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New register aims to set standards for nurses who carry out spirometry


Primary care nurses will be able to prove their ability to perform spirometry, under a new certification and registration scheme set to be brought in over the next five years.

According to those behind it, “key” to the launch of the initiative is a national register of healthcare professionals certified to perform and interpret diagnostic spirometry in adults.

“This will ensure that everyone is clear about the standards required”

Monica Fletcher

The voluntary scheme, endorsed by NHS England, aims to introduce an element of control for the first time on the main investigation used for diagnosing chronic obstructive pulmonary disease and also routinely asthma.

To comply with the scheme, specialist respiratory nurses and practice nurses – along with GPs – will have to demonstrate they can perform and interpret spirometry to standards set by the Association for Respiratory Technology and Physiology (ATRP).

Once certified, nurses will then need to show they remain competent in performing the lung function tests every three years via an observed assessment and the submission of a “comprehensive portfolio”.

A competency assessment framework for diagnostic spirometry in adults – titled Improving the quality of diagnostic spirometry in adults: the national register of certified professionals and operators – was published last month, which set out the details of the scheme.

Those behind it said the move was a response to a 2014 report on respiratory deaths by an all-party parliamentary group, which looked at why premature mortality from respiratory disease remained so high and how death rates could be improved.

“Spirometry needs to be done to the required standard to ensure patients are diagnosed and monitored safely”

Nigel Sparrow

The framework has been co-produced by a stakeholder group including the ARTP, the Association of Respiratory Nurse Specialists (ARNS), Asthma UK, the British Lung Foundation, the British Thoracic Society, Education for Health, and the Primary Care Respiratory Society UK.

The document sets out how healthcare professionals performing and interpreting diagnostic spirometry should be trained, assessed and certified.

It cites three levels of competency – foundation, full and interpretation only – and the routes available to gain initial certification.

It also explains how to join the new national register, the process of recertification and an experienced practitioner scheme, which recognises prior experience and competence.

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

In addition, an independent National Spirometry Quality Scrutiny Board will be established to oversee the quality assurance process.

Monica Fletcher

Monica Fletcher

Monica Fletcher

Monica Fletcher, chair of the stakeholder group and chief executive of Education for Health, said: “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,” added Ms Fletcher who is a nurse by background.

Dr Matthew Hodson, chair of the 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.”

Professor Mike Morgan, national clinical director for respiratory at NHS England, noted that diagnostic spirometry was provided many settings – including 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,” he said.


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Professor Sue Hill, chief scientific officer at NHS England, added: “Any diagnostic test that influences the eventual diagnosis and treatment that a patient receives needs to be performed to recognised standards by competent professionals.”

Professor Hill said the competency assessment framework built on the existing Guide to Performing Quality Assured Diagnostic Spirometry, which was published in 2013 by the same group behind the new framework.

“We are currently working on an overarching guide to help clinical commissioning groups in commissioning quality assured diagnostic spirometry,” she added.

Nursing Times understands that those behind the new initiative hope that the certification process will fit within this guide, so that it will be seen as necessary in order to commission a quality service – and therefore get round the fact that the scheme will not be a mandatory practice requirement.

Professor Nigel Sparrow, senior national GP advisor at the Care Quality Commission, noted that during its general practice inspections the regulator needed to be “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,” he said.

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

  • An information leaflet summarising the new certification scheme and register has also been published.

Readers' comments (5)

  • does this mean we now have to be on another register like the NMC where we have to pay for the priviledge and have to have revalidation as well? are nurses now going to replace respiratory technicains?

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  • This is not nursing give the job to the right profession then there will be less mistakes made

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  • This is definitely part of nursing long term conditions in primary care settings and has been for years. A register is a way to ensure quality diagnostic and monitoring spirometry is performed - particularly in general practice. Often the person performing the spirometry may not have had training for a number of years, the machines may not be regularly calibrated and this affects the readings and could adversely affect care/treatment.

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  • Is this register only for England?

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  • If the Spirometry register will be like the one that has been made for smear takers then I think it will be good to standardise this diagnostic testing and ensure everyone will keep themselves updated.

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