GROWING PRIMARY CARE RESEARCH

INTERVIEWEES:

DR ALEX TODD, GP Partner & Research

Lead, Shore Medical Partnership

BECCA MILNE, Research

Nurse, Shore Medical Partnership

SHIRLEY-ANN CLIMIE, Research Administrator, Shore Medical Partnership

ALEX: I’ve always fostered an interest in research which was sparked by my time at Nottingham University when I worked with the Anaesthetic research team. I worked on a study looking at the effects of topical local anaesthetics and we presented our findings in Porto at the European Society of Regional Anaesthesia and were published in Regional Anaesthesia and Pain Management. Since then, I have been keeping an eye out for opportunities to get involved with research and when I joined Shore in 2021, we had the perfect opportunity to start.

After three months, we started to have discussions with the Clinical Research Network (CRN) for possible funding models and support. We started on the Research Sites Initiative (RSI) scheme in October 2021 as a sessional practice at Primary Care Network level. The funding from the CRN has allowed us to cover most of the costs of staff and enabled us to engage with research studies.

Initially, we focused our work on vaccine and pandemic related studies acting as a Patient Identification Centre (PIC). This included working on studies such as PANORAMIC, PRINCIPLE, REGAIN, COV-BOOST and COVID Vaccine Monitor.

Slowly over time we started to grow the team, with Shirley-Ann doing a day a week on the administration and then earlier this year Rebecca came on board for one day a week, which has allowed us to engage with more in-depth studies.

We’ve since taken on ATTACK, which looks at Chronic Kidney Disease (CKD) and aspirin use, then subsequently ATHENA, looking at amitriptyline in treatment of longterm pain from shingles and now DEFINE, which explores fractional exhaled nitric oxide (FeNO) guided asthma management that Becca has taken the lead on.

BECCA: It’s very different working in a primary care setting but in a small amount of time we are now in a position to take on more exciting studies. And that’s where DEFINE comes in, it’s the first interventional in-house study. It’s a big learning curve, but everyone is so on-board with research and willing. There’s a synergy there between me and the nurses here that are interested in research and it makes it much easier to share the work between us, it's great for our future.

SHIRLEY-ANN: This role has many similarities with my previous role as a Senior Project Manager, such as the attention-to-detail required and the project set up – in both roles it is important to ensure that all administration is tightly controlled.

A New Model For Primary Care Research

ALEX: Shirley-Ann dedicates one day a week to research administration and four to the practice reception. Study administration needs more time than she has at the moment, it really snowballs once you start taking on extra projects. their rash. That can be difficult if we only have one day a week allocated towards research and the patient comes through on day four of their rash when we’re not available. That’s where the CRN support has been invaluable, the CRN nurses can consent on days that we can’t and their experience has helped us hugely. We’ve had lots of help from other, more experienced, sites locally too. The Adam Practice has been really helpful in supporting us and Oaks Healthcare in Portsmouth have kindly given up their time to work with us and guide us.

The sheer scale of it can make it challenging. We have found it’s easier running a trial within one site, then we expand and grow once we know how the study works and how we best can run them. We’re slowly learning and developing the best ways that fit our model.

Another challenge has been communicating studies to 200 staff members. It can be difficult to keep awareness up when there are so many studies ongoing but to help, we’ve produced laminated sheets about each study that’s running and given them to staff and relevant teams. I also try to send regular updates by email or WhatsApp to point staff in the right direction.

SHIRLEY-ANN: I’m keen to expand my research role and take on more hours as I really enjoy the time that I spend on research, it’s a constant learning curve. With my experience on reception, I’m able to ensure that the team is aware of everything we are doing at a grassroots level.

Creating Impact Through Pcn Research

primary care is very busy, through research they’re able to access additional intervention and potential investigation more easily.

BECCA: It’s been really positive. People are really willing to help and like to know they are helping.

ALEX: We’ve tried to take on studies that we think are of real value and to answer important questions. If you relay that to patients, they see the benefits and value of building that evidence base in primary care for the future.

ALEX: All our cases come through an external care navigation unit, engagement from them is needed to identify suitable patients quickly. With ATHENA, identifying patients with shingles needed to be done within five days of the onset of

ALEX: We have around 58,000 patients across our six sites which makes it possible to run wide searches across our patch and engage patients with research.

I’ve found the response from patients positive. I think they really value the contact they get from clinicians during a time when

BECCA: People here are excited about research. Post-COVID, people are really willing to be engaged –especially staff. Having a dedicated research team helps to reassure people that their workload won’t be drastically increased or become a burden and we’re potentially changing medicine for the future. Most people go into this sort of profession because they care and want to make things better. By being a part of research, you’re doing that and it's something you can see in front of your eyes.

SHIRLEY-ANN: We are planning a presentation to the board at the end of Q1/Q2 which will hopefully show that we have the appetite and the capacity to take on more projects.

ALEX: I wasn’t sure how patients would react with us contacting them with research opportunities, but it’s been really nice to see that they do want to engage. Most want to take part and have been very grateful for the opportunity.

It’s important to have protected time for research, especially as a GP because otherwise it can be difficult to fit in. I hope over time, as our reputation builds, we’ll be able to take on more studies, both commercial and non-commercial.

Ideally the future would involve practices working collaboratively at scale to deliver high-quality research, more awareness that funding is available will help enable them.

It can seem daunting to start up without much research experience but you can start slowly with support from the CRN and engage with light studies – acting as a PIC site for example. Then it can grow gradually over time without much risk. Just getting started is the biggest step.

BECCA: Knowing that there is support out there, especially from the network, is so important.

Useful Links To Studies

As is communicating with other practices to gain as much experience and knowledge as you can.

SHIRLEY- ANN: We’ve had a positive response from the CRN team. I’ve attended the NIHR course which is a great networking opportunity because everyone is really motivated and keen to help – it’s a joy to be part of the research community.

PANORAMIC: https://www.panoramictrial.org/

PRINCIPLE: https://www.principletrial.org/

REGAIN: https://trialsjournal.biomedcentral.com/articles/10.1186/ s13063-020-04978-9

COV-BOOST: https://covboost.web.ox.ac.uk/home

COVID Vaccine Monitor: https://vaccinemonitor-yellowcard.mhra.gov.uk/

ATTACK: https://www.southampton.ac.uk/attack-trial/index.page

ATHENA: https://www.phc.ox.ac.uk/research/infectious-diseases/ current-projects/athena-preventing-long-term-pain-from-shingles

DEFINE: https://www.phctrials.ox.ac.uk/studies/define