Intended for healthcare professionals


Clinical trials in primary care

BMJ 1999; 318 doi: (Published 29 May 1999) Cite this as: BMJ 1999;318:1484

Costs of research should not be borne by service practitioners

  1. Sue Wilson (, Research fellow,
  2. B Delaney, Senior lecturer,
  3. Andrea Roalfe, Medical statistician,
  4. R Hobbs, Professor
  1. Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational Health, University of Birmingham, Birmingham B15 2TT
  2. Sandwell Health Authority, Kingston House, West Bromwich B70 9LD

    EDITOR—Foy et al debate the role of financial incentives to improve the recruitment of patients to primary care based trials.1 The critical issue should more properly be whether the real costs of research should be borne by service practitioners. We suggest that they should not. This is especially true of general practice in the United Kingdom, since the NHS has an exclusively service agreement with the independent contractors in general practice. Indeed, the Culyer funding mechanism has set aside ad hoc funding specifically to meet the “excess service costs” of supporting research in primary care.

    Ethical trials require participating clinicians and patients to be in equipoise and for informed consent to be obtained. Assessing eligibility, explaining a trial, addressing patients' questions, obtaining consent, randomising patients, and collecting baseline data are time consuming. Grant proposals should include the true cost of research studies. Funding bodies cover the salaries of research staff and overheads; general practitioners should not be expected to give their time freely.

    A randomised controlled trial, based in primary care, of the cost effectiveness of open access …

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