GPs from primary care research networks have told GPonline that funding and opportunities for research carried out within primary care by GPs or groups of practices has dried up in recent years, forcing them to cut staff and scale back the work they carry out.
The National Institute for Health Research (NIHR) says funding for primary care research has risen almost 10% to £66m over the past five years - and is clear there has been no ‘strategic decision’ to reduce primary care research work.
But primary care research networks say the role of general practice is increasingly limited to recruiting patients and playing a supporting role for research carried out by hospitals and universities rather than taking the lead.
Dr Nick Jones, a former GP investigator at the Bath Area Research Organisation Network (BARONET) and former industry clinical lead for the primary care research network at the NIHR, said practices like his felt they had been ‘bled out of existence as research sites’.
‘The level of research that we’ve been getting through in primary care has dwindled to more or less nothing,’ he told GPonline.
Of 10 practices originally active within BARONET, only four are still acting as research sites. ‘We’d been going really successfully for about 15-20 years, but within the last five years there have been five other practices that dropped out of BARONET for the same kind of reasons as us. There was simply not enough work coming through to justify carrying on doing research. We needed research to pay our staff, and without the staff we can’t do the research.’
Perfect research sites
Dr Toby Cookson, another GP investigator with BARONET, said underfunding was ‘now beginning to extinguish primary care research sites’. He said: ‘We see ourselves as the perfect sites – dedicated, highly experienced and skilled teams of nurses and doctors working in increasingly big organisations with entirely computer based records which go back over 20 years and loyal, stable practice populations with a group of patients who are keen to help us as much as possible. We have excellent track records at recruitment and retention.’
He added: ‘Strangely, this is unappealing to the higher powers in the research world.’
A senior London doctor backed up concerns about reductions in primary care-based research. Dr Ricky Banarsee, director of the West London research network community interest company (WeLReN CiC) told GPonline: ‘In primary care, the only thing that you are given is the funding to do with supporting the research - you will never have the chance to do the research. It’s a bit unfair.
‘Four or five years ago we had £250,000 for research to share between the eight CCGs in West London. Now we’re given about £50,000.’ He described reductions in primary care research opportunities as ‘soul-destroying’, and warned that experienced GPs had been driven out of research work.
However, an NIHR spokeswoman said: ‘There is not, nor has there been, any strategic decision to reduce in any way the amount or the level of spending on research in primary care.’
The NIHR said funding for primary care has increased by just under 10% in the last five five years to over £66m in 2017/18, and pointed out that there remains within NIHR ‘a speciality group solely focused on primary care’.
The spokeswoman said the NIHR ‘recognises the need for high quality research in primary care’, and suggested fluctuation in research funding may ‘reflect the number and quality of research applications submitted’.
She added: ‘Each local clinical research network (CRN) has a variety of incentivisation programmes to promote research within general practices and in 2016/17, 48% of all general practices in England took part in NIHR CRN research studies. More recently, in 2017/18 primary care contributed to 21% of all CRN recruitment.’
The NIHR was unable to say what proportion of research is passed on to general practice sites. It was also unable to say how many patients recruited for research programmes through primary care were fed into secondary care-based studies.
RCGP chair Professor Helen Stokes-Lampard said: ‘Research in primary care is of the utmost importance for improving healthcare for everyone, and the development of high quality care that we, as GPs, and our teams deliver to patients. We are on the frontline of patient care, making the vast majority of NHS patient contacts daily, we know the questions that need to be answered, and we have access to the right patients to ask, so the potential value of frontline research conducted in general practice is immense.’