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Rapid Responses: Rapid Responses published:
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Best Research for Best Health
- Stephen K. Smith (6 February 2006)
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Research originating in Primary Care needs support
- Jim Sikorski, Susan Robinson and Martin Edwards (7 February 2006)
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Best Research
- Robert Boyd, Mike Burrows (8 February 2006)
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The changing face of clinical research
- Liam O'Toole (8 February 2006)
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Stephen K. Smith, Principal, Faculty of Medicine, Imperial College London Imperial College London, Level 2, Faculty Building, South Kensington campus, London SW7 2AZ
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Professor Allyson Pollock, in her recent editorial, raises important concerns about the new NHS research strategy “Best Research for Best Health". Particularly, will the public be best served by this new strategy that seeks to position the NHS as ”an internationally recognised centre of research excellence”? On the face of it there seems little to argue about, as research is the basis of modern diagnostic and therapeutic medicine and any attempt to improve this endeavour must be for the greater good. However her editorial raises two important questions - how will it effect the direction of research strategy and if tailored too closely to the needs of industry, will this compromise the common good? Underlying these questions lurk deeper currents that have bedevilled clinical research in the UK for over fifty years. This activity is a complicated business requiring co-ordination and integration of clinical service, research, education and exploitation. Each of these functions has unique capabilities, culture, governance and management structures. Recognition of the need for transparent mechanisms that allow universities and the NHS to work together for the benefit of patients would go a long way to improving clinical research in the UK to the benefit of both the health and wealth of the nation. The relationship with industry in this context should be beneficial assuming that all share the same ethical concerns and are committed to the speedy development of new treatments. A system that for the first time seeks to apportion NHS funds for research in a “transparent, sustainable and contestable activity based funding system” seems right and so long as this NHS research money is secured against service pressures, this new approach deserves to be given a chance. Stephen K Smith Principal, Faculty of Medicine Imperial College London Competing interests: None declared |
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Jim Sikorski, GP, Chair Lewisham Reserach Unit Sydenham Green Health Centre, 26 Holmshaw Close, London SE26 4TH, Susan Robinson and Martin Edwards
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EDITOR – Pollock et al 1 are to be thanked for their clear summary of the problems inherent in the UK Department of Health’s new research strategy. 2 The proposed reorganisation of primary care research networks is one aspect of this strategy and is also a concern. Not only is it possible that pharmaceutical industry representatives will have membership of key strategic groups within reorganised primary care networks but also it appears that the predominant research paradigm will be one of the large randomised controlled trial (RCT). One of the clear strengths of the current networks is the broad range of studies and methodologies which can be identified in their research portfolios. This range of topics represents the diversity of work in primary care as well as the welcome opportunity that has existed in recent years for many to investigate an area of their practice which has fired their curiosity and enthusiasm. There are potential advantages to the NHS as a whole in practitioners becoming involved in their own research, albeit on a small scale, since this is likely to lead to individuals possessing the critical skills required to practice evidence-based medicine. The presence of this cohort of research-experienced practitioners is furthermore a resource for other colleagues in primary care. The proposed total budget for the portion of the Department of Health’s funding available to open competition (correctly, if not somewhat ironically, named the Research for Patient Benefit (RfPB) project scheme) will be only Ł25 million. This will mean that obtaining funding for small scale projects will be an uphill struggle. The practice of good primary health care depends on a broad range of knowledge – e.g. from the beneficial effects of medicines to why patients do not take them. A straw-poll of ‘papers that changed my practice’ amongst primary care practitioners is not likely to produce a list of reports of RCTs. Unfortunately the centrally prescribed clinical areas to be addressed within the new research networks, together with commercial pressures, are likely to deliver an unhealthy balance of trials of therapeutic agents. The unique contribution of primary care research is in danger of being diminished. Dr Jim Sikorski, GP Researcher and Chair, Dr Susan Robinson, Research Fellow, Dr Martin Edwards, GP Researcher, Lewisham Research Unit 1. Pollock A, McNally N, Kerrison S Best Research. The new UK medical research strategy helps industry, but will it improve health? BMJ 2006;332:247-8. 2. Department of Health. Best research for best health: a new National Health research strategy. 2006. www.dh.gov.uk/assetRoot/04/12/71/52/04127152.pdf Competing interests: The correspondents are members, and have received funding from, Lewisham Research Unit, a Department of Health funded primary care research group. |
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Robert Boyd, Greater Manchester NHS R & D Director c/o University of Manchester M13 9PL, Mike Burrows
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Surely the goal of research in the NHS should be to achieve synergy, not opposition between research of the highest international quality and maintaining and improving public health and the care of present and future patients. To achieve this requires addressing the needs of several constituencies in a way which has the potential to benefit them all. It also requires allocation of resource in a way which will most effectively achieve this goal given that resource is always finite. Research policy also has to achieve collaboration with those players outside the NHS notably, but not exclusively, the pharmaceutical and medical devices industries without whom successful use of research in many domains of practice can not be achieved. Such relationships should not be focused on 'freebies' or drug lunches but (in line with the PICTIF report) on the recognition that only an ethical and effective relationship with commerce can provide in quantity for the NHS, and other healthcare systems worldwide, the further new vaccines, pharmaceuticals and instrumentation that have been so effective at improving health care over the last generation. In the Greater Manchester Research Alliance we are endeavoring to achieve just this synergy of patients who volunteer to engage in clinical studies and trials with clinicians and academics supported by NHS management and the commercial sector. We are optimistic that the new DH strategy, "Best Research for Best Health" will support us and others in our aims. It has identified the right challenges and boldly established a coherent group of appropriate solutions together with funding streams ring-fenced for research. Its central themes of transparent allocation of resource in response to quality and of support for research staff to develop and to achieve their goals unencumbered by the layers of bureaucracy so pungently reported by Galbraith et al (BMJ 332 238 2006) will, we believe, provide the most important step change in research for and with patients since the inception of the NHS R & D program some fifteen years ago. We do not recognize the new strategy in this week's somewhat dystopic leader by Alison Pollock and her colleagues (Best Research, BMJ, 2006, 332, 247-8). By contrast, we welcome it warmly. Dr Mike Burrows, Chief Executive Salford PCT, Chair Greater Manchester Research Alliance Strategy Board. Email: Mike.Burrows@SALFORD- PCT.NHS.UK Professor Sir Robert Boyd, Greater Manchester Director of NHS R & D. Email: rboyd@doctors.org.uk Competing interests: The North West is arguably a region which might benefit from the new Strategy. |
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Liam O'Toole, Chief Executive UKCRC, 20 Park Crescent, London, W1B 1AL
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EDITOR - Pollock et al draw attention to the fact that that the clinical research environment in this country is likely to change significantly over the next few years. They discuss major vehicles for change such as the Department of Health for England’s new research strategy 'Best Research for Best Health' and the UK Clinical Research Collaboration (UKCRC). The authors express concern that the needs of industry are inappropriately driving this change. As the authors point out, the UK Clinical Research Collaboration is a key instrument for change. It was set up in response to growing concern from many quarters, including the Academy of Medical Sciences1, that clinical research in the UK was in a state of decline. The goal of the UKCRC is to reverse this trend and create an environment that facilitates high quality clinical research. To do this the UKCRC brings together the major stakeholders from Government, charity, industry, the NHS and academia. What has characterised the first 15 months of the UKCRC’s existence has been the unprecedented degree to which the Partners and wider stakeholders have been prepared to work together to deliver common goals. This has not always been easy or comfortable and has required compromise. However, what is interesting is the way in which the partnership has quickly tackled complex issues that in the past we have failed to adequately address by working in isolation. For example, a new career structure for clinical academics has been launched and there is major new investment in research infrastructure particularly in the NHS. The structural and cultural change needed to put UK clinical research back on the global map requires co-operation and commitment from a broad- based coalition of stakeholders including medical research charities, public sector bodies and industry. Progress has only been possible because we have focused on an agenda for change that will benefit clinical research funded by each of these sectors. Yes the vision shared by all UKCRC Partners will benefit industry but it will also benefit medical research charities and research councils, the academic community, the NHS and ultimately patients. As in all partnerships, industry will be expected to do its bit to contribute to change and has already indicated its willingness to do so. Liam O’Toole Chief Executive, UK Clinical Research Collaboration 1. Stewart PM. Improving Clinical Research BMJ 2003;327:999-1000 (1 November.) Competing interests: Liam O’Toole is chief executive of the UKCRC which is a partnership of the main organisations working to improve the clinical research environment in the UK. The UKCRC is funded jointly by the Partner organisations. |
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