Primary Care and the Clinical Research Network A wake up call
"Primary care services provide the first point of contact in the healthcare system, acting as the 'front door' of the NHS. Primary care includes general practice, community pharmacy, dental and optometry services." - NHS England
98% of the UK population are registered with a general practitioner. In 2019 there were 307 million GP Practice appointments, equating to more than a million appointments per working day and is rising year-on-year. This contrasts with 43 million in secondary care in the same year: 5 million emergency admissions in England, 14 million GP referrals to hospital and 24 million ED attendances.
The NIHR Clinical Research Network exists to deliver research relevant to the population through timely recruitment of study participants and widening patient choice to take part. Yet most research pre pandemic was still being driven from or through secondary care whilst there was a continuing gradual decline in primary care research activity.
"Over the years I have attended many research discussions and so often it is only at the end of the meeting that someone says '.....and what about primary care?'" - Phil Evans
There is a need to be able to deliver tangible improvement in the quantity and breadth of research supported and managed in primary care in what is a broad and complex care delivery environment most often encountered by the public.
Any new approach needed to be pragmatic in developing traction for research in primary care where it can have the most likely long term benefit, taking into account:
- The developing Primary and community care sector and the platforms and influences within it
- The developing research ambition
- Current and likely future resources within the CRN
- Precedents and recent innovations for effective approaches to achieving change
- The policy and contractual drivers impacting on Primary care research
- The likely benefits to patients and public in this context
"The Clinical Research Network, working with our NIHR and wider strategic stakeholders, will develop, promote, and facilitate high quality research in the primary care setting that is integral to delivering health and care, for the population’s benefit." - Blueprint vision of the CRN primary care strategy.
Key themes in the CRN Strategy:
In a fast-changing Research and Primary Care environment, it is important that the following principles are also applied across the board to ensure a fully agile and responsive approach to embedding research in Primary Care settings relevant to the needs of the wider population:
Describing exactly what kinds of services are covered or not covered in primary care is somewhat controversial. However, for the sake of research delivery the following was agreed as an approximation:
Since the launch of the 5 year CRN Primary Care Strategy in 2021 the CRN has set up an internal Primary Care Research Programme Board, developed an operational delivery plan, and begun undertaking a series of projects to develop the infrastructure for primary care research. Part of the programme is to increase awareness of primary care, and research activity in this setting and the learning event is one way this is being done.