Intended for healthcare professionals


Moving the research agenda to where it matters

BMJ 1999; 319 doi: (Published 24 July 1999) Cite this as: BMJ 1999;319:206

It's time to rattle the academic cage in primary care

  1. David Kernick, General practitioner,
  2. Jonathan Stead, General practitioner,
  3. Michael Dixon, General practitioner
  1. St Thomas Health Centre, Exeter EX4 1HJ
  2. Wyndham House, Silverton, Devon EX5 4HZ
  3. College Surgery, Cullompton, Devon EX15 1TJ

    Ninety per cent of healthcare contacts take place in primary care, and the importance of undertaking research in this setting is well recognised.1 2 Primary care research is not new but has evolved around university departments of general practice. Here, academics work within a fixed hierarchical structure—which may inhibit flexibility and innovation. Funding spirals, assessment exercises, and internal politics often divorce research practitioners from their service commitments and there remains a dissonance between the view of the world of those who guide decision making in health care and those who commission and provide it.

    General practitioners are reluctant to follow evidence based guidelines3; health economists continue to develop technical solutions that are inaccessible and unacceptable to end users4; university academics remain trapped in a paradigm of hypothesis generation, experimental design, and interpretation of data as they seek to make reality fit their disciplinary matrices. Although research general practices and research practice networks have evolved to foster research that …

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