The community setting in the UK offers unique opportunities for delivering health and social care research.
This page describes some of the NIHR support and services that are available to help you to plan and deliver clinical research in the community. If you would like to know more please use the contact form to get in touch.
In addition to General Practice (GPs), the community setting is vast and includes: pharmacies, care homes, hospices, ambulance services, prisons, schools, Opticians and community based practices.
A range of healthcare providers and professionals can help us to access large, diverse and often hard to reach patient populations. They can also help us to access patients who are at different stages of their disease progression, such as those who are self-managing long-term conditions, or accessing care through a primary care or community care setting, rather than secondary care services.
Add to this the fact that in recent years the management of many long-term conditions has shifted from secondary to primary care in the UK. The National Health Service (NHS) “Five Year Forward View” strategy supports this change and is looking to further break down healthcare provision barriers, allowing for more care to be delivered, and for patients to have more control of their own healthcare.
If your research is looking at long-term, chronic conditions in adults and older patients, then conducting your study in a care home setting could be beneficial for a number of reasons.
Firstly, the sheer number of potential patients, coupled with the fact they represent a diverse demographic, means that the care home setting provides an excellent cross section of the UK’s older adult population.
In 2017 the Competition and Markets Authority (CMA) calculated that there were 11,300 care homes in existence in the UK, operated by around 5,500 different providers. It also estimated that there were around 410,000 people living in those care homes, which equates to approximately 6% of the population. To put these numbers in context: there are twice as many people living within care homes in England and Wales than there are staying in hospitals.
Secondly, care homes offer different levels of care which range from helping residents to self-manage long-term conditions, right through to nursing residents with complex and severe illness and multiple morbidities. As well as offering opportunities to rapidly identify potential participants for studies, they also widen access to research for patients who are not accessing secondary care. Care homes are also both keen and able to reach out to relatives of residents and offer opportunities to take part in research, where appropriate.
Providing equitable access to health research is a high priority for the NIHR and it is therefore important that care home residents, and their relatives, are given opportunities to participate in studies and trials. Linked to this is the fact that overwhelming enthusiasm exists among care home residents to become involved in health research, as the videos below will demonstrate.
To encourage and support care home research the NIHR co-funded and launched the ENRICH (Enabling Research In Care Homes) initiative in 2013. This initiative has a dual purpose of helping researchers to access and engage care home residents, and also to ensure that the care home residents have opportunities to take part in clinical research. There are currently over 850 research-ready care homes registered with ENRICH and work continues to increase this number.
In addition, the NIHR Clinical Research Network is funded by the government to support researchers to plan, set-up and deliver high quality research in England through it’s Study Support Service. Our national and local teams can assist with all aspects of study delivery from feasibility, through to site identification, study set-up and performance monitoring. The following videos describe why researchers should consider care homes as sites for health research and provide some advice to those who are keen to explore this opportunity further.
Herncliffe Care Home in Keighley, West Yorkshire, is a research-active care home and has supported a number of studies including the FinCH study. In the first video Care Home Manager, Mary Harrison, and Research Nurse, Angus Sturrock, explain what care homes have to offer and convey how care home employees, residents and relatives are keen to take part. Care home resident, Doreen, also explains why she feels it is important to take part in health research when opportunities arise.
In the second video Care Home Manager, Mary Harrison, and Research Nurse, Angus Sturrock, provide advice and information for researchers about the range of NIHR support available and how to get started.
A Public Health research paper published in August 2014 in the British Medical Journal showed that the majority of the UK population (89.2%) can access a community pharmacy within a 20 minute walk and, crucially, access is greater in areas of highest deprivation. In comparison the figures are lower for ability to access a General Practice within a 20 minute walk (84.8%). In 2017 an NHS digital publication calculated that there were almost 12,000 community pharmacies in the country, an increase of 13.5% since 2008. These facts combined create an attractive prospect for health researchers for a number of reasons, with accessibility being the key benefit.
