Primary Care

Delivery

The NIHR supports patients and the public to participate in high quality research taking place in health and care settings across England, advancing knowledge and improving care.

NIHR Clinical Research Network

The NIHR Clinical Research Network (CRN) includes 30 specialty groups, who coordinate and support the delivery of high quality research by therapy area. Some of this research is funded by the NIHR, but most of it is funded by non-commercial organisations, such as charities or universities, and the life sciences industry.

We provide researchers with the practical support they need to make research happen through our Study Support Service. This service supports the set up and delivery of clinical research in the NHS and in other health and care settings.

We have a tailored Study Support Service offer for non-commercial organisations, as well as a tailored offer for the life sciences industry.

Supporting primary care research

The CRN Primary Care Specialty Group works with researchers and primary care practitioners such as GPs, practice nurses, pharmacists and dentists to promote the successful delivery of research studies in the NHS. We support a wide range of research, including studies that look at:

• Promoting a healthier lifestyle
• Disease diagnosis and prevention
• Management of long-term illnesses such as diabetes or hypertension
• Prevention of future ill-health
• Treating common conditions such as tonsillitis or influenza

Where there are considerable overlaps with other specialty areas, for example diabetes, mental health and cardiovascular disease, we work closely with our colleagues from across the CRN to deliver high quality research in a primary care setting.

The Primary Care Specialty has a proven track record of successful recruitment across all manner of conditions and complex interventions. In 2019/20, over 150,000 participants were recruited into 430 studies, with 97 per cent of studies recruiting to time and target.

One of the major issues facing primary care professionals engaging with research was, until recently, the lack of clarity around indemnity for medical negligence in undertaking research. This is now provided by the Clinical Negligence Scheme for General Practice (CNSGP )within the remit of NHS Resolution. You can find out more by visiting the CNSGP website.

In 2021 the CRN developed their Primary Care Strategy, which is the CRN vision for enhancing research in the complex landscape of primary care.  The emphasis on a broad definition of primary care, collaboration with stakeholders and the direction offered by a dedicated CRN Primary Care Programme Board, recognises the gaps and challenges that exist.  It provides a much needed national plan to focus energy and resources to support and drive new research and evidence to address population need.

Who we are

As well as providing research delivery staff, we also bring together highly engaged NHS consultants and clinical academics from top UK universities, bringing both clinical and academic expertise to your research. Our experts in the CRN Specialty Group can advise on delivering your study in the NHS and in particular geographic regions.

Dr Simon Royal is the CRN National Specialty Lead for primary care. Read Dr Royal's full biography.

Dr Simon Royal is supported by local specialty leads in each of the 15 NIHR Local Clinical Research Networks.

Our collaborators and stakeholders

The Clinical Research Network (CRN) Primary Care specialty has developed close links with key stakeholders and clinical researchers to input into the delivery of studies and influence the primary care research agenda.

We have established a longstanding partnership with the Royal College of General Practitioners (RCGP) and support them on a number of initiatives, such as:

• The RCGP Awards which recognise outstanding contributions of NHS general practices and First5®  GPs who are active in research.
• Research Ready® for general practices, relaunched in 2021, was developed by the Royal College of General Practitioners and the Clinical Research Network to support practices to carry out high quality research. This quality framework helps practices to develop a research culture and ethos.

Working with the Royal Pharmaceutical Society, the NIHR have developed Research Ready® for pharmacies to support pharmacies to carry out high quality research. This quality framework helps pharmacies to develop a research culture and ethos.

Clinical Practice Research Datalink

The Clinical Practice Research Datalink (CPRD) provides access to high quality, anonymised primary care data for retrospective and prospective research studies, such as outcomes research, epidemiology and randomised controlled trials.

The primary care data are linked to a range of other health related data to provide a longitudinal, representative UK population health dataset.

CPRD data and services can be highly tailored to meet specific research needs.

• Find out more about using CPRD data

Funding

Our funding programmes fund high quality research in primary care that benefits the NHS, public health and social care. We also provide career development funding awards for primary care researchers - see the careers tab for more information.

Our funding programmes

Most of our funding programmes run funding calls open to research proposals on any topic (researcher-led calls), including research proposals in primary care.

• Find funding opportunities in primary care

We have previously held a themed call on primary care interventions (2013). NIHR themed calls are funding opportunities focusing on a particular research topic, in which all our funding programmes participate.

