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Primary Care

The NIHR is the nation's largest funder of health and care research and provides the people, facilities and technology that enable research to thrive. We work in partnership with the NHS, universities, local government, other research funders (including industry and charities), patients and the public to improve the health and wealth of the nation. 

In 2018/19, the NIHR Clinical Research Network (CRN) supported 562 primary care studies, 209 of which were new studies, and recruited 160,146 patients to studies within this specialty area.

The NIHR School for Primary Care Research is a partnership between nine leading academic centres for primary care research in England. The School brings together academics and practitioners from across the country to collaborate on cutting edge, topical primary care studies that have an impact both at policy level and in general practices around the country.

Screening and brief intervention for obesity in primary care (BWeL)

Obesity greatly increases the risk of long-term health consequences - including diabetes, cardiovascular disease, disability and depression - creating a huge strain on health services and costing the NHS in England an estimated £6.1 billion a year.

Guidelines recommend that GPs and primary care practitioners routinely screen and offer advice to their patients to motivate weight loss through behavioural weight loss programmes. Yet despite the high prevalence of obesity - primary care patient surveys and recordings of consultations indicate that GPs do not routinely intervene. 

The NIHR Clinical Research Network (CRN)-supported BWeL trial set out to assess the effect of delivering a brief, opportunistic behavioural-change intervention within primary care services on weight loss amongst clinically obese patients. It was the first clinical trial to look at the potential impact that different opportunistic GP interventions may have on reducing obesity in primary care.

The study found that the behavioural change intervention used was not only clinically effective and short enough to be deliverable within GP appointments, but also extremely cost effective.

Identification of gambling problems in primary care

Gambling is increasing in the UK, with surveys indicating that around 59% of British adults had gambling activities in 2010, up 7% from three years earlier. Primary care presents a potential context for identifying patients with a gambling problem, who would benefit from the early intervention or specialist services. Experts say it is an area that needs more attention if primary care services are to help those in need.

In a cross sectional study funded by the NIHR School for Primary Care Research, a team of researchers at the University of Bristol explored gambling problems and gambling-related problems (anxiety, financial strain and relationship breakdowns), among 1000 patients attending general practices across 11 general practices in southwest England.

The study found that an improved understanding of the burden of, and responses to, gambling problems is required by general practices in order to address the health-related behaviour.

Evaluating an online consultation system in GP practices

GP workload has increased by 16 percent between 2007 and 2014, putting pressure on UK primary care services. GP practices have struggled to meet this challenge, and two thirds of GPs report unmanageable workloads. Difficulties accessing appointments have become a source of patient dissatisfaction. Online consultations are potentially a way to improve patient access and to reduce GPs’ workload from face-to-face consultations.

Researchers at the NIHR Collaboration for Leadership in Applied Health Research and Care West evaluated the effectiveness, acceptability and impact of implementing an online consultation system called eConsult, a platform that patients access via their GP practice website.

Across the participating practices patient use of the system was low during the pilot. Although the system did save some patients having to see their GP, the majority of e-consultations resulted in either a face-to-face consultation or a telephone call from a GP.

Education and support to help GPs spot early signs of psychosis

Psychotic disorders such as schizophrenia cause enormous disability and are very expensive for families and society. Early intervention services identify and treat people with first episode psychosis or mental states putting them at high risk of developing psychosis with the aim of improving outcomes and possibly preventing more serious disease and disability.

In the Liaison with Education and General Practices (LEGS) trial, funded by NIHR Programme Grants for Applied Research, 24 general practices were randomised to a “high-intensity” intervention which involved a specialist mental health professional providing a one hour educational session at each practice, a booster session one year later and ongoing liaison and support.

The researchers found that this tailored education session doubled the early identification and referral of people with, or at risk of, psychotic illness compared to a postal educational campaign or practice as usual. It was also the most cost-effective intervention mainly due to the potential for subsequent savings from prevention of people developing more severe illness.

Treating back pain according to patient prognosis

It is widely known that back pain can be a considerable problem for some people and remains a challenge for GPs and physiotherapists to treat.

The STarT Back Trial, funded by Arthritis Research UK, is an example of a stratified care approach according to a patient’s prognosis (low, medium or high risk). By using a targeted questionnaire tool, primary care clinicians can identify the correct course of treatment for the patient. The study compared the clinical and cost effectiveness of those participants who received the stratified care approach with those that did not.

The study recruited 1573 participants, 18 years and over who were suffering from back pain. Consultations took place at 10 general practices within West Midlands North region. Potential participants were identified via support from the NIHR Clinical Research Network.

Diagnosis of UTIs in young children

The NIHR Clinical Research Network (CRN) Primary Care Specialty supported research that will help GPs diagnose urinary tract infections in children and improve antibiotic use.

The study, funded by the NIHR Health Technology Assessment (HTA) Programme, sought to develop algorithms to accurately identify pre-school children in whom urine should be obtained and assess whether or not dipstick urinalysis provides additional diagnostic information.

After a three-year study involving more than 7,000 children, researchers have developed a technique to help GPs and nurses diagnose urinary tract infections in children. There is also hope is that this will help to better target antibiotic prescribing, so only those who are likely to benefit from antibiotics receive them.

Find a primary care study in your area

You can find out more about primary care studies in your area through the Be Part of Research website.

We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.

We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.

Support for primary care research

We are working 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 which 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 Network to deliver high quality research in a primary care setting.

You can find out more about Primary care studies in your area through our Be Part of Research website.

National Primary Care Specialty Group

Each of our 15 Local Clinical Research Networks has at least one nominated local Clinical Specialty Research Lead for Primary care. These clinicians lead research groups to promote and support Primary care health research across health and care settings in their area.

Resources

Primary Care specialty profile

The Primary Care Specialty profile gives an overview of our offer to the Life Science industry.

Preparing primary and community care in the NHS for genomic research: A joint report by the NIHR CRN and RCGP

In June 2019, the NIHR Clinical Research Network (CRN) published a joint paper in partnership with the Royal College of General Practitioners (RCGP) on preparing primary and community care NHS organisations for genomic research. Find out more and download the report here.

The General Practice Podcast

Associate Professor Philip Evans, NIHR Clinical Research Network National Specialty Lead for Primary Care, talks about the role of research in general practice in this podcast for Ockham Health.

 

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 also established a longstanding partnership with the Royal College of General Practitioners (RCGP), supporting the following initiatives:

RCGP Awards

The awards recognise outstanding contributions of NHS general practices and First5® who are active in research. For further information visit the RCGP Research Awards webpage.

RCGP Research Ready® for general practices

Research Ready® for general practices 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. Find out more.

RCGP Research Ready®  for pharmacies

Research Ready® for pharmacies was developed by the Royal Pharmaceutical Society and the Clinical Research Network to support pharmacies to carry out high quality research. This quality framework helps pharmacies to develop a research culture and ethos. Find out more.

Clinical Practice Research Datalink (CPRD)

Clinical Practice Research Datalink (CPRD) is a UK Government research service, jointly supported by the National Institute for Health Research and the Medicines and Healthcare Products Regulatory Agency. CPRD provides access to anonymised NHS data for observational and interventional public health research. 

Find out more about contributing and using data at www.cprd.com

The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.

NIHR Collaborations for Leadership in Applied Health Research and Care 

NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are collaborations between local providers of NHS services and NHS commissioners, universities, other local organisations and the relevant Academic Health Science Network. The primary focus of CLAHRCs is on research targeted at chronic disease and public health interventions. The following CLAHRC undertakes research in primary care:

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 School for Primary Care Research

The NIHR School for Primary Care Research is a partnership between nine leading academic centres for primary care research in England. The School brings together academics and practitioners from across the country to collaborate on cutting edge, topical primary care studies that have an impact both at policy level and in general practices around the country.

Work with our infrastructure

The NIHR Office for Clinical Research Infrastructure (NOCRI) helps public, charity and industry research funders work in partnership with NIHR infrastructure. Find out more about how they can support collaborations in the partners and industry section of our website.

The NIHR funds and supports world-class experts in the field of primary care. In addition, our experts in the NIHR Clinical Research Network (National Specialty Leads) can advise on delivering your primary care study in the NHS or wider health and social care settings.

Associate Professor Philip Evans

Associate Professor Philip Evans MPhil FRCGP is the NIHR Clinical Research Network National Specialty Lead for Primary Care.

Associate Professor Evans is a GP at St Leonard’s Practice in Exeter, Devon. He is the NIHR Clinical Research Network Specialty Cluster Lead for Dermatology, Mental Health, Primary Care and Public Health based at King’s College in London and the National Specialty Lead for Primary Care both inside and outside of general practice.

He trained in Guy’s Hospital and then did GP training in Plymouth before moving to Exeter as a GP in 1987 and he has been in the same practice ever since. Professor Evans was an RCGP Research Training Fellow from 1988-1990 and then Lecturer in the University of Exeter. He is now an Associate Professor in the University of Exeter Medical School. He has a research interest in the management of pre-diabetes and also the prevention and diagnosis of type 2 diabetes in primary care.

He has been Director of three Primary Care Research Networks, most recently the Primary Care Research Network South West.

E: p.h.evans@exeter.ac.uk 

Professor Richard Hobbs

Professor Richard Hobbs is the National Director of the NIHR School for Primary Care Research (2009-) and was co-Director of the Quality and Outcomes (QOF) Review Panel from 2005-09. He sits on many national and international scientific and research funding boards, including the Council of the British Heart Foundation (until 2012), the Board of the British Primary Care Cardiovascular Society, and am President of the European Primary Care Cardiovascular Society (EPCCS).

His research interests focus on cardiovascular epidemiology and clinical trials, especially relating to vascular and stroke risk, and heart failure. Overall his publications include 28 book chapters, 13 edited books and over 350 original papers in peer reviewed journals such as the Lancet, Annals of Internal Medicine, BMJ, Atherosclerosis, EHJ and Stroke. His research has impacted on international health policies and clinical guidelines. Within the NHS, he has consulted on National Service Frameworks for CHD, atrial fibrillation, and heart failure and several National Institute of Clinical Excellence (NICE) reviews.  He has also provided clinical care in inner-city general practice for over 30 years.

Related specialties

Dermatology

Mental health

Primary care

Public health and prevention

 

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