Scaling up: embedding primary care research in the new models of care
While UK primary care researchers compare favourably in terms of publications and citations, delivering primary care studies is challenging with the situation exacerbated by the increasing pressures within general practice. In Kent, Surrey and Sussex this is further compounded by the lack of research infrastructure when compared to other regions, with nationally the lowest proportion of population participating in research.
Our aim was to make a significant difference to local primary care research capacity and delivery by working with GP clusters and a large Vanguard Multispecialty Care Provider. We developed a multi-faceted strategy aimed at embedding research generation, delivery, and evaluation as an integral part of new models of primary care. We used Normalization Process Theory (NPT) to plan implementation and identify where work needed to be focused.
At clinician level we found that research was often understood as either portfolio study delivery, in-house evaluation or developing research grant applications. Presenting and explaining a clear integrated strategy that included all three aspects was important for shared understanding. Clarification of how the strategy would be self-sustaining and the added value it would bring for the Vanguard was key in ensuring buy-in. Continued support has been enabled by the appointment of a GP research lead and a dedicated research facilitator who work between the Vanguard and the academic primary care unit. For network research delivery we drew on lessons learned from our pilot work with GP clusters including issues in research governance. In terms of our NPT-based analysis, it was the collective action required to minimise workload on individual practices versus the governance issues of patient recruitment through a centralised Vanguard-wide research office that proved most challenging.
The scaling up of primary care organisations has been used as an opportunity to rethink how primary care research can be galvanised in an area with comparatively low research activity. The Vanguard patient population of 170,000 has helped reframe levels of support provided by the Clinical Research Network. The consequences of having GPs with special interest working with research active secondary care specialists has triggered the development of a research environment and emerging research themes. Evaluation of Vanguard initiatives is supported by the academic unit. Longer term appraisal is required to assess the success of each component of the research strategy, and how they are synergised to ensure continued sustainability. Data governance and recruitment to studies merits particular attention if primary care research is to be scaled up within the new models of care.