Have an idea for research in primary care? The NIHR Research Design Service can help you turn it into a funding application, offering advice on research design, research methods, identifying funding sources, and involving patients and the public.

• Find out more about the NIHR Research Design Service

Our portfolio of primary care research

You can search and view all the primary care research we’ve funded on NIHR Funding and Awards.

In addition, a number of our research programmes publish comprehensive accounts of our primary care research in the NIHR Journals Library.

Our research schools

The NIHR School for Primary Care Research (SPCR) is a partnership between nine leading academic centres for primary care research in England.

SPCR aims to increase the evidence base for primary care practice through high quality research and strategic leadership, and to build capacity in primary care with a well established training programme.

Careers

The NIHR attracts, trains and supports the best researchers in primary care to tackle the complex health and care challenges of the future.

Our investment in people sustains excellent research capacity and expertise throughout clinical and non-clinical academic career pathways and provides high quality learning and development opportunities for the delivery workforce in our infrastructure.

Funding research careers

The NIHR Academy is responsible for the development and coordination of NIHR academic training, career development and research capacity development.

There is a wide range of NIHR training and career development awards available at different career stages, from pre-doctoral through to Research Professorships. These awards comprise both personal awards, which can be applied for directly with the NIHR, and institutional awards which should be applied for through the host institution.

• Find out more about our training programmes

Supporting the delivery workforce

Associate Principal Investigator Scheme for PRINCIPLE Study

The Associate Principal Investigator (PI) Scheme aims to develop junior doctors, nurses and allied health professionals to become the PIs of the future and provides formal recognition of a trainee's engagement in NIHR Portfolio research studies.

The NIHR Associate Principal Investigator (API) scheme in primary care, linked to the PRINCIPLE platform study of COVID-19 treatment in the community, was launched on 19 May 2021. It is designed to encourage doctors and other health professionals in a general practice site to recruit into the study and gain NIHR accreditation and experience of research in practice.

Find out more about the API Scheme for PRINCIPLE

• Find out about our career development support for healthcare professionals

Support

The NIHR invests significantly in people, centres of excellence, collaborations, services and facilities to support health and care research in England. Collectively these form the world-class NIHR infrastructure.

This national research infrastructure is available to use by UKRI, research charities and the life sciences industry as well as NIHR researchers.

• Find out more about working with our research infrastructure as a researcher or a member of the life sciences industry

NIHR Applied Research Collaborations

NIHR Applied Research Collaborations (ARCs) support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems.

The following ARC undertakes research in primary care: 

• NIHR Applied Research Collaboration Kent, Surrey and Sussex

NIHR Medtech and In vitro diagnostics Co-operatives

NIHR Medtech and In vitro diagnostics Co-operatives (MICs) build expertise and capacity in the NHS to develop new medical technologies and provide evidence on commercially-supplied in vitro diagnostic tests.

The following MIC undertakes research in primary care:

• NIHR Community Healthcare MedTech and In Vitro Diagnostics Co-operative

NIHR Clinical Research Network

The NIHR Clinical Research Network (CRN) supports set up and delivery of clinical research in the NHS and in other health and care settings. Find out more on the delivery tab.

Experts

The NIHR funds and supports world-class experts in mental health. Find out more about collaborating with our experts.

In addition, our experts can advise on delivering your mental health study in the NHS or in other health and social care settings. Get our expert advice on delivering your research.

National Specialty Lead

Dr Simon Royal is the NIHR CRN National Specialty Lead for Primary Care. He is a salaried GP and Research Lead at the University of Nottingham Health Service and has a research interest in vaccinology and mental health.

• Read Dr Royal's full biography

 Director of the NIHR School for Primary Care Research

Professor Christian Mallen is the National Director of the NIHR School for Primary Care Research. He is the Head of the School of Medicine at Keele University, and an NIHR Research Professor in General Practice.

• Read Professor Mallen’s full biography

Public Involvement

We engage with and involve patients, carers, service users and members of the public in order to improve the reach, quality and impact of research in primary care.

Have your say in research

We involve patients, carers, service users and members of the public in our national research funding and support activities, including in primary care research.

• Find out more about getting involved in our national funding and support activities

The researchers we fund also involve patients in planning and delivering their primary care research.

