Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
How do you create a successful school of primary care research? Measuring outputs through academic papers, presentations at international meetings, and the general impact of research, the UK primary care community has had remarkable success. The ten year celebration meeting of the School of Primary Care Research (SPCR) in England was an opportunity to reflect on their achievements and try to pick out the key factors in that success.
It wasn’t always this way. As an academic and an editor I know the struggle that researchers had in the early days. There were few grants, publication was mostly in GP specialist journals, and academic departments of general practice were still developing. When Martin Roland, the first Director of the SPCR sought his first academic post, he wrote speculatively to one of the senior academics – few of the current wave of researchers could appreciate the paucity of opportunity at that time. Later, Richard Hobbs, current Director of the SPCR, and I were on a committee trying to spread around the first meager investments in career development grants and fellowships. Research in primary care was making progress but it was slow. The SPCR, however, has facilitated a remarkable development. There is now a thriving academic community with a strong research base. Primary care may still be under represented in universities, relative to other academic specialties, but it certainly holds its own. I asked Professor Richard Hobbs, current chair of SPCR about the secrets of this success.
There are three components that I would particularly applaud. Firstly, the creation of collaborative academic units that have allowed the development of a critical mass of expertise sufficient to undertake large trials. This underpinned many high quality research studies published in the top medical journals. Secondly, the creation of an academic career structure that allows aspiring primary care researchers to access career development opportunities, join well mentored and supported PhD pathways, and progress to funded senior academic opportunities. Thirdly, and possibly the most important, enabling this new wave of accomplished researchers ensures leadership for the future. We may recognise the current achievements of the SPCR but creating this cohort of skilled researchers will be its lasting legacy.
What was needed? It required bright ambitious and talented leaders with vision and commitment, prepared to work exceptionally hard, make sacrifices, and inspire others. Many of these academic leaders were present at the meeting. But, it also needed funding and this finance was facilitated by the current Chief Medical Officer, Sally Davies, whose support never faltered.
What did they achieve? Primary care research has evolved from a relatively small scale operation asking predominantly general practice focused research questions to now addressing policy and clinical questions of national and international relevance supported by large scale research units. With this growth, those early pioneering researchers have become leaders in their field, achieving considerable international recognition.
Is there a downside? If success is achieved by coalescing small into large research units, then smaller units almost inevitably atrophy and some academic departments must have lost out greatly. If success is achieved by joining large academic centres, researchers have also had to relocate closer to larger centres of excellence thus disrupting families and creating medical practice organisational difficulties. My impression, and I would be happy to be contradicted, is that while there may be funding for more protected research time, clinicians have inevitably become distanced from traditional clinical practice. If you do a limited number of clinical sessions each week, you see a different type of patient and yet it is important that research questions remain patient focused and generated from within general practice. I also sense a slight distancing between ordinary clinical practice and academia-reflected in how research meetings have become disengaged from clinical, professional, educational, and college meetings. But, the UK’s Royal College of General Practitioners is very supportive and, when I interviewed, Dr Helen Stokes, its current Chair, she was emphatic in her endorsement of the importance of research.
The 10th anniversary of the SPCR is a time for celebration. It has been a remarkable story, and this milestone should allow the key players an opportunity to stand back and recognise what that have done. I suspect that they have been so involved in making it happen that they don’t appreciate the scale of their success. As a GP, I recognise how their research has improved clinical practice and contributed greatly to the health of patients. As an academic colleague, I am immensely proud of their achievements. As an editor, it has been an immense privilege for me to have shared part of the journey.
Respect to all the SPCR colleagues and their achievements. The downside is an equity issue – harder to grow academic capacity elsewhere, no blue skies funding to get new units going, and recruitment a big problem for other universities … Wish the SPCR could get NIHR support to conduct collaborative studies and even shared posts with other units to help grow capacity everywhere! Every medical school needs a department of general practice, for research, teaching and profile of the discipline.
PS I have been doing 2 sessions a week for 15 years and still feel that gives me real GP contact with patients!