Please tell us about your role as a Clinical Scientist at the University Hospitals Coventry & Warwickshire – including some of your recent research?
Being a Clinical Scientist is a great job, which I feel offers the best of everything. I undertake and report respiratory tests, perform research, run clinics and teach others both within physiology and those working in the community. I have worked in Respiratory Physiology for 24 years and have been a Clinical Scientist for 20 of those. I am now working towards being a Consultant Clinical Scientist. For the last few years, I have been in a deputy lead position, which since early 2023 has been at UHCW. My previous role at University Hospitals Birmingham was focussed on occupational asthma and the importance of serial peak flow measurements. Over the years I have published several papers about how to improve the sensitivity and specificity of this test1-4. My new role encompasses more varied physiological tests (although the occupational work continues!) and therefore my scope of research has also widened. At the BTS 2023 winter meeting and the ERS 2023 conference, our department showed the importance of gas transfer as well as spirometry in those found to have emphysema via the Targeted Lung Health programme5, and that certain CPET measures can be used to detect CTEPH (Chronic Thromboembolic Pulmonary Hypertension) earlier which will consequently lead to a change in our patient pathway6-7. In 2024 we are planning to delve into the impact of spirometry teaching in primary care outcomes.
Spirometry, although considered a basic test, gives us a wealth of information when performed to good quality, which, when considered with a clinical history may enable a diagnosis or be the ignition for onward referral and further detailed testing.
What impact can high quality diagnostic testing have on patient outcomes?
Aside from my day job, I have a voluntary role within the Association for Respiratory Technology and Physiology (ARTP), initially as the Spirometry Chair and currently as the Education Chair. It has enabled me to see the impact of testing in both primary and secondary care, as well as other settings such as occupational health. Spirometry, although considered a basic test, gives us a wealth of information when performed to good quality, which, when considered with a clinical history may enable a diagnosis or be the ignition for onward referral and further detailed testing. However, as with any test, if it is not performed well, the information can be misinterpreted, and a patient incorrectly diagnosed or diagnoses missed, leading to incorrect treatment or no treatment at all. Over the last 20 years, ARTP have created and developed a Spirometry certificate comprising of a portfolio, MCQ and practical examination that can be used to show competence to help improve the quality of spirometry and avoid these issues. ARTP also provide other certificates of competence for more detailed testing such as full lung function, sleep diagnostics and capillary blood gases, with more currently being developed such as for cardio pulmonary exercise testing (CPET).
Can you tell us a little about the national spirometry register, what it does and the value it provides?
The National Spirometry Register contains the people who have undertaken the ARTP spirometry certificate. There are 3 levels that candidates can be certified at: Full (performing and reporting), performing only or reporting only. There are certificates for adults, paediatrics and also a combined certificate for those working with both. There are currently 2340 people on the register who are spread all over the United Kingdom. The Register allows the public to be able to look up and see who is competent in spirometry and at what level, much in the same way as other professional registers do. This gives valuable information to service users and service providers, but also allows us to see where competency needs to grow. In an ideal world, there would be a competent spirometry practitioner available for each GP practice, therefore bringing the simpler diagnostic tests closer to the patient.How can health professionals help in increasing the amount of spirometry and other physiological tests performed in respiratory? Why is this important?
There has been a real push for more professionals to become trained and competent in spirometry via NHS England and funding has been made available for this. However, further help is needed to make space available to perform spirometry, increase staffing, ensure there is up-to-date equipment and improve confidence in general. Spreading the word that spirometry testing can resume as it did pre-COVID needs to be publicised. Risk can be largely reduced just with the use of bacterial/viral filters. The risk of not performing spirometry also needs to be a major consideration as this may outweigh the risk of performing it. Due to stoppages, we now have many previously competent practitioners who are out of practice. This is where secondary care could be used to provide bases for experience.
Increasing spirometry provision is important not only as it aids diagnosis, but it can be the building block for further testing. More detailed respiratory testing is starting to grow through the advent of Community Diagnostic Centres (CDCs) that are being created around the UK. Existing healthcare professionals therefore need to continue to train others and grow their workforces at all levels from spirometry to advanced testing so that patients are able to be referred to the right place for their needs.Could you tell us more about the support available to build the workforce to support the CDCs and more advanced services you have mentioned?
CDCs are designed to offer full lung function testing (including spirometry, gas transfer and static lung volumes plus fractional exhaled nitric oxide) with or without reversibility assessment. There may also be scope to offer some sleep services such as limited multichannel sleep studies or overnight oximetry. Healthcare scientists of Band 4-5 would be ideal for these services with an overall Band 6 or 7 lead for more complex reporting and management. In secondary care, these tests will still continue, but more advanced tests such as cardio-pulmonary exercise testing (CPET), Non-invasive ventilation (NIV), oxygen services and full polysomnography could be more available, assisting patients referred to a more specialised service. A range of bands from 3-8 can be utilised in secondary care to offer all test types.
For our workforce to grow, we need to support this training and experience. It may feel overwhelming in an already stretched department, but the effort is definitely worth it for future investment in our hospital and community settings.
Fortunately, there are now several ways to become qualified for these different roles. There are apprenticeships ranging from level 2 to level 6 for upskilling employed staff, but there are bursaries available for certain levels (https://nshcs.hee.nhs.uk/programmes/apprenticeships/). There is the Practitioner training Programme (3-year full-time degree) aimed at a band 5 role, the Scientific Training Programme (3-year masters programme while working as a salaried band 6 via direct entry or as an inhouse employed member of staff with centrally funded money available) with an intended band 6-7 outcome role, and the Higher Specialist Scientific Training Programme (5-year PhD while already working in a salaried role with yearly bursary available) leading to a Consultant Clinic Scientist role aimed at a band 8+ (for all levels: https://nshcs.hee.nhs.uk/programmes/). There are also equivalence routes for all of these training levels through the Academy of Healthcare Science (AHCS). More recently there are also programmes for graduates with other scientific degrees to be able to convert to respiratory and sleep physiology aimed at band 5-6 positions (https://nshcs.hee.nhs.uk/programmes/respiratory-and-sleep-training-programmes/).
For our workforce to grow, we need to support this training and experience. It may feel overwhelming in an already stretched department, but the effort is definitely worth it for future investment in our hospital and community settings.
References
- Moore VC, Jaakkola MS, Burge CB, Robertson AS, Pantin CF, Vellore AD, Burge PS. A new diagnostic score for occupational asthma: the area between the curves (ABC score) of peak expiratory flow on days at and away from work. Chest. 2009;135(2):307-14.
- Moore VC, Jaakkola, MS, Burge CB, Pantin CF, Robertson AS, & Burge PS. (2010). Do long periods off work in peak expiratory flow monitoring improve the sensitivity of occupational asthma diagnosis?. Occupational and environmental medicine, 67(8), 562–567.
- Moore VC, Jaakkola MS, Burge CB, Pantin CF, Robertson AS, Vellore AD, Burge PS. PEF analysis requiring shorter records for occupational asthma diagnosis. Occup Med (Lond). 2009;59(6):413-7.
- Moore VC, Jaakkola MS, Burge CB, Pantin CF, Robertson AS, Burge PS. Shift work effects on serial PEF measurements for occupational asthma. Occup Med (Lond). 2012 Oct;62(7):525-32
- Moore VC, Choudhury AM, Jaiteh A, Shakespeare J. Targeting lung health in Coventry: does lung function corroborate with CT evidence of emphysema? Thorax 2023;78(Suppl 4):A222
- Shakespeare J, Moore VC, Shuker S, Burge J, Parr D. Utility of CPET for the investigation of persistent breathlessness in post PE patients. European Respiratory Journal 2023; 62: Suppl. 67, PA5065.
- Shakespeare J, Burge J, Moore VC, Shuker S, Parr D. Predictive value of CPET in identifying patients with chronic thromboembolic pulmonary hypertension (CTEPH). European Respiratory Journal 2023; 62: Suppl. 67, PA5059.