• Find out how to get involved in NIHR-funded research in your local area

Our Local Clinical Research Networks involve people in primary care research taking place in your local area.

• Find your Local Clinical Research Network to see how you can get involved

Involvement opportunities across the NIHR

The NIHR Community Healthcare MedTech and In vitro diagnostics Co-operative works with members of the public across all of its themes and at all levels, helping to ensure that their research is grounded in issues that matter to patients and society.

• Find out more about getting involved with their research

The NIHR School for Primary Care Research, which aims to gather evidence to help decide what will make primary care better for everyone, is committed to meaningful patient and public involvement and public engagement.

• Find out more about getting involved with the School for Primary Care Research

Take part in research

Be Part of Research is an online service that lists opportunities to take part in primary care research across the UK.

Primary Care Programme

The NIHR are committed to strengthening research in primary care settings. The NIHR Clinical Research Network’s (CRN) Primary Care Programme will equip researchers and healthcare professionals to deliver research in Primary Care and lead to improved outcomes for patients.

Why is a Primary Care Strategy needed?

In late 2020 we recognised that Primary Care research activity had reached a crisis point. A lack of academic opportunities for GPs and other Primary Care health professionals, increased workloads and inadequate funding had seen a decrease in patient recruitment numbers and a drop in practices delivering Primary Care studies. It was not widely understood that research in this setting is fundamental to wider research delivery and patient care.

The Primary Care Strategy was written in 2021 by CRN and members of the public. It describes our aims to: 

• Allow everyone to access and benefit from health and care research
• Make research ‘business as usual’ in a Primary Care setting, in order to integrate with other systems
• Increase the range of research opportunities available in the CRN portfolio, to meet the needs of different people
• Contribute to an overall increase in research activity across the health and care sector.

Read the Primary Care Strategy and find out more about its aims and objectives. To receive a PDF version of the strategy please contact crnprimarycare@nihr.ac.uk.

Delivery of the Primary Care Programme

A Primary Care Programme Board was set up to deliver the strategy over a five year time frame through a number of projects. Primary Care research experts are involved to make sure the projects are relevant, innovative, and will support the Primary Care workforce. Each of the projects are linked to four key themes within the strategy:

• Theme A: Research is available and responsive to the health and care needs of our population
• Theme B: Digital: Adaptive connection of research systems and processes to Primary Care systems 
• Theme C: Strategic engagement and incentivisation 
• Theme D: Strategic development of the Primary Care Research Workforce

We have sub groups in place to deliver projects which fit into each of these themes. If you are interested in finding out more, or getting involved in the Primary Care Programme through one of our subgroups, please contact sarah.birch@nihr.ac.uk (Programme Manager)

For a timeline of our key milestones and achievements to date, please click here. 

Find out more about some of our current key projects and how you can get involved below:

• Primary Care Baseline Local Clinical Research Network (LCRN) Funding Attribution Report
• Primary Care High Level Objectives Review
• Implementing learning from COVID-19
• Improving Digital Solutions for Primary Care Research Delivery
• Standardising IT solutions
• Improving the Interactive Costing Tool
• Patient Identification Centres
• Life Sciences Industry Project
• Incentivisation work with NHS England

Primary Care Baseline Local Clinical Research Network (LCRN) Funding Attribution Report

The allocation of LCRN funding to primary care is currently identified in 2 ways during each financial year:

• In the quarterly LCRN returns, using the values attributed to delivery in the finance tool in line with the CRN Finance Tool Reporting Guidance
• The Finance Fact Sheet returned at year-end, as part of the Annual Report required documentation in line with the Finance Fact Sheet Guidance

The aim of the two reporting mechanisms is to accurately capture Primary Care spending in each LCRN. However, there remains a significant discrepancy between how this is reported by individual LCRNs in both formats. This varies from 0.84% of annual LCRN spend to almost 13%. 

The Baseline Funding Survey was launched in April 2022, following feedback from the Division 5 RDM group and Finance colleagues as to the appropriate format.

