What do you need to know about research in primary care?

The jargon, acronyms and funding streams keep changing. It’s difficult for all of us to keep up to date with it all!

The DoH published 'Best Research for Best Health: A new national health research strategy' in 2006 and changed the organisation and funding of research throughout the NHS.

Details are at The National Institute for Health Research website (NIHR): www.nihr.ac.uk

All the funding is more centrally controlled and focused on NHS priorities. 

General Information about research

RESEARCH is finding out what we ought to do or the attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods Clinical research is based primarily on patients or ex-patients and designed to answer a question about disease (aetiology, concomitants, diagnosis, prevention, outcome or treatment).

This page tries to be a summary of what is happening in the world of primary research around Bristol, and point you in the right direction for more information. If you have any suggestions about how we can improve this section, or want to learn more, or get involved with research in primary care email contact@bristolgpsolutions.org.uk.

There are two main types of research in primary care, commercial (industry) and non-commercial (academic). Non-commercial research is usually funded by the NHS, research councils, charities or grant giving bodies and covers a wide range of activities motivated by knowledge rather than commercial gain. Commercial research is usually funded by pharmaceutical companies undertaking clinical trials of new medicines.

ALL research in NHS primary care must comply with NHS research governance guidelines. The local policy that covers all the Bristol area PCTs is at http://www.apcrc.nhs.uk/research_governance.htm

There is a grey area between clinical audit and research (e.g. innovations) and if you are unsure, you are advised to ask the chairman of the local ethical committee for guidance.

The Research Networks

The research networks (general, topic clinical and primary care- see below) support the NHS funding streams e.g. Medical Research Council (MRC), Health Technology Assessment (HTA), and help these bodies realise the research they are funding. In addition, they support industry research that is in the interests of the NHS. http://www.ukcrn.org.uk/index/

The South West’s Primary Care Research Network (PCRN SW): www.pcrnsw.org

Dr Phil Evans, based in Exeter is the Director, and the local contact for the network is Dr Peter Brindle who is also Director of R&D, Avon Primary Care Research Consortium. The network has set up an annual primary care incentive scheme (PCIS) and has £330K from Western Comprehensive Research Network to reward/support practices that host research.

Level 1 practices receive £1500pa to complete a site profile, designate a research lead, hold 1-2 meetings each year with the local network facilitator, comply with research governance, consider new studies on a regular basis, consider commercial studies for adoption by the practice, host up to 3 NIHR studies each year, and undertake the clinical activity to recruit patients.

Level 2 practices receive £4000pa for additional work that hosts 4 or more NIHR studies each year, undertake rapid feasibility assessments for new (often commercial) research, maintain high quality and validated diagnostic registers, and the lead clinicians undertake GCP training by the end of the first year.

High recruiting level 2 practices can also apply for additional sessional funding (get more information from Jane Bridger janebridger@nhs.net).

There is also Flexibility and Sustainability funding that will support practices do research. Details of 2009-2010 due soon. http://www.wren.soton.ac.uk/fsf.html (info Jane Bridger janebridger@nhs.net).

Lead clinicians in Level 2 PCIS practices will be expected to have undertaken a half-day course in ‘Good Clinical Practice (GCP) and the EU Directive in Primary Care’. PRCNSW provides this course free of charge around the South West on a regular basis. http://www.wren.soton.ac.uk/PCIS_Event_2009.htm

On line GCP courses are also available. http://www.ukcrn.org.uk/index/training.html

PCIS for practices has replaced the Bristol and District Primary Care Research and Development Consortium. Terry Kemple is now a ‘research champion’ for the PCRN to encourage and facilitate researchers and practices in successful research.

More details are at www.pcrnsw.org website or contact Dr Jane Bridger (email janebridger@nhs.net) for more information. 

Western Local Comprehensive Research Network (CLRN) is one of 25 CLRNs across England which form part of the NIHR Comprehensive Clinical Research Network (CCRN). CCRN provides support for clinical trials and other well designed studies in all areas of disease and clinical need, includes all research that isn't in the topic specific networks (see below), manages the NHS service support costs, research management and governance. UBHT lead this network. http://www.ukcrn.org.uk/index/networks/comprehensive/clrns/western.html

The DoH funded topic research networks provide hubs and/or spokes for research across the region. These include

Medicines for children. This is lead by Prof Adam Finn in Bristol.The contact for the network is Dr Ruth Allen Ruth.Allen@bristol.ac.uk Tel: 0117 3420197 Mobile: 07775764820 - http://www.mcrn.org.uk

Dementias & Neurodegenerative Diseases Research Network (Dendron) - http://www.dendron.org.uk/rn/south_west.html

Diabetes Network - http://www.ukcrn.org.uk/index/networks/diabetes.html

Mental Health Network - http://www.mhrn.info/dnn/Default.aspx?tabid=83

Stroke Network - http://www.ukcrn.org.uk/index/networks/stroke.html

Cancer Network - http://www.ukcrn.org.uk/index/networks/cancer.html

The Avon Primary Care Research Collaborative is hosted by NHS Bristol  and is responsible for all Research Management and Governance in the following PCTs: NHS South Gloucestershire, NHS North Somerset, and NHS Bristol.

The Avon Primary Care Research Collaborative website is: www.apcrc.nhs.uk.

NHS acute trusts

The two acute trusts in Bristol (North Bristol and UHBT) have research programmes and may involve primary care to recruit patients or host research.

NBT research http://www.nbt.nhs.uk/research...

