Primary Care Specialty Profile
Why you should deliver primary care research in the UK
Primary care has a unique structure in the National Health Service (NHS) in England. Ninety nine per cent of patients have cradle-to-grave registration with an individual general practice that holds their complete Electronic Health Record. General practice is the ‘jewel in the crown’ of the NHS with 7,000 general practices in England providing over 300 million consultations every year.
In early 2017, the Primary Care Specialty recruited its one millionth participant into a study, and within 2018/19 alone recruited over 160,000 participants.
The Clinical Research Network (CRN) provides researchers with the practical support they need to make research happen in the NHS and the wider health and social care environment. As well as providing research delivery staff, we also bring together communities of clinical practice to provide national networks of research expertise. The Primary Care Specialty is one of 31 such communities and is made up of leading research-interested clinicians and practitioners at both national and local level. Our job is to ensure that the primary care studies that we support are delivered to time and target.
We can provide:
We have a network of leading primary care researchers across the15 Local Clinical Research Networks, with the specific skills and expertise to provide both strategic leadership and on-the-ground practical advice to facilitate recruitment, as well as early feedback on research protocols. In addition, we work collaboratively with the respective primary care networks across the devolved nations.
Access to participants
Research takes place across the full spectrum of primary care, from prevention to palliation. Primary care management of chronic diseases, such as diabetes and asthma, makes it the ideal sector for recruitment into both academic and commercial studies.
Participants can be identified easily from their Electronic Health Records by their own practice, or by data-sharing agreements across a number of practices. The specialty also identifies and recruits participants into studies set in other parts of the health service including hospitals, community clinics and public health.
We work closely with the Clinical Practice Research Datalink (CPRD) to undertake large scale population health studies.
Overall 38 per cent of general practices across England took part in NIHR Clinical Research Network Portfolio studies in 2018/19, equating to the recruitment of participants at over 2,700 general practices.
We deliver an integrated approach at a local level across both primary and secondary care and in hub and spoke models. Outreach teams, including research nurses from established research sites, can work with practices to promote effective and timely recruitment.
The Primary Care Specialty has a proven track record of successful recruitment across all manner of conditions and complex interventions. In 2018/19 , over 160,000 participants were recruited into 501 studies, with 82 per cent of studies recruiting to time and target.
We have experience of recruiting at scale - up to 10,000 for some interventional studies - working with larger practices including federations and mega-partnerships to facilitate research.
The quality of data recording in primary care and its data-rich environment promote efficient and accurate feasibility and facilitate subsequent recruitment. For example, prescribing and prevalence data are available at practice and Clinical Commissioning Group (CCG) level across the whole country.
The Specialty has a close relationship with the Royal College of General Practitioners to recognise research active clinicians and practices in delivering excellence and innovation in clinical research. The Royal College of General Practitioners Research Ready® scheme has accredited over 600 practices in the UK.
BWeL (Brief Interventions for Weight Loss)
The Specialty supported the recruitment of 1,882 participants across 56 practices, into the first clinical trial to look at the impact of different opportunistic GP interventions in reducing obesity in primary care. The behavioural change intervention used not only proved to be clinically effective but extremely cost effective, informing Public Health England guidance.
PReDicT (Predicting Response to Depression Treatment)
Following a Horizon 2020 SME award of €4M to P1vital Ltd, the company wished to evaluate the performance of the P1vital® PReDicT Test as their newly-developed CE marked Class 1 medical device in assessing response to SSRI treatment in patients with depression. A randomised controlled trial of patients whose treatment was guided by the PReDicT Test was compared to those following standard care across primary care practices in the UK, France, Spain, Germany and the Netherlands.
P1vital used the CRN to identify 26 primary care sites and over a 28-month recruitment period enrolled 488 participants finishing to target in September 2018.
P1vital engaged with NIHR support services that assisted in the development of a model agreement using established costing templates. Site identification and initiation were facilitated by the local network staff in participating regions and performance data was monitored to ensure timely delivery. Overall, they found the experience of working with UK primary care compared very favourably with the other European sites.
“NIHR CRN Primary Care Specialty played an invaluable role in the success of our PReDicT trial and continues to support us as we seek to use our new technology to improve the care of NHS patients with depression.”
Jonathan Kingslake, CEO of P1vital Products Ltd
CANDID (CANcer Diagnosis Decision Rules)
The study harnessed the collaboration between Primary and Secondary Care two-week wait clinics to recruit 24,397 participants across 476 GP sites, into the investigation of what symptoms and examinations are best for predicting lung and bowel cancer.
“The CRN has provided diverse support, from taking the pain out of approaching practices, with costs and has been an incredibly useful resource. I can’t imagine running the studies without them now.”
Professor Paul Little, Chief Investigator
Find out more about our primary care specialty.