Primary care trusts and primary care research

Primary care is central to the NHS and primary care research provides “the missing link in the development of high quality, evidence based health care for populations.”¹,² The recent development of primary care trusts, which are responsible for commissioning local health services, has changed the landscape for primary care research in the NHS.³ In addition to their already formidable service duties, primary care trusts also have research responsibilities.⁴ Unfortunately, the competing demands on primary care trusts for establishing research governance and meeting government targets have made primary care research a luxury that few trusts can afford.

Despite the government's documented commitment to primary care trusts and their role in primary care research, scepticism exists about the ability of the trusts to take on this role. In a 2002 House of Lords debate, Baroness Northover questioned the health minister on the responsibilities of primary care trusts, saying, “Many of us have doubts about primary care trusts, both in relation to their lack of preparedness for their responsibilities and their natural primary care orientation... there can be no certainty that primary care trusts will commission in a way that promotes and safeguards education, training, and research.”⁵

A recent joint ministerial review responded to these concerns.⁶ The review supported the original assessments, identifying “a lack of understanding in primary care trusts about roles and responsibilities in relation to learning and research across the whole of health, social care, and education.”⁶ The review also found that primary care trusts “find it difficult to influence their local research strategy as the bulk of NHS research funding is allocated, without reference to them, to secondary care organisations.”⁶

Similarly, the financial support for primary care research is also a cause for concern. The 2002-3 allocation for primary care research was only a small proportion of the £540m NHS budget.⁷ In addition, the recent annual research and development report from the NHS ranked the primary care focus of current NHS research programmes poorly, with about one quarter ranking weak.⁸

The key to supporting primary care research lies in successful partnerships between primary care trusts and the academic sector. Because many primary care trusts do not currently have expertise in research, primary care research networks and academic departments ought to be natural partners for primary care trusts. The development of sites for the national network for the management and governance of primary care trust research offers a location for the coexistence of management, capacity building, and partnership.

Since the 1980s primary care research networks, which are multidisciplinary networks of general practices active in research, have formed an important part of the backbone of primary care research.⁹ Primary care research networks are unique in that they also offer a wealth of experience in research capacity building in community settings, which is precisely the need faced by primary care trusts.¹⁰

Many academic departments of primary care are keen to build partnerships with primary care trusts.¹¹ Such linkages would help universities build research capacity and enable primary care trusts to meet their education and research objectives. However, some medical schools fear that small scale, local health services research will not be highly rated in the impending research assessment exercise that will take place in 2007 and thus may be dissuaded from working with primary care trusts.

Many opportunities exist for primary care research and primary care trusts to have a central role in improving the quality of primary care in the NHS.¹² The new general practice contract has provisions that offer further opportunities for primary care trust leadership and collaboration in research and service development. Specifically, the new framework for the measurement of quality of care, requires substantial input and participation by primary care trusts. They will be responsible for developing data systems to track and monitor performance of general practitioners and ensure that the quality framework functions.

Over the next few years, the National Programme for Information Technology will also be rolled out, leading to the eventual creation of integrated health records across primary and secondary care. The existence of these data, alongside data from the new general practitioner contract, creates major opportunities for primary care research.

An essential prerequisite to taking advantage of these opportunities is clear guidance on national and local research and development priorities for primary care. This in turn needs to be combined with adequate levels of funding, both centrally from the Department of Health and locally from primary care trusts. Evidence suggests that this is happening, for example, through the requirement that the new clinical research networks have strong input from primary care. However, if this does not occur, primary care research may decline further, leading to major long term adverse consequences for the NHS and healthcare systems overseas that rely on the NHS to provide evidence to support their own reforms.