The following initial outputs were delivered as part of the project:

• A detailed baseline data gathering exercise from all 15 LCRNs about their current categorisation of primary care spending
• Defined areas of spend required to support primary care, resulting from the baseline data- gathering exercise

Results have identified that the current mechanism of gathering data to describe Primary Care funding allocations is inaccurate and under-estimates by 1.58% of the total allocation on average per LCRN.  In total this under-estimate results in a figure of £15,363,505 as opposed to the final figure of primary care spending totalling £19,933,236

As a result of this survey analysis, a number of recommendations have been put forward, including: 

• Using this survey annually
• Developing a further understanding of the funding schemes in each region
• Introducing minimum spend categories for Primary Care funding going forward

Primary Care High Level Objectives Review

A group was formed to review the current Higher Level Objectives (HLOs) in place relating to Primary care. This had been identified as an area of concern during the development of the strategy and a key priority to resolve. Four areas were identified to explore in more detail: 

• Deprivation
• Invitation to research/ research activity
• Participant identification centres
• Recruitment

A final recommendation report was approved via the CRN CC Executive in October 2022. 

In January 2023, it was announced that new HLOs for 2023/24 would have no Provider Participation metrics included

Implementing learning from COVID-19

The Quality Improvement: Implementing the Learning from COVID-19 Studies in Primary Care project is reflecting on learning from COVID-19 studies, to focus on increasing efficiency and effectiveness as we move forward.

During the pandemic the need for primary care delivery of COVID-19 studies gradually increased. There was recognition that the trials of interventions for patients with mild-to-moderate COVID-19 in the community were increasingly important, as was the identification of patients with Long COVID, the vast majority of whom are in primary care.

Find out more about our response to the pandemic:

• The NIHR has set up the record-breaking PANORAMIC study to test novel oral antivirals in a primary care setting. You can find out more about PANORAMIC on the study website or take a look at our case study from a trial participant. 
• The PRINCIPLE trial was the first study to test potential treatments for COVID-19 through GP surgeries and in the community. Take a look at our PRINCIPLE case study. 

Improving Digital Solutions for Primary Care Research Delivery

The Digital Solutions for Primary Care Research Delivery Project aims to improve processes to make them more efficient. This will make research more accessible to healthcare professionals and members of the public. Work underway includes:

• Research coding in Primary Care
• Data opt-out and research participation
• IT Challenges in Primary Care study delivery

Standardising IT solutions

Primary Care Research Informatics & Digital Environment Solutions (PRIDES) aims to standardise the IT solutions development and sharing processes that are essential for complex studies delivered in primary care settings.

The PRIDES Service offers researchers and GP practices support and advice on how best to use digital solutions to deliver studies in primary care settings. We work closely with key stakeholders to support the development of research solutions and tools for use in GP Practices.

Find out how this service can help you by visiting the PRIDES website.

Improving the Interactive Costing Tool

A number of functionality changes, recommended by an expert primary care working group, have been made to the NIHR's commercial interactive Costing Tool (ICT) in order to standardise indirect costs at 70% and improve  the accuracy of the tool for use in primary care. Read more.

Patient Identification Centres

Participant Identification Centres (PICs) are NHS/HSC organisations that identify potential research participants. The PIC project focuses on introducing standard reporting of PIC Activity within the Central Portfolio Management System (via Local Portfolio Management Systems), concentrating initially on data integrity held within the systems.

Life Sciences Industry Project

There is a lot of potential for Primary Care Life Sciences Industry research building. Some of this has been demonstrated by our experience from the pandemic, and work successfully delivered through the Primary Care Programme.

The aim of the Life Sciences Industry Project is to address the fact that Primary Care is currently under-represented in commercial research as a delivery setting.
We are in the process of forming a Commercial Advisory Group to advise on how to learn more about the benefits, challenges, barriers and solutions companies have discovered when working with primary care either as sites or PICs. If you would like to be involved or register an interest, please contact karen.l.matthews@nihr.ac.uk

To learn more about our industry offer, please contact supportmystudy@nihr.ac.uk or industry@nihr.ac.uk

Incentivisation work with NHS England

We are currently working with NHS England to explore the potential of incentivisation into the GP Contract for research. We will work in partnership with Be Part of Research and look to incentivise GPs who introduce the service to their patients. Fortnightly meetings are taking place, and we aim to launch a pilot incentivisation scheme by September 2023. 

Get in touch

As we work towards planning for the second year of the Primary Care Strategy, we want to hear what you have been doing in this space.

We are also happy to answer any questions you may have about the strategy and the work that we are delivering, or provide any resources which may support you in telling others about the strategy.

Share your questions and feedback via this google form.