Do primary care groups and trusts have the resources and opportunities to commission research? And if they do, should they, asks Bonnie Sibbald

Should primary care groups and trusts engage in research? They have assumed wide responsibilities for developing and commissioning primary healthcare services, but they cannot hope to achieve their goals if they do not know the needs of their populations, or what treatments or interventions are most cost-effective in meeting those needs. Research can help to provide the answers.

But should they become involved in the commissioning or conduct of research, making it part of their core business? There are compelling reasons why they should.

Where primary care managers, providers and commissioners are excluded from deciding the focus for research, there is a very real danger that the knowledge generated will not be relevant to them. A classic example is the clinical trial conducted in hospital settings with patients who differ markedly from those in general practice.

Knowledge gained in this select group may be of limited relevance to most patients, who are cared for in general practice alone.

Also, the research questions may be of little or limited relevance to primary care. Universities and research councils have been accused of attaching more value to basic or biomedical research than to applied health services research. So we may discover more effective drugs for common conditions, but make little progress in understanding how to organise care to ensure these new technologies are delivered to the patients who need them.

PCG/Ts understand the business of primary care and are best placed to say what information they need to support and inform the development of community services. No business can sit back hoping that others will understand its needs and rush to supply the relevant information and technology.

PCG/Ts must work to identify and articulate their needs if they wish them to be addressed. The government understands this need and has invited suggestions for managing the process by which research priorities are identified.

1Primary care has traditionally hosted research led by others, and this needs to continue. But it has become increasingly difficult to gain the support of providers and managers.

There is the problem of excessive workload, and research is not sufficiently valued by healthcare providers. It is seen as irrelevant to the day-to-day business of caring for patients.

The opportunities for PCG/Ts to change this antiresearch culture are tremendous. They have responsibility for workforce development, staff appraisal systems, quality assurance and quality improvement, and so are well placed to raise the status and signal the importance of research through policies in all these areas.

Should PCGs actually lead research? Some would argue that they should not because they lack the necessary skills and their population base is too small to address key questions. But these are not reasons why primary care organisations should not lead research, only why they may find it difficult.

In the past decade, government and professional bodies have recognised the need to improve research capacity in primary care. Primary care research networks, research training fellowships, postdoctoral fellowships and career scientist awards are all part of this. Alliances of primary care organisations can get around problems of scale. Three Manchesterbased PCTs have consolidated their research and development resources. Partnerships with universities will also be valuable and may become a condition for the award of NHS R&D funds.

1PCG/Ts need the capability to conduct research because some knowledge needs will be specific to that PCG. They will need to know, for example, what are the main barriers to the local uptake of new technologies and they will need the capacity to evaluate local solutions to local problems. Such research is generally seen as parochial by university academics and major research funders, who are more interested in addressing questions of national and international importance. Yet answering such questions is vital to the ability of local organisations such as PCG/Ts to meet their statutory obligations.

Also, engaging in research can be a powerful factor in promoting evidence-based change. So PCG/Ts need to be capable users, commissioners, and conductors of research if they are to promote cost-effective healthcare provision.

REFERENCE

1 Department of Health. NHS Priorities and Needs R&D Funding. August 2000.