been doing spirometry for years. If my name is not on the National register, will I be able to continue doing spirometry?
It is expected that from March 31 2021, those healthcare professionals performing and/or interpreting spirometry will be on the National register. You could apply to be assessed under the Experienced Practitioner Scheme in order to join the National register, which means that you do not need to do any training.
Does the National register apply just to primary care or also to other healthcare professionals?
It applies to all healthcare professionals except those who have undertaken training in spirometry as part of their core professional training – e.g. hospital specialists, respiratory physiologists
I am a practice nurse who has attended a one day course on performing spirometry – will I have to go on a training course?
You will have the choice of:
- Going on a refresher course, or undertaking other training – via the ARTP accredited training route (ICST blended learning – a mix of online and a half day practical skills workshop), or with another trainer/training organisation.
- If you feel confident of your skills, you could progress directly to be assessed, and if you are deemed to be competent, then you will be added to the National register. This route is known as the Experienced Practitioner Scheme.
What has happened to the ARTP accredited training centres which used to run spirometry training courses?
These training centres do not operate any longer. Instead, there is a range of providers of training to choose from. The ARTP has developed an accredited course which comprises online learning, and in addition, for people performing spirometry, a half day practical skills workshop. But you are free to choose any provider of training. After any training, you will need to go through the assessment process to demonstrate your competence before joining the National register.
Can I undertake any training in order to join the National register or can I only take training from certain organisations?
You can receive training from any training provider (organisation or individual) which is providing training in diagnostic spirometry. The ARTP has set up a new training programme which is a mix of online study, and a half day practical skills workshop – the National ARTP spirometry programme. This is managed by the Institute of Clinical Science and Technology https://www.clinicalscience.org.uk/national-artp-spirometry-programme/. ARTP accredited trainer/assessors are involved in delivering the half day practical skills workshops which are part of the ARTP accredited blended learning programme (except for Interpretation only where there is no need to attend).
I have been interpreting spirometry for many years and it would be a waste of time for me to attend training. What impact will this have on me?
The Experienced Practitioner Scheme is designed to provide an opportunity for experienced healthcare professionals to have their competence assessed without undertaking any training. This applies to people who are experienced in performing and/or interpreting spirometry. If you are deemed competent in performing and/or interpreting spirometry, you can join the National register.
Can I have my competence assessed by any training organisation?
No, other training organisations cannot certify you as competent in order to join the National register. You must be assessed by the ARTP by going through their assessment process.
Spirometry is different in children – does this cover both adults and children?
Spirometry is not as well established as a diagnostic tool in children as in adults. The National register was only set up to cover the performance and/or interpretation of spirometry in adults, so the issue of paediatrics is under active discussion.
If we need to train up our practice nurse, who will pay for the training course?
This may vary by the local area. In some areas the cost of training will be the responsibility of the practice or Trust; in others it may be that training is covered by another organisation, such as CCG, or Academic health science network. You need to check on local arrangements. In some areas, funds for quality improvement have been accessed to pay for the training of healthcare professionals.
If we don’t want to train someone up in our practice, what are our other options to ensure that our patients have access to diagnostic spirometry?
The document is not prescriptive about the setting in which spirometry takes place, and it is recognised that providing a good diagnostic spirometry service may take different forms in different places. If you don’t have anyone certified in the practice to provide spirometry, other models of provision can be explored locally. Practices and CCGs are sometimes discussing the best approach to ensuring that high quality diagnostic spirometry is available to all patients who need it. Models under discussion include – having a respiratory diagnostic hub for a group of practices to which all patients with respiratory symptoms are referred; having spirometry performed in practices, but having an external expert review and interpret results and feedback to the patient’s practice so that the spirometric information can be considered alongside other information needed for diagnosis.
What training courses are available in my area?
The ARTP course is largely online, with just a half day workshop as face to face training. If you sign up for the ARTP approved training programme, you will have an opportunity to sign up for the half day practical skills workshop that is closest to you. To our knowledge there is no central place where you can find out about courses from other providers.