Midwives, nurses and AHPs still make up a tiny fraction of NHS clinical researchers. The NIHR’s Dave Jones tells Jennifer Trueland why and how this is changing
When Dave Jones was a newly qualified doctor, patients with bleeding ulcers were a regular occurrence in the health service. In many cases treating them required emergency surgery with an expensive hospital stay.
Then researchers discovered that a bacterium, helicobacter pylori, was implicated, and that treating patients with a simple combination of drugs was all that was needed; it transformed care – and had a huge economic benefit.
“Treatment costs a few pounds,” says Professor Jones, NIHR dean for faculty trainees with the NHS National Institute for Health Research. “This has saved thousands of millions of pounds. Yet, before H pylori, if you’d asked how we were going to deal with the numbers of people with bleeding ulcers, the suggestion would have been training more surgeons.”
This, in a nutshell, is why research is so important to the health service, says Professor Jones. And it’s also why clinicians should be at the heart of it.
“In our lifetime we’ve seen great discoveries,” he says. “But first and foremost, it’s about quality, and finding ways to give better healthcare. A culture of questioning is very important for that, and that’s what clinical academics do – they ask questions about what they can do better, and because they are working with patients, they can see the gaps that lead to the questions, and they have the curiosity to seek the answers.”
The UK has a great tradition of medical academics, he says. Indeed, he’s one himself, specialising in liver medicine in a role that has combined teaching, research, and treating patients.
But clinical research should not be the preserve of medics, he says: other disciplines, such as nursing and midwifery, allied health professionals and healthcare scientists should get the chance to bring their questioning minds, and expertise, to the research table as the different professions make an ever greater contribution to the delivery of quality care.
That’s why the NIHR and Health Education England have set up the Integrated Clinical Academic (ICA) programme for non-medical professions, complementing the NIHR Integrated Academic Training programme for doctors and dentists.
The ICA programme has five elements, plus a mentorship scheme. Internships are designed to give clinicians a taste of what research involves, and include an introduction to all aspects of clinical research from trial design and data management to conducting primary research. The six month programme includes backfill for the intern’s time, and allows the intern to do a research project supervised by a clinical academic supervisor.
The next step up is a Masters in Clinical Research Studentship, which can be taken over one or two years (full or part time). These are fully funded and available at 10 host universities across England.
The Clinical Doctoral Research Fellowship is aimed at graduates with some research experience who want a career that combines clinical practice with research.
The two post-doctoral programmes, Clinical Lectureship and Senior Clinical Lectureship combine clinical and academic activities and the award funds 50 per cent of the award holder’s salary.
According to Professor Jones, the NHS benefits from a research-active workforce, across all disciplines. “Training and research go hand in hand,” he says. “And there are skills that translate very well to clinical practice.”
For example, researchers with experience of getting consent from people taking part in trials develop expertise in ensuring that patients know what’s going on with their care. “Researchers understand consent, and this spreads out to the rest of their colleagues too,” he says. “Having research-active individuals has an impact on whole departments and organisations.”
Attracting research grants and partnerships with industry can also bring resources and kudos to trusts, he says, adding that the NHS is well placed to be a world-leading research environment.
“We have a unique structure in the NHS because it’s a single system. We have the NIHR, which is a national organisation; we have clinical research networks, and we’ve got lots of great people. In fact, it’s so good that some people ask what’s the catch,” he says. “We can drive innovation and bring economic benefit and improve patient care, and training is also unique.
“But the downside is that research still isn’t always seen as core business in the health service. I think it is core business because it brings everything together and there’s growing evidence that being a research-active organisation is good for patient care. But there are still those who think that spending money on research and development is a luxury.”
Growing an expert body of clinical academics, deployed throughout the health service, who will lead and inspire others to follow in their footsteps – and will help drive improvements in patient care – is a hugely important step, he believes.
“Research and development is much more embattled in the current economic climate, so we have to demonstrate that research can make savings, and that being a research-active organisation does bring benefits, both to patients, and to the organisation.”
“Blue sky thinking might be great, but you really have to think about where it goes,” he adds
Having an open mind and considering where research might lead to a step change is important, but so too is keeping a weather eye on practical application.
“Henry Ford used to say that if you asked people what they wanted [before the motor car was invented] they’d have asked for faster horses. It’s important for us to keep it focused on real returns: who benefits, how do they benefit, and when?
“Blue sky thinking might be great, but you really have to think about where it goes,” he adds.
He accepts there is a long way to go until non-medical clinical research becomes embedded in organisations. Indeed, he believes his work won’t be done until, in his local area of Newcastle, nurses, AHPs and healthcare scientists have joint professorial and clinical appointments with the trust and university, as is the case for physicians like him. But he says that the increasing drive towards multidisciplinary working – and interdisciplinary respect – is helping to change the culture.
“We need to back away from the doctor driven research narrative. I remember when I hurt my knee whilst I was skiing. I saw an orthopaedic surgeon who couldn’t do anything for me, then I saw a physiotherapist who sorted me out in 15 minutes.
“We have nurse-led services, and physio-led services, and all sorts of AHPs who are the experts in what they do – they must be supported to do research because they are the ones who are seeing the gaps, and who know the questions that must be answered.”
In comparison with medicine, there are “tiny” numbers of AHP, nurse and midwifery academics, he adds. This could partly be a result of history and tradition: because there have traditionally been so few of them, there is much less opportunity for positive role-modelling. “They have been less likely to come across inspirational people in their field,” he adds. “We need the inspirational people to draw people in and help them to dream the dream.”
Creating a career structure
The ICA programme is part of wider efforts to develop that population of clinical academics who will, over time, help to create a new tradition where clinical research is no longer predominantly a medics-only zone.
“It’s partly about attracting people in, through internships, and masters degrees, but it’s also about creating that career structure,” he says.
“I want to see the non-medical [clinical research] pathway coming together faster, because I think it benefits us all. There have been, and there still are, barriers, but I think they are breaking down.
“There are a lot of bright and talented people out there, with the drive to do this. It gives me enormous optimism.” l
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