Delivering research in the current primary care climate is challenging, but the NIHR is committed to eliminate the obstacles, says academic GP Professor Philip Evans
We have seen an amazing demonstration of the power and promise of research in primary care during the pandemic. This includes recruitment into the Covid vaccine studies and delivering vital research into oral antivirals – with more than 26,000 people joining the PANORAMIC study across the UK in just over nine months.
Delivering research in the pandemic is one thing, but delivering research in the current primary care climate is another. The many challenges facing primary care, predominantly those of excessive workload, mean that there are real barriers facing primary care staff who are getting involved in research and delivering research in their communities.
At the National Institute for Health and Care Research (NIHR), we are building on what we learned from the research response to Covid and helping to overcome these barriers, bringing the benefits of research to patients, practices, practitioners and the wider populations served by primary care.
There are benefits to being involved in research from a patient perspective, including access to new treatments and a willingness to contribute to the general research effort to help test discoveries that can help others. This was well illustrated in the sign-up for the NHS Covid Vaccine Research Registry during the pandemic – with more than 500,000 people volunteering to be contacted about taking part in Covid vaccine research.
Meanwhile, undertaking research enables practices to offer innovative work to attract and retain staff, and it is a new income stream, too. It can also allow practitioners to develop portfolio careers involving research and build more diverse career options. As with other portfolio careers, new skills will need to be attained as well as potentially new qualifications.
From the perspective of the practice population, primary care research allows the opportunity to bring research to where patients are, rather than waiting for the patients to come to us. In the era of population health management, there are real opportunities to undertake game-changing research, particularly in areas of the greatest burden for specific diseases. There are also some amazing examples of engagement with patients and deprived populations, such as research in the Deep End practices serving deprived areas in England.
Yet barriers remain. Although these are common to most specialties, primary care has specific issues around the lack of opportunities to undertake research, especially once GPs are established in practice. It is often perceived that research is ‘too academic’ or too ‘ivory tower’, but a distinction must be drawn between the large number of practices delivering research on behalf of the NIHR Clinical Research Network (CRN), which currently stands at 51%*, and the smaller number of academics who are funded to develop the research that is then delivered within these practices.
Other challenges include some of the difficulties of using GP records for recruitment. Overall, however, there is a need for greater funding, both for important research studies but also to create more opportunities to enable GPs to participate in research.
The NIHR is working hard to overcome these barriers and is increasingly offering support for individuals who are new to research. We have placed many resources on our learning platform NIHR Learn to help early and later career researchers. We also have our established CRN PRIDES service that facilitates identification of patients for research using GP clinical systems. In addition, the CRN provides resources and research staff to assist practices in undertaking research, hence minimising the impact on practices of the delivery of research.
NIHR’s new strategy for research in the primary care setting is based around some overarching themes that will help tackle the barriers in this area. Our aim is for research to respond to the needs of patients, but to make this a reality, it’s vital to help connect research systems and processes to support better research. We also want research to be seen as something everyone can be involved in, so we are finding better ways to incentivise and promote it at all levels.
Finally, we’re working to attract, develop and maintain a highly skilled and diverse workforce of primary care professionals to help us realise the benefits of research in primary care for everyone and inform evidence-based care in primary care.
As the UK’s health and social care systems move into a new phase, now is the time to recognise the challenges but also the evolving opportunities of delivering research in primary care.
Associate professor Philip Evans is an academic GP and recently retired as a partner after 31 years at St Leonard’s Practice in Exeter, Devon. He is deputy medical director at NIHR CRN
*2021/2022 annual statistics data