Published: 10/01/2001, Volume 112, No. 5787 Page 28 29
Primary care as an academic discipline is expanding worldwide, with more GPs taking part in research.
1A survey in West Midlands region found that 84 per cent of GP respondents had participated in research or audit, 16 per cent had initiated their own research, 9 per cent had published in a peer-reviewed journal, 6 per cent had generated research funding and 3 per cent had held a research training fellowship.
2But the shortcomings of the research base in primary care have been well documented. In 1999, annual primary care research spend was only 7 per cent of Department of Health research and development spending, 4.6 per cent of Medical Research Council spending and 0.1 per cent of Wellcome project grant spending.
3There are only 0.0062 academic GP posts per NHS GP compared to 0.45 specialist academic posts per NHS consultant, though many research leaders in primary care have an academic affiliation (between 61 per cent and 78 per cent of lead authors in a survey of published research, depending on their profession).
3Research activity in primary care is most developed among GPs, and largely non-existent in other professional groups, most notably professions allied to medicine.
The DoH has taken a step towards remedying the problem by committing to increased funding via a programme run jointly with the MRC and through regional offices. The aim is to increase the proportion of funding going into primary care research, raising awareness, building capacity and making primary care more evidence-based.
Attention has focused on the need for a critique of what is seen as evidence and how a primary care research agenda might differ from a conventional medical model; a recognition of the importance of seeing research alongside education in primary care; and a developing interest in the way research networks contribute.
4There is also a recognition of the need to consider how research can best operate, given the structures and characteristic timetables of primary care and the particular contribution of research general practices.
5Primary care trusts provide a new context for primary care research that can draw on the multidisciplinary team and their locality focus. But while intentions are clear with regard to developing and implementing PCT research strategies, few models exist.Here we describe the development and implementation of a research strategy in Bradford South and West PCT.
The PCT includes 92 GPs organised into 24 practices, serving 147,100 people. It became a primary care group in April 1999, and moved to trust status in October 2000. It is known for its innovative practice in areas such as the development of GP specialists and locality centres.
The first step was to identify a PCT research lead among the GPs. This person would work with the clinical governance lead, the audit manager, the primary care development manager and the education lead to ensure the research strategy fitted into the PCT's broader aims.
The research strategy was drawn up in the context of an emerging regional approach of developing a research-conscious workforce. The emphasis was on developing basic staff awareness and a graded programme of support for those able and willing to develop further expertise.
5The questions asked were:
Should the strategy build on existing strengths or should the priority be to seek widespread research literacy?
Should resources be concentrated with a small number of practices or spread across the PCT?
Should the PCT support those already involved in research to continue and develop their interests or should there be a focus on PCT priorities, specifically those arising from national service frameworks?
The key aims of the strategy were to build up research capacity and to support local research interests, while responding to national guidance and priorities (see box). The initial focus was to develop projects in the areas of coronary heart disease, diabetes, and mental health, reflecting both local and national priorities.
All PCT staff were invited to a research day to bring them together with other relevant bodies.
The aim was to publicise the research strategy and get feedback on issues such as capacity building, overcoming barriers, and the areas of research the PCT should concentrate on.
The turnout of around 50 people included HA staff, pharmacists, community staff and representatives from local universities and regional research networks. People showed great enthusiasm to work together in a multidisciplinary way.
We also wanted to obtain baseline data about ongoing activity. A questionnaire was sent to the lead clinician of each practice, asking them:
Had any research been undertaken in the practice within the past three years? If so what and by whom?
Was there was any research ongoing or planned in the practice, and who was involved?
Were any practice members interested in becoming involved in research in priority areas?
What practice developments had been done or were planned (eg GP specialist services) and what arrangements had been made for evaluation?
What difficulties had they experienced, or perceived, in undertaking research?
How they would like the PCT to support research?
Fourteen out of 24 people replied. Three practices did not want to participate in any form of research.
Eight practices had not been involved in any research activity. Five practices had - with GPs, practice nurses, health visitors and district nurses - been involved in research in areas such as health needs assessment, child development, care of elderly people, triage, smoking cessation, family planning, diabetes, antibiotic prescribing and drug trials.
Eight practices wanted to do research in PCT priority areas. Seven practices were more interested in research on service development, which would financially benefit their practice. There was a commitment to evaluation of services.
Most felt that doing research was useful for their practices, but they did not have the time, knowledge, facilities or skills to take it on.
The strategy, feedback from the research day and questionnaire results were discussed with the clinical governance group, lead clinicians and practice managers. The practice managers' group helped address time and organisational barriers (for example, providing support so research could be practice-based to reduce staff travelling time).
Problems relating to IT were discussed with the IT lead. Close working with the clinical governance lead, who was also a board member, helped ensure the PCT was not only supportive, but provided the necessary finance to implement the strategy.
Capacity building is being done at each level within the organisation:
nIndividuals - via personal development plans.
Practice - by concentrating resources in practices that have a clear research agenda and are working closely in a multidisciplinary way. The idea is that these practices develop 'research leader' status and collaborate with other practices in the PCT.
Trust level - by ensuring that new service developments within practices are evaluated, including providing resources to develop and support research.
The PCT has funded three posts.A research lead will oversee the research agenda, link with funding bodies, and help with development of research projects for competitive funding.This post is occupied by a GP researcher.A full-time researcher will work with the multidisciplinary teams to raise awareness, develop interest, capacity and skills and directly develop research proposals.Administrative support will organise research days, events, meetings and help with dissemination.
The PCT is in the early stages of developing a research culture. Its experience has been framed by a recognition that trust status provides a new context for primary care research, which supports collaboration between professions and between practices. It also introduces a corporate agenda into an environment that has previously been driven by individual interests.
Developments need to recognise the differences in interest and expertise, both within and between practices and professions. It is not a case of letting those who move fastest run away from the others, or proceeding at the speed of the slowest.Rather, the trust can foster a dynamic of its own, which generates research awareness and supports growing and focused activity.
Key aims of the research strategy
To develop a research culture in which findings are valued and used in practice.
To encourage the development of research skills and link research to practice.
To develop a register of research activity, to ensure co-ordination and prevent duplication.
To establish a network of trained researchers, investigators and collaborator practices.
To ensure a multidisciplinary approach.
1Thomas P, Griffiths F, Kai J, O'Dwyer A. Networks for research in primary healthcare. Br Med J 2001;
2 Jowett SM, Macleod J, Wilson S, Hobbs FDR.
Research in primary care:
extent of involvement and perceived determinants among practitioners from one English region. British J of General Practice 2000; 50:
3 Campbell SM, Roland MO, Bentley E, Dowell J, Hassall K, Pooley JE, Price H. Research capacity in UK primary care.
British J of General Practice 1999; 49: 967-970.
4 Delaney BC, Fitzmaurice DA. Primary care research needs extending not moving.
Br Med J 2000; 320: 313.
5 Green LA, Dovey SM.
Practice based primary care research networks. Br Med J 2001; 322: 567-568.
Dr Shahid Ali is research lead, Dr Matthew Walsh is clinical governance lead, Gideon Seymour is primary care development manager, Julie Bolus is quality and audit manager and Dr Robert Ashworth is education lead with Bradford South and West primary care trust.Dr Stephanie Honey is research fellow and Neil Small is professor of community and primary care with the department of community and primary care, Bradford University.