Energised, refreshed, and inspired. The National Institute of Health Research, School for Primary Care Research annual research showcase meeting in Oxford brought together senior academics, key opinion leaders and young researchers from the Universities of Birmingham, Bristol, Keele, Manchester, Nottingham, Oxford, Southampton and UCL. But, unlike many academic conferences, the focus wasn’t just on scholarly content alone, but under the wider theme of “Promoting excellence and impact”.
Trisha Greenhalgh, currently professor of primary care at Barts and the London School of Medicine and Dentistry but soon to move to Oxford, gave the keynote address, entirely appropriate given her academic title as Dean for Research Impact. Her main message was that research must make a difference and that assessing the impact of one’s work is important at both ends of the research process from grant acquisition to dissemination and evaluation. Academic research in the UK is measured using the Research Excellence Framework where 20% of the score is based on impact, with ‘reach’ and ‘significance’ being the main criteria. Research grant giving bodies also want to know that the work they fund will make a difference so that, for example, the UK Research Councils weight “Pathways to impact”, and the Europe Horizon 2020 prioritises societal impact. Internationally, world university rankings also place more and more emphasis on impact. One cannot really argue if the “moral purpose” of academia is to serve society. And, using an economic payback framework: If we put money into research- we need to know what we are getting back. It is, however, naïve to think the research impact trajectory is linear and that the findings of a brilliant paper will be implemented immediately.
Carol Coupland, in her superb plenary, showed the amazing potential of her general practice database to identify the risk of myocardial infarction in those taking antidepressants, exploring a topic that recently made headlines- there was little strong evidence. Clare Taylor, in another impressive plenary, had developed her research question from own her general practice experience of seeing cardiac failure patients with breathlessness, their ankles and feet so swollen that they came to the practice in their slippers, and who were unable to leave their homes until the effect of their diuretics had abated in the afternoon. She asked what was the incidence, what were the survival rates, have survival rates improved and, is there a difference between confirmed (hospital letter or echo) and unconfirmed cases ( just a diagnostic code on the record)? Her findings, in practical terms, were that the average UK general practice will have 4-5 patients with heart failure, there will be one death each year, about half will be dead in five years, and one will survive ten years after their initial diagnosis. Interestingly, there has been no change in survival rates.
Three shorts papers caught my attention. Gemma Lasseter, a researcher at Bristol, showed that patients don’t really understand the meaning of consent when researchers ask to use their data in primary care and, in many cases, didn’t appreciate how their clinical data might be used. For me there were two salient points- that we need to work harder to ensure that patients understand how researchers use their clinical data and, that patients still value the confidentiality and security of the doctor patient consultation. Evan Kontopantelis, statistician in the Centre for Primary care at the University of Manchester, showed some fascinating work on the quality and outcomes framework- the clinical indicators used in UK performance related pay. He demonstrated that, even when payment was removed from an indicator, there was no noticeable reduction in performance- which I thought was a great tribute to general practice. But, perhaps the most unusual talk was Sarah Knowles’ talk on a “Hack Day” where six members of Patient and Public Involvement Groups pitched their ideas to meeting of 35 non researchers and 25 researchers to generate new research ideas and priorities. It wasn’t easy, some of the hackers needed support when their ideas were not universally accepted, and some didn’t realise that universities didn’t have a great pot of money for research. Their day’s output was captured in a fascinating diagram. It was very different concept and may need some development but it’s an innovative idea with potential.
The day concluded in a discussion with Debbie Sharp, David Mant, Paul Little and Roger Jones, led by Richard Hobbs, Director of the NIHR English School for Primary Care Research and it was interesting to hear these leading lights describe the impact of their research. And, as Trish Greenhalgh indicated at the start of the meeting, there was seldom a direct trajectory. It also led to an interesting dialogue with the audience where I was surprised that researchers seemed reluctant to promote their work publicly and engage with the media. As an editor, where our business is communication, I would argue that academics need to work harder to make their work suitable for publication, learn skills to engage with the media, and adopt modern methods of communication through social media and the web to spread their message. If primary care researchers don’t sing their own successes and engage with every opportunity for public communication, others are not so reluctant.