Helen Carr is a General Practitioner in Guildford and a Visiting Research Fellow in the Department of Health Care Management and Policy at Surrey University in the United Kingdom
“Research? We don’t do that in this practice!”
This was the dismissive comment made by one of my GP colleagues in the suburban practice where I am a salaried GP in the south of England. “Sad but harmless,” was the response from my research boss when I asked him about how his GP colleagues viewed his research activities.
I am fairly new to the big wide world of primary care research, and couldn’t give you an accurate assessment of its state in England, but I can tell you what it looks like from where I’m sitting in my practice near London. It’s definitely been a minority sport round here. Most people are fascinated but somewhat surprised when I mention my involvement with Surrey University, and most seem to associate it with eccentricity, boring minutiae or white lab coats.
That’s it, you see. We are near London, not in London; not far enough away from London to have our own medical school, yet full of GPs who are working hard and near breaking-point just running their clinical practices within the current political and financial pressures, with no time or head-space to take much interest in anything else.
But we are making some changes and seeing some results! We are just coming to the end of recruitment to an exercise trial based at two local sports centres. 13 out of the 22 GP practices in our locality have recruited patients for us. Only two or three of those practices has ever participated in research before. We have over 600 participants in the trial and hundreds more who were keen but have had to be turned away due to the vagaries of the physical activity questionnaire making them ineligible. GPs, Practice Nurses, Practice Managers and patients in this town previously largely untapped by primary care researchers are busy managing, recruiting and participating in a trial, reaping benefits and hopefully getting a taste for something that is meaningful, relevant and good for patients.
Our locality of 22 primary care practices makes up a local Clinical Commissioning Group (CCG) which commissions health care for over 200,000 people in our geographical area. It also hosts a CCG Clinical Research Forum. This exciting new group brings the health care managers at the CCG together with Surrey University staff, research network staff and interested GPs to discuss and plan how primary care research can impact our population. This is exciting – this feels real, this is about locally-based top-down projects, built around the needs in our area and with an eye to being pragmatic and relevant. That phrase “interested GPs”, though, sounds better than it is – the five of us who attend are already involved either in research or in the CCG.
When I attended a two-day regional conference on primary care research earlier this year I was amazed to find myself surrounded by keen young researchers, the majority of them not clinically-trained, working together in big teams on all sorts of fascinating projects that I could see were relevant to my work as a GP. Why don’t I see that in my town? Why did I feel so lonely, the only attendee from my area, the only one in my 40s? Where were all the “people like me”, the middle-aged GPs whose brains enjoy a bit of stimulation outside the consulting room door? Where were all the jobbing GPs from country towns like mine, who have access to thousands of real patients leading ordinary lives in ordinary places?
The challenges for primary care research in England?
How to bridge that gap – how to recruit GPs like me, in practices like mine, with patients like mine – bringing all that data into the fold and making research activity a core part of every GP’s work, enabling every patient, even those living far from the usual medical school recruitment areas, to have access to research opportunities. Sad but harmless? We are working to change that attitude round here.
This blog is part of a series on global primary care research that CMAJBlogs is publishing in the lead-up to the NAPCRG Annual Meeting 2014
Thank you Helen. That was excellent. It is a mystery to me too as to why most GPs seem to be resistant to the idea of taking part in research. When I say that we are sitting on a gold mine of clinical data, they agree but point out how very busy they are. When you demonstrate that this is not an adequate excuse by doing a bit of research yourself, it just makes them cross. When you suggest they might help you with a research project, you can see the fear in their eyes!