NHS LONG TERM PLAN
Although the number of GP registrars entering GP training is increasing, there is still a shortfall of around 6000 GPs in England alone - according to figures published by the Royal College of General Practitioners.4
Investment in PCNs is really about investing in the workforce. As part of the new GP contract, additional funding is being made available for a broader range of clinical staff to work within networks - ultimately to deliver a new range of additional services, such as anticipatory care working with community services.
This new investment is in workforce roles to complement traditional GP activity. These include, over the next five years: pharmacists; social prescribers; first contact physiotherapists; paramedics/advanced clinical practitioners; paramedics (ACCPs); and physician associates. Each PCN will also have a clinical director, who, in most cases, will be appointed from the constituent GPs. This broader mix of clinical staff within general practice presents exciting new opportunities for primary care networks to become involved - if they are not already - and deliver primary care research. This may well happen in areas which have not previously been sufficiently resourced to engage with primary care clinical research or use the support of the NIHR Clinical Research Network (CRN).
Incentivising research
The contract framework refers to PCN participation in research being actively encouraged from 2020/215
proven link to better care. Studies in secondary care have shown6
- in light of the that ‘research-
active’ organisations consistently deliver improved patient care and outcomes, compared with those which are not. This is the first time ever that research has been specifically incentivised within the GP contract and is a step-change in the appreciation of the benefits of primary care research to patients, participants, practices and practitioners. Incentivising primary care networks to become more research active is a ‘win-win’ situation - not only for GPs themselves - but also for patients in terms of providing equity of access across England enabling patients to take part in important clinical research studies. Furthermore, research is just beginning to be incorporated within the healthcare regulatory framework. Recently the Care Quality Commission (CQC) included research-related questions within the ‘well- led’ category of its inspection framework for secondary care providers. While, anecdotally, some GP practices report that research has also featured in their CQC assessment visits, despite it not formally being included within the assessment protocol for general practice.
More research out of hospital
Ensuring that more clinical research is taking place in primary care settings is essential to
AUGUST 2019
Ensuring that more clinical research is taking place in primary care settings is essential to delivering the best possible research for some of the most common health challenges we face today.
delivering the best possible research for some of the most common health challenges we face today. Many such common, chronic conditions - for example diabetes, asthma or high blood pressure - are typically managed within primary care.
By doing more within primary care settings, we will go some way to ensure research is more accessible and readily available to patients in the community - without the inconvenience for patients having to attend acute settings. Making it as easy as possible for people to take part in studies is paramount to developing effective care and treatment for these conditions. With a key focus of the NHS Long Term Plan around improving out of hospital care and services, the direction of travel is around treating more patients in the community rather than in hospital settings - closer to their homes - and this can only be a good thing in terms of improving participation in research.
Primary care research: The benefits of involvement
Research participation has many additional benefits for primary care providers, including quality improvement, professional development, and income
generation - among others. Delivering research is financially beneficial for general practice, particularly if commercial research is undertaken, while non-commercial research also provides appropriate reimbursement to fully cover any costs incurred. By taking part in research, GPs will also ensure they are at the forefront and cutting edge of medical knowledge and research in primary care. Delivering research enhances personal and practice development. For example, by helping to run research trials and develop new trials, GPs and registrars can develop new skills in terms of clinical research management and the setting up and running of trials. Some of these skills are transferable to the rest of their professional activity. With fewer GPs working full-time - the latest figures from NHS Digital cite 44,396 registered GPs, but only 34,510 whole time equivalents - research can also help to attract and retain GPs and registrars, as an increasing number of GPs adopt a portfolio career with a mix of clinical and associated roles. Research is a classic example of a fulfilling portfolio career, holding the potential for GPs at any stage in their career to become involved in innovative and cutting edge work which ultimately holds the potential to make a difference to wider society and patients across the NHS. In terms of the resources and commitment required for GPs and practices to get involved in research, there is scope for all types of involvement, depending on the extent to which the practice wishes to become involved. Delivering primary care research within general practice can range from something as simple as a database search to identify potential participants - who can then be sent mailshots and referred to another recruiting site; to data collection through the distribution of patient questionnaires; all the way to the other end of the spectrum - which could include involvement in complex trials assessing the efficacy of novel medications or treatments not currently available on the NHS.
NIHR support for your study
The NIHR Clinical Research Network (CRN)7 is the part of the NIHR responsible for supporting the delivery of research studies across England. It offers a range of support and resources8
to support primary care
practitioners and researchers, including study support around identifying and
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