F E AT URE PRIMA RY CA RE
Has your practice ever considered getting involved in primary care research? GP David Shukla offers a personal perspective on the benefits
RESEARCH READY
I
N 2007 I joined a GP surgery in Dudley already established in teaching and training, and as a young partner I was keen to bring something new to the practice. We regularly received a newsletter from the local Clinical Research Network (CRN) hosted at the University of Birmingham, detailing
research studies being run in primary care and recruiting GP practices to take part. The CRN is part of the National Institute for Health Research (NIHR), which is considered the ‘research arm’ of the NHS. I contacted the CRN for further information and we were visited by two of their ‘research facilitators’ who explained what was involved and provided us with details of studies considered suitable for a practice with no research experience. We felt that getting involved in primary care research could benefit the practice by giving our patients the opportunity to partake in research relevant to them, which could potentially bring about benefits to their care. We were encouraged to undertake
training in Good Clinical Practice (GCP), which is the international ethical, scientific and practical standard to which all clinical research is conducted. Compliance with GCP provides public assurance that the rights, safety and wellbeing of research participants are protected, and is a requirement of the Research Governance Framework for Health and Social Care (2005) which covers all research in the NHS in England. The NIHR offers GCP training either as a face-to-face workshop, or as an online module.
COUGH STUDY The first study we joined was the 3C cough study which recruited patients presenting with an acute cough. The study involved asking a few questions about presenting symptoms, recording a detailed examination, and then undertaking a follow-up ‘notes review’ which was conducted by our practice nurse or healthcare assistant one month after initial attendance, detailing what had happened to the patient in the interim (e.g. recovered, admitted, referred, died or not returned).
12 / MDDUS INSIGHT / Q2 2018
Within a few weeks we were up and running with the study and the partners and GP registrars were recruiting patients into the trial. With an autumn start, the timing was perfect and our acute cough presentations generated practice income in the region of £30 per patient recruited. By the end of the recruitment period we had consented 117 patients, second highest in the West Midlands, and the study team reached their 30,000 recruit target overall. The patients enjoyed being given a little
extra time in consultations and asked more detailed questions, and the staff felt increasingly skilled in managing this particular clinical area. So we took on other studies involving conditions including cancer, atrial fibrillation, chronic obstructive pulmonary disease (COPD), gout, heart disease, Helicobacter pylori infection and smoking cessation. Taking part in these studies meant that some of our patients were given access to novel treatments and received more intensive monitoring and review, as well as accessing additional support in managing their chronic conditions and generally enjoying the ‘altruism’ of giving something back to the NHS. As clinicians, we valued learning more about the conditions, gaining an understanding of how research is carried out and being able to add something different into our annual appraisal documentation. Income generated from our involvement was invested back into the practice, allowing for additional staff training and support. The support that we received from our local CRN team was fantastic, and they would frequently pre-select us, knowing that we would recruit well into their studies. We subsequently completed the Royal College of General Practitioners’ (RCGP) Research Ready accreditation, which is a framework to ensure practices run research in accordance with correct clinical and legal frameworks (including contacting indemnity providers to ensure this is in place, and notifying the Information Commissioner’s Office). Our participation also paid off in
our Care Quality Commission (CQC) practice inspection, where we were able to demonstrate how research benefited patients and contributed to continuous quality improvement (QI). For example, the FAST study (Febuoxstat versus Allopurinol Streamline Trial) improved the management of our patients with gout by optimising urate-lowering therapy for them. Another study, the ‘TargetCOPD2’ trial, invited current and ex-smokers into the practice for lung function testing, resulting in a rise in recorded COPD prevalence with the associated benefits for patients previously not known to be suffering from the condition – the so-called ‘missing millions’. We achieved an overall ‘outstanding’ rating from the CQC, with specific mention of our research activity in the report. Several years on from that first study,
we now participate in approximately five studies per year and have just taken on our first commercial research study, partnering with a major pharmaceutical company. The work required in a commerical study is more detailed and intensive and, again, the support we have recieived from the CRN has been invaluable.
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