UHBT research: http://www.uhbristol.nhs.uk/research.html

Universities

University of Bristol. The Division of Primary Health care, is an active research unit. Current projects include http://www.bris.ac.uk/Depts/PrimaryHealthCare/research.htm

UHBT/ University of Bristol Joint clinical academic and commercial research unit programme is based at the BRI and wants to recruit practices to host commercial and non-commercial research. For more information contact Sue.allen@bris.ac.uk

University of West of England Research in the School for Health and Social Care August 1st 2007 saw the establishment of the new Faculty of Health and Life Sciences based upon a merger of the previous faculties of Applied Sciences and Health and Social Care. These pages refer mainly to research in what has become the School of Health and Social Care (the other school is now known as the School of Life Sciences; formally the Faculty of Applied Sciences).Much of the research of the school lies within its three University-recognised research centres
- Centre for Public Health Research (Director: Judy Orme)
- Centre for Clinical and Health Services Research (Director: Professor Selena Gray)
- Centre for Learning and Workforce Research (Director: Dr Pam Moule) as well as its postgraduate research studies.

In addition, it has close links with a number of other research groupings. 

First, there is the Centre for Child and Adolescent Health, which is a joint initiative between the University of the West England and the University of Bristol and based in the University of Bristol under the direction of Professor Alan Emond. 

Second, there are very close links with the Centre for Appearance Research, Professor Nicky Rumsey (Co-Director, Professor in Health Psychology) and Dr Diana Harcourt (Co-Director, Reader in Health Psychology)  which was based in the Faculty of Applied Sciences, but which is now providing a focus for psycho-social research on health related issues for the new faculty.

Third, the School works closely with the Speech and Language Therapy Research Unit, hosted by North Bristol NHS Trust and directed by Professor Sue Roulstone and Dr Brian Pertheram. In addition, the School of Health and Social Care is delighted to host the Centre for Local Democracy, which is a multi faculty initiative under the direction of Professor Chris Miller.

Finally, it also hosts SOLAR which is a whole systems actions research group which is under the direction of Professor Danny Burns.

University of Bath http://www.bathspa.ac.uk/

An active contributor to the NIHR Portfolio, with studies currently focusing on how technology can support patients, e.g. chronic pain SMARTII, or with sleep, SOMNIA. For more information contact Lisa Austin, Research Manager la217@bath.ac.uk

http://www.bath.ac.uk/health/researchsupport/pbspcrc/

What's new in research

UHBT NHS Trust Research research news http://www.uhbristol.nhs.uk/research/latest-news.html

RCGP research news http://www.rcgp.org.uk/research/whats_new/index.asp 

Resources

http://www.rcgp.org.uk/research/resources/index.asp

In October 2008 the Research and Development Support Service (RDSU) at the BRI changed to become the Research Design Service (RDS) which will concentrate more with NIHR and the NHS regional ‘research for patient benefit’ studies. For contact information see http://ww.uhbristol.nhs.uk/research/how-to-contact-us.html

There are regular Research Skills Workshops at the BRI and Southmead Hospital. http://www.uhbristol.nhs.uk/research/information-for-researchers.html

UK Federation of Primary Care Research Networks. The Federation was established in 1998 to bring together research networks from around the UK, to facilitate their collective functioning and promote their interests at a national level. Its future may be threatened by the changes in financing research. hhttp://www.ukf-pcro.org/

How to get started

The RCGP/PCT study day in April 2006 discussed this and the slides from that day will help you: The programme and the power point slides

'Insights From Practice-based Researchers to Develop Family Medicine Faculty as Scholars' examines how practice based research can get started http://www.stfm.org/fmhub/fm2007/July/Linda504.pdf

GP school Education and Research

The Severn Deanery serves the northern half of NHS Education South West.  The school of primary care commissions and undertakes research into postgraduate medical education in primary care.  It collaborates in this with a number of research bodies including independent researchers, universities and the RCGP. For more information http://primarycare.severndeanery.org/faculty/research

Educational research has been an apparently ugly Cinderella that is waiting a makeover and an invitation to the ball for improving quality of teaching and learning. The literature has too many studies that are observational, address only local questions, are small scale, repetitive, lack any theoretical basis, and do not build on the knowledge base. In planning a project it’s helpful to start by writing a ten sentence abstract of the completed project that includes the practical problem that you are trying to solve, the theoretical problem you are trying to solve (the theory should include an explanation a prediction and a testable hypothesis), the methodology (what data is needed, is there a defined outcome, where is the data obtained, how is it collected, how many subjects, how is the data recorded and stored), the analysis (how will the results be analysed) and the findings (what do you expect to find including the practical and theoretical implications).

The Society for Academic Primary Care (SAPC), formerly the Association of University Departments of General Practice (AUDGP) promotes excellence in research, education and policy development in general practice and primary health http://www.sapc.ac.uk/

The North American Primary Care Research Group (NAPCRG) is a multidisciplinary organization for primary care researchers. Founded in 1972 and oriented to family medicine, NAPCRG welcomes members from all primary care generalist disciplines and related fields, including epidemiology, behavioral sciences, and health services research http://www.napcrg.org/

The MRC General Practice Research Framework (MRC GPRF) is an organisation of over 1000 general practices throughout the UK involved in epidemiological, primary care and health services research. Working in partnership with researchers the GPRF serves as a national resource to undertake high quality studies that require a co-ordinated framework of general practices http://www.gprf.mrc.ac.uk/

INVOLVE - promoting public involvement in NHS, public health and social care research www.invo.org.uk

The EQUATOR Network promotes transparent and accurate reporting of health research, and provides up-to-date resources related to health research reporting for:

authors of research articles

journal editors and peer reviewers

reporting guideline developers