When compared to a General Practice, community pharmacies offer more convenient opening hours, out of hours support, access on weekends and they do not require appointments. Community pharmacists can also access harder to reach patient populations and different patient populations to General Practice and secondary care. For example, some people might not know if they need to visit a GP and may instead visit a pharmacy for advice about what they believe to be minor ailments. This provides access to patient populations at a different, and often very early, stage of their illness or condition compared access via a GP or secondary care. In addition, people with long-term conditions see the pharmacist more frequently than they see their GP, for instance when collecting repeat prescriptions. Again giving pharmacists a different level of access to those patients.
In the UK two initiatives have been established to help harness research capacity and capabilities in community pharmacies.
Community Pharmacy Research Champions exist in each of the 15 regional areas that are served by the NIHR Clinical Research Network. These individuals help researchers to access the research-ready pharmacies in their area. They also support the growth of the pharmacy research infrastructure by promoting research and supporting fellow pharmacists in their locality to engage in research activities. In addition, the NIHR Clinical Research Network is funded by the government to support researchers to plan, set-up and deliver high quality research in England through it’s Study Support Service. Our national and local teams can assist with all of aspects of study delivery from feasibility, through to site identification, study set-up and performance monitoring.
The Royal Pharmaceutical Society runs a ‘Research Ready’ accreditation scheme for pharmacies in the UK. It requires a pharmacy to have a dedicated research lead and for all staff to have undertaken Good Clinical Practice (GCP) training (which is mandatory for employees who will help to deliver a study). There are currently over 100 pharmacies registered.
The following videos explain further why researchers should consider delivering health research through community pharmacies and provide some advice to those who are keen to explore this opportunity further.
Jhoots Pharmacy in Castle Bromwich is a research-ready pharmacy and has supported a number of studies including the Rococo study.
In the first video Lead Pharmacist, Julie Shenton, is joined by Community Research Champion, Kaldeep Singh, and Pharmacist, Kiran Sidhu, to explain some of the benefits and opportunities that pharmacies offer, when compared to the more traditional settings of primary care (general practice) and secondary care.
In the second video the same pharmacy team describe the different ways that community pharmacies can support research delivery.
In the final video Community Research Champion, Kaldeep Singh, and Lead Pharmacist, Julie Shenton, provide valuable advice and information for researchers who are considering delivering health research in a pharmacy setting.
Learn more about how we help to deliver research in community settings.
Professor Yan Yiannakou is a strong advocate for community-based health research. In the videos below he describes what he calls “the power of reaching out into the community” to recruit patients into studies, and to provide wider access to health research for patients.
Many common and chronic conditions such as episodic migraines and diverticular disease are no longer looked after in secondary care, due to our excellent primary care system in the UK. As a result, only the patients with the most severe or refractory illness present at secondary care. Professor Yiannakou explains how adopting a community-based recruitment strategy can help researchers to achieve patient cohorts that are more typical of the wider patient population.
The new P3 Clinical Trial Unit in Newcastle, where Professor Yiannakou is based, has been designed to bridge both primary and secondary care, and to reach into the community. It focuses predominantly on recruiting patients from the community into commercial contract studies that are typically investigating conditions where the patients are not being treated in hospitals or specialist clinics.
In this first video Professor Yiannakou cites the Relieve-IBS-D study as an example which struggled to recruit patients from secondary care. In contrast, when the recruitment strategy was switched to focus on GPs, pharmacies and social media, the study recruited 180 patients in under a year.
IBS is a common condition experienced by 10% of the UK population. Despite its prevalence, IBS studies are struggling to recruit sufficient patients. One reason is that studies still focus their recruitment strategies on hospitals. However, most IBS patients prefer to manage their own condition with help from pharmacists, also avoiding frequent visits to the GP.
ContactMe-IBS is investigating how effective social media and other techniques are at delivering patients into IBS Randomised Controlled Trials (RCTs). It works by recruiting patients to a research-registry on the understanding that those patients have consented to be contacted about suitable research studies.
In this second video Professor Yiannakou describes how the study has had a “tremendous response” from across the community setting. In two years over 3000 patients have registered and both observational and interventional trials are benefitting from this valuable research resource. One study, which aimed to recruit 1000 patients, had previously recruited 470 patients over the course of a year. Using the registry it recruited 530 patients in one week.
Learn more about how we help to deliver research in community settings such as pharmacies and care homes.