Q&A with Professor Philip Evans
“The future of Primary Care research and its challenges”
Primary care has a unique structure in the NHS in England. Almost 100 per cent of patients are registered with a general practice which holds their unique health record. Primary care organisations are the first point of contact with patients with 7,840 practices providing over 340 million consultations every year.
This data-rich structure greatly facilitates clinical research recruitment and to date the primary care research community is thriving. But how can we maintain this engagement to ensure patients continue to have access to the latest treatments and medical technologies?
Professor Philip Evans is National Specialty Lead for Primary Care for the NIHR Clinical Research Network, we asked him what the future research landscape will look like and how we’re going to rise to the challenge.
In 2015/16, 42 per cent of general practices in England were research active and since the Primary Care specialty began, one million people have now participated in Primary Care research studies - how has the Network driven this engagement?
“Traditionally, patients were recruited to research studies through secondary care in hospitals. The Network soon realised that for a large number of specialty areas, the patients we needed to access were in primary care, and registered with their local general practice; so we started to approach general practices about research.
“Due to our Network structure, we could provide the practices with the funding and resources they needed to start out in research and local support was available to help them with study set-up and delivery. The main thing was to make sure that practices, as independent businesses, were not disadvantaged by taking on research.
“We later worked with the Royal College of General Practitioners on Research Ready®, this was and still is an excellent model for exposing practices to research and providing accreditation.”
In 2015/16, the NIHR supported 249 open Primary Care research studies, 25 of these studies were sponsored by the life sciences industry - this is an area of the research portfolio that we need to grow…
What are the challenges for the NIHR and how will the Clinical Research Network tackle this over the next year?
“We need to promote the UK to the life sciences industry as the place to do research. Primary care has a unique structure in the NHS, almost 100 per cent of patients have cradle-to-grave contact with their general practice, and these practices hold their complete health records - this greatly facilities recruitment to research studies. The life sciences industry often target patients with chronic illness and these are frequently managed exclusively in primary care.
“Of our 7,840 general practices in England over 1,000 are now Research Ready® accredited and 42 per cent research active. We must continue to support these research active practices but also promote the benefits of doing research to other practices. We also need to look at primary care in its broadest sense and look outside single general practices; we are continually looking for opportunities to engage in commercial research with other providers such as pharmacies, dentists and federations.
“The Network has also encouraged practices to submit data to the large epidemiological databases such as the Clinical Practice Research Datalink (CPRD) providing much-needed answers to important health questions in primary care.”
What are the challenges for primary care organisations?
“I think it’s important to say that not all general practices would have the capacity to support commercial research. It is quite a commitment and there are a number of practicalities to consider; would they need to employ new staff, what training would they need, what equipment is required? It’s often both a cultural and managerial shift within the practice which takes time to implement.
“However, we are now seeing an increase in collaborative working between practices, which is a very efficient way of working for sharing expertise and increasing the database of patients available for recruitment.”
How can primary care organisations, as one of the first points of contact with patients, help the public to see the NIHR as a force for good?
“Patients get to know and build a relationship with their GP and their practice so general practices have a very important and influential role to fulfill in keeping patients informed of their healthcare options, including participation in research. Patient Participation Groups are also an important vehicle for promoting research.”
As National Specialty Lead for Primary Care and a practising clinician - how do you see the primary care landscape in the future and how will research have impacted on this?
“The NHS landscape is changing rapidly, particularly with the workload pressures on primary and secondary care and our ageing population. As outlined in the NHS Five Year Forward View, in five years time the NHS could look very different. It is imperative that the NIHR and NHS research change with it and be ahead of the game to ensure we meet the future needs of patients and the public.
“Working with industry has many benefits, it attracts investment, it drives growth, but ultimately, it results in new treatments and medical technologies for patients. We must maintain and strive to increase the level of commercial research activity within the NHS, ensuring there are opportunities to take part across all sectors of healthcare as well as public health and social care.”