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A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7232.419 (Published 12 February 2000) Cite this as: BMJ 2000;320:419

Rapid Response:

The research needs of primary care

Editor - Thomas stresses the need for increased links between
research and service development in primary care:1 opportunities to
achieve this should not be missed. Radical changes are underway in
primary care service provision as part of the Government's NHS
modernisation. Personal Medical Services schemes, service commissioning
by Primary Care Trusts, and the development of walk-in centres are
changing the form and function of health services, increasing the need for
well designed health services research into effectiveness and cost
effectiveness. Few GP commissioned services have been formally evaluated
to date, and little is known about the associated practical problems.
In 1999, we succeeded in completing a randomised-controlled trial of an
innovative referrals facilitator service.2 This was a GP commissioned
service, where GPs identified the need, service design and locality
funding for the service. The high level of GP interest and ownership of
the service was helpful in supporting the trial. Despite this partnership
approach, we experienced substantial problems in gaining GP participation,
and a lower than anticipated recruitment rate, as experienced by Wilson et
al in their dyspepsia trial.3 Our trial had to be extended, both in time
and number of GPs involved. Consequently the final report of the
evaluation followed rather than preceded local decisions on future NHS
funding of the service.
High quality evaluative research in primary care is needed more than ever,
but there are significant practical barriers to GP support and
participation. Primary care workloads and culture are not currently
conducive to 'ordinary primary care professionals' participating in
research. Thomas rightly highlights the needs for local partnerships, but
more needs to be done to encourage this. The existence of primary care
research networks is not enough: many GPs are not involved, and often
clear links do not exist with PCTs. The government has been largely
silent on the roles and responsibilities of PCTs in promoting primary care
research, despite their key role in primary care innovation. Modern
primary care must incorporate the capacity to evaluate new services: this
should be reflected in plans and accountability requirements of PCTs.
Meanwhile, primary care researchers must continue to allow for highly
variable recruitment rates and delays when planning trials.

Clare Grant, Clinical Lecturer in Primary Care
Division of Primary Care
University of Bristol
Canynge Hall
Whiteladies Road
Bristol BS8 3AW

Chris Hine, Consultant in Public Health Medicine
Avon Health Authority
King Square House
Bristol BS2 8EE

1. Grant C, Goodenough T, Harvey I, Hine C. A randomised controlled
trial and economic analysis of a referrals facilitator between primary
care and the voluntary sector BMJ 2000;320:419-23

2. Thomas P. The research needs of primary care (editorial) BMJ
2000;321:2-3

3. Wilson S, Delaney B, Roalfe A, Roberts L, Redman V, Wearn A, Hobbs
F. Randomised controlled trials in primary care: case study BMJ
2000;321:24-27

Competing interests: No competing interests

19 July 2000
Clare Grant