Primary care research networks in the United Kingdom

Abstract

Frank Sullivan and colleagues describe the new bodies emerging to coordinate and boost primary care research in the four UK countries

In British primary care, where 80% of National Health Service consultations take place, policy decisions often depend more on optimistic theory than on evidence.¹ Conducting research has generally been a low priority for primary care clinicians in the United Kingdom. The ethos of independent small business in general practice tends more towards innovation than research, and scarce academic training opportunities are associated with a culture where research is not much expected, valued, or rewarded.² Yet with leadership, resource, and good relationships between researchers and service providers, primary care research can underpin effective and efficient practice in ways that specialist perspectives alone cannot.^{3 4 5}

Moreover, the UK has developed primary care research infrastructures that have been enabling and influential internationally.^{6 7 8} Most recently, the new national health research strategy aims to “re-engineer the environment in which clinical research is conducted” through the UK Clinical Research Network (UKCRN), which involves primary care centrally (figure).⁹ This network is intended to offer a managed approach to hosting high quality research in the health service and to assuring recruitment and retention of study participants. In primary care this contrasts with the previously established diverse, capacity building, practitioner centred networks.¹⁰ The four countries of the UK are using different approaches in primary care to realise this new network. We describe them briefly here, to demonstrate the direction and scale of the changes.

Infrastructure of UK Clinical Research Network

England

In England (population >50 million) one primary care research network has been established across the whole country. This is part of a wider initiative, which will include six topic specific networks and a comprehensive clinical research infrastructure through which service support, research governance, and academic staff will also be funded.¹¹ The England wide primary care research network comprises central coordination of eight distinct local networks. These networks link interested practice teams and local academic units of general practice to participate in a wide range of national projects led from the service, universities, and industry. The leadership is currently negotiating a sometimes painful transition away from prioritising capacity building for research at the local level and towards national priorities.¹¹

A National School for Primary Care Research was established in 2006.¹² Focused initially on the five English academic departments of general practice and primary care scoring 5 or 5* in the last research assessment exercise, it has two aims. These are to improve primary care through evidence from research at each stage along the patient pathway (from prevention to management of long term conditions) and to work with UKCRN and other interested organisations to develop a world class UK primary care research portfolio.

Scotland

Scotland (population 5 million) was the first part of the UK to establish, in 1999, a school of primary care. The Scottish Executive and NHS Education Scotland fund the Scottish School of Primary Care to build research capacity and capability through a network called Scottish Practices and Professionals Involved in Research. The Scottish Funding Council has also recently provided extra funds to a consortium of all Scottish higher education institutions engaged in primary care research.¹³ This virtual organisation includes all Scottish academics with an interest in primary care research and the many clinicians who undertake, participate in, and facilitate research while carrying out their normal clinical work (currently 1700 people).

Wales

Wales (population 3 million) will have a single unified research infrastructure—Clinical Research Collaboration Cymru—covering primary, secondary, and tertiary health care and social care. The Welsh Assembly has commissioned a research professionals' network to support research and recruit patients into high quality, peer reviewed studies. The network will eventually include up to 22 accredited “nodal” research general practices, each with a half time research nurse or equivalent resource. These practices will recruit patients into studies, develop research in neighbouring general practices and other primary health and social care facilities, and link with research professionals in hospital settings. Plans for a Welsh School of Primary Care Research are being developed.

Northern Ireland

Northern Ireland (population 1.7 million) has no ring fenced investment for research in primary care. The Northern Ireland Research and Development Office supports several “recognised research groups” which focus on specialised areas of care and are encouraged to include primary care in their work.¹⁴ A Northern Ireland Clinical Research Network is developing currently, with planned provision of a comprehensive infrastructure and central administrative resource for research in primary, secondary, tertiary, and social care. This network will collaborate with UKCRN to avoid duplication of policy and procedure development and to achieve mutual benefit in enhancing local capacity for high quality research projects. Whether a specific network similar to that for primary care in England will be established remains undecided; the progress of networks in other areas of the UK will undoubtedly inform this decision.

These models reflect a range of cultures and priorities in both the service and research arms of the health services serving the four nations. The vision of effective UK wide networking in research is not yet, however, reflected by current realities. The challenges and transaction costs of collaborations between local organisations, let alone between nations, are high. Setting of timescales and management of human and other resources will have to be realistic if the best that is promised is not to become the enemy of the evolving good.