Monica Fletcher June 2014.jpg

Competency assessment in diagnostic spirometry

More than just another hoop to jump through

Monday, September 12, 2016

Chair of the Stakeholder Group and Chief Executive of Education for Health, Monica Fletcher, explains why it’s important to quality assure diagnostic spirometry

One in five people in the UK are affected by respiratory disease. It is responsible for more than 700,000 hospital admissions and over 6 million inpatient bed-days in the UK each year. It is the third biggest cause of death in the UK and is one of the 5 leading causes of death in the UK.

Spirometry is one of the essential lung function investigations in the diagnosis, severity assessment and monitoring of many respiratory conditions. Diagnostic spirometry has to be performed to a high standard. If it is not, there is a risk that the diagnosis will be wrong - and that as a result patients will receive inappropriate treatments (which could be potentially harmful) and very expensive treatments. So it must be quality-assured and only performed and interpreted by people who have been assessed as competent, otherwise the accuracy of the diagnosis cannot be relied on.        

Work started back in 2013 when a practical, step by step guide to performing diagnostic spirometry was produced. Then in 2014, an All Party Parliamentary Group inquiry looked at why premature mortality from respiratory disease remained so high and how death rates could be improved. This focussed attention on a key missing bit of the jigsaw puzzle - the need to have a national system of competency assessment.

With support from NHS England, 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 set about doing this. Our newly published competency assessment framework includes setting up a new National Register of certified healthcare professionals.

Download the framework via the Knowledge portal: Improving the Quality of Diagnostic Spirometry in Adults

There are 3 levels of competency assessment:

Foundation: those who have been assessed as competent to perform safe, accurate and reliable spirometry tests without interpretation

Full: those who have been assessed as competent to perform and interpret spirometry in terms of physiological changes

Interpretation only: those who have been assessed as competent in interpretation only


The framework describes:

- how healthcare professionals performing and/or interpreting diagnostic spirometry should be trained, assessed and certified

- the routes available to gain initial certification

- the Experienced Practitioner Scheme, which recognises prior experience and competence without need for training

- how to join the National Register

- the process of recertification (every 3 years)


We are phasing implementation over 4 years up to 31 March 2021, to allow sufficient time for the necessary training, assessment and certification infrastructure to be set up.   

Some people – particularly those who have been performing and interpreting spirometry for a number of years – may bemoan what they see as yet more red tape.  But whether you are a patient, commissioner, employer or healthcare professional it is important to be assured that healthcare staff performing and/or interpreting diagnostic spirometry are competent to do so.

If you have any comments or questions following this feature, please post them in the discussion area below.

The competency framework is also available on the Primary Care Commissioning website: