Intended for healthcare professionals

Letters

Spreading research in primary care safely

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7303.48 (Published 07 July 2001) Cite this as: BMJ 2001;323:48
  1. Anna Eleri Livingstone (a.e.livingstone{at}qmw.ac.uk), general practitioner
  1. Limehouse Practice, Gill Street Health Centre, London E14 8HQ

    EDITOR—The contributions by Green and Dovey and Thomas et al discuss general practice research networks. They highlight how crucial research based in primary health care is to the effective delivery of this care and the understanding of population health. 1 2 The news section of the same issue, however, reports the suspension of an east London general practitioner for entering patients in a trial without consent and forging signatures.3

    I am concerned about how the potential of general practices to contribute to research, whether it be experimental or observational, can be maximised, while the registered patients and primary healthcare team can be supported in ensuring that research is safe and worthwhile. This needs to be discussed in terms of facilitation and funding, and through governance procedures for all practices and community health settings.

    Currently the pharmaceutical industry and other outside agencies, including hospital academic departments, make regular approaches, in the case of the first, to practices to provide data or enter patients into studies. The practice team is often unsupported in judging the appropriateness and, when primary care is underfunded, may be swayed by inducements. At the same time, in practices, new investigators, perhaps considering extending audit or doing a project as part of continuing professional development, may be unaware of the possible ethical and practical pitfalls.

    The Department of Health and the Royal College of General Practitioners are rolling out, after a pilot study, an elaborate accreditation procedure for research practices at two levels, collaborative and independent, which is to be priced at £2600, in addition to considerable cost to the practices in time and effort. Accreditation may soon become a requirement for research funding. There are no clear guidelines about what makes a good and safe research practice, other than an extensive list of criteria reviewed for accreditation and practices have to be already involved in research to be accredited. Such a procedure in its present form would only ever involve very few practices.

    It is right in giving large grants to support research to aim to ensure the safe and effective use of them, and the accreditation of organisations managing them is probably very appropriate. How does this fit in, however, with maximising the potential of general practice to provide that laboratory for population research in terms of appropriately accessing participants or supporting primary care team members as developing researchers? Does there not need to be a much more basic and practical framework for governing and facilitating general practices in relation to research, which could have avoided the situation in east London?

    Footnotes

    • Competing interests AEL is a member of East London and Essex Network of Research Practices.

    References

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