Domhnall MacAuley on the school of primary care research 2012 showcase

Domhnall MacauleyWