The introduction of the new GP contract in 1990 was followed in rapid succession by initiatives such as fundholding and the internal market, total purchasing, commissioning pilots, personal medical services pilots, and now primary care groups and trusts.
There was considerable criticism that as fundholding had not been subjected to an official evaluation, it was difficult to assess its impact. This has since been rectified with ongoing evaluations of the later initiatives, generally commissioned by the Department of Health from university-based researchers. But there are problems associated with such evaluations that have left some observers wondering about their usefulness.
Take the total purchasing pilots. The first-wave pilots were the subject of a wide-ranging evaluation.
1But the second wave was set up and running before the evaluation had reported. The assumption appeared to be that total purchasing pilots were a good thing and should be expanded even though the evidence was not available.
Some of the findings from the study indicated that in order to be successful, certain pre-conditions were necessary - good relationships with other groups or organisations such as health authorities, social services and patients, an understanding of the different 'cultures'within the NHS, and good management. The advice from the researchers was to proceed with caution.
2Then came the PCG/Ts. It might have been hoped that lessons were learned from the total purchasing evaluation. But what has happened? PCGs are rushing headlong to PCT status without as much as a backward glance - certainly not at the findings of the total purchasing pilots (and other) evaluations.
A similar case is PMS pilots. The national evaluation has not yet reported publicly (although it has to the DoH), yet the assumption is that PMS is a good thing, and it is taking off in a big way.
Many of the total purchasing pilot lessons are relevant here, too, but appear to have been disregarded. There is a serious danger that many wheels are being re-invented, when reading the total purchasing and other evaluation reports would provide useful guidance.
This is all rather dispiriting to researchers. Where are they going wrong? How can they ensure that their findings are disseminated, via policymakers, to practitioners? How can the gulf between researchers and policy-makers and practitioners be bridged? The problem may be, again, a difference in cultures, with researchers producing reports which are not seen as particularly applicable to practitioners on the ground. Researchers do try to include practitioners in their research plans; they produce reports which are sent out to practitioners, but perhaps a culture of active 'doing' rather than passive 'listening', coupled with heavy workloads, means that expecting them to be useful is simply wishful thinking.
There are numerous ways forward. It has been shown, for example, that getting research findings into practice is far from straightforward, and that active rather than passive dissemination of information is required.
3Practitioners can be trained in research methods so that they understand the research culture, and researchers can be encouraged to write userfriendly, as well as academic, reports. The three groups - policy-makers, practitioners and researchers - can come together at conferences, or better still, at workshops. The national listening exercise acknowledged that communication is a key task for the new National Co-ordinating Centre for NHS Service Delivery and Organisation Research and Development.
4Its aim is to involve stakeholders (those who are not researchers) in the work of the programme, including disseminating research evidence and ensuring that communication of results is effective.
Ultimately, researchers like to think that their efforts are of use to practitioners as well as policymakers and do not simply sit gathering dust on shelves; and policymakers and practitioners like to have access to summarised information of direct use in the planning of service changes.
There is clearly a need for more discussion between the groups, improved dissemination, and, above all, a greater mutual understanding of each other's ways of working.
REFERENCES 1Mays N, Goodwin N, Killoran A, Malbon G. To t a l Purchasing: a step towards primary care groups. King's Fund, London, 1998.
2Leese B, Mahon A.
Management and Relationships in Total Purchasing Pilots: relevance for primary care groups.
J Management in Medicine 1999;13 (2-3): 13-22.
3Bero L, Grillie R, Grimshaw J et al. Closing the Gap Between Research and Practice: an overview of systematic reviews of interventions to promote the implementation of research findings. Br Med J 1998; 317 (7156): 465-468.
4Fulop N, Allen P. National Listening Exercise: report of the findings. NCCSDO, London, March 2000.