We are aware that many HBs have contacted practices to state that all persons involved in performing spirometry and reading spirometry are to undertake specific ARTP accredited training in order to continue offering this service within general practice. This has come about following release of the All Wales Respiratory Plan.

Whilst we acknowledge the good intentions of the All Wales Respiratory Health Implementation Group’s efforts to improve respiratory care, we are concerned that the unintended consequences of these proposals have not been considered. As well as the ongoing actual monetary costs of ongoing training, the practical implications for these proposals on General Practice and actual contractual requirements for GPs with respect to spirometry assessments have not been fully appreciated or realised.

That aside, the following issues have come to our attention:

· To date, no clarity or evidence base has been provided to GPs to explain why practice nurses need to attend this specific training course. Therefore, at present, we fail to see the value or merit to this proposal, over and above what training general practice staff have already done.

· Whilst initial costs are intended to be met by Welsh Government/Local Health Boards, there has been no consideration for providing resources for the ongoing training, which we understand is required every 3 years, nor the costs of renewal of accreditation or essential backfill to cover practice staff undertaking training. From reviewing this course it appears to require attendance at a 2 day course followed by around 250 hours of coursework. We are aware that some HBs have offered to fund the fees of the 2 day course but not for time / locum backfill for this training.

· The GMS contract does not require practices to perform spirometry. It simply requires practices to ensure patients can access the investigation. Given that GPs are operating at critical capacity, if this decision is not reconsidered, there is a very real risk that practices will disinvest in performing spirometry and will simply refer all patients requiring this test to secondary care.

· In terms of continuity of care, the reality is that there will be an expectation that patients will have ongoing monitoring of spirometry changes undertaken within the practice. However, this will not be possible if all practices are required to have completed ARTP training.

We hope the above clarifies the national position and can confirm that at no point have GPC Wales been consulted. We have raised this with representatives of the All Wales Respiratory Plan and will be in touch once these discussions have been concluded.

Best wishes

Dr Charlotte Jones