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Original Research: Paul Thomas, Jonathan Graffy, Paul Wallace, and Mike Kirby How Primary Care Networks Can Help Integrate Academic and Service Initiatives in Primary Care Ann Fam Med 2006; 4: 235-239 [Abstract] [Full text] [PDF]

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Electronic letters published:

Practice Based Commissioning

Paul R Thomas   (17 June 2006)

Balancing PCRNs and the NHS agendas

Oksana V. Hoile   (6 June 2006)

Practice Based Commissioning 17 June 2006
Paul R Thomas, London, UK General Practitioner Send response to journal: Re: Practice Based Commissioning	Thank you Oksana Hoile, for your interest in our paper. I share your view that understanding how primary care research networks (PCRNs) can best be successful is of great contemporary importance in the UK. You, rightly in my view, point out that ‘Best Research for Best Health’ and the new UK clinical networks for research both threaten truly primary care research. They will do this by diverting attention towards the consideration of one disease at a time, and neglecting the complex interplay of multiple dis-eases and local contexts that are commonly the concern of primary care practitioners. Funding for the latter may become hard to find. I think that PCRNs could, and should, facilitate meaningful relationships between researchers concerned with isolated phenomena and generalists concerned with more complex inter-connected phenomena. In the UK, Practice Based Commissioning (PBC) offers a place to do this in a way that could also integrate the other networks you describe and promote a strong primary care voice in research circles. Donovan showed how recruitment to trials is increased when local practitioners also puzzle about the issues involved.1 Networks could broker collaboration between researchers and those leading PBC and clinical governance to stimulate parallel inquiries, and through this increase the depth and breadth of thinking about primary care issues. PBCs with PCRN support could negotiate the use of resources gained through recruitment into trials to fund such primary care-led inquiries. In North West London we are developing a Consortium for research between eight Primary Care Trusts in the expectation that it will develop these kinds of win-win partnerships. We aim to develop broad agreement that audit is an enquiry designed to facilitate local learning, and research is an enquiry designed to facilitate learning in further away places. Both should have a ‘hard’ and a ‘soft’ edge. Actually the methods used could be identical, creating potential pathways between one activity and the other. Locally-led audits could even be designed as pilot research projects and leaders of one progress to lead the other. Leaders of research, audit and policy will also be expected to collaborate to enhance the quality of locally relevant guidelines and locally led innovation. Reference 1. Donovan J, Mills N, Smith M, Brindle L, Jacoby A, Peters T et al. Improving design and conduct of randomised controlled trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study. BMJ 2002;325:766-70. Competing interests:   Author of original paper
Balancing PCRNs and the NHS agendas 6 June 2006
Oksana V. Hoile, Clacton-on-Sea, Essex, UK Head of Research & Development, Essex Primary Care R&D Office/Manager EPCRN, Tendring PCT Send response to journal: Re: Balancing PCRNs and the NHS agendas	Authors raised some important issues such as: Diverse models of networks limit opportunities for rigorous evaluation of their effectiveness and comparison of endpoints; It is possible to achieve sound research outputs via 'less' structured networks, though links with academia are key to success; PCRNs are in possession of invaluable local knowledge, e.g. research interests, local population profile, capacity and willingness to host research initiated elsewhere; Personal development associated with engaging in research and subsequent improvement in individual's ability to deliver enhanced evidence-based care may be underestimated and undervalued. The presented findings, though limited in their generalisability, echo my personal observations in managing a PCRN. The concepts of 'learning modes' and opportunities for translating local research into practice are interesting and have produced improvements in patient care, despite their relatively low status in relation to 'scientific' attainment. Experience of PCRNs points to potentially effective models of collaboration involving multidisciplinary health, academia and social care sectors. The importance of collaboration between such different establishments cannot be over-emphasised! Would newly established networks, with their somewhat restricted research portfolio and responsibilities, reduce opportunities for carrying out studies reflecting patient pathways? This has previously happened to UK cancer networks that, having successfully increased recruitment into clinical trials(1), have somewhat neglected research into cancer care involving community based service delivery. It is anticipated that these would be addressed through balanced research portfolio led by the School of Primary Care and comprehensive networks(2). The timing of this article is critical and would have been even more beneficial had it been made public at the time of the consultation of the 'Best Research For Best Health' Strategy, when value of investments in primary care research networks was scrutinised. Keeping primary care practitioners interested in research at the time when emphasis of the NHS is on improving commissioning of services around 6 key priorities, coupled with a greater top-down research agenda, will be a challenge for new generation of networks. A greater cross-fertilisation of academic-NHS research plans will be required to achieve a balanced research portfolio. Taking on board experiences of the diverse models of PCRNs should help the UKCRN to move their agenda forward. I would like to congratulate authors of this article on bringing attention back to 'softer' aspects of primary care research without which it could be difficult to plan the future of R&D in primary care. (1) CRD (2006) Increasing patient participation in cancer trials. Centre for Reviews & Dissemination, University of York (2) DH (2006) Best Research for Best Health: A new national health research strategy - The NHS contribution to health research in England. Department of Health, Crown 2006 Competing interests:   I am a PCRN Manager with an interest in the Primary Care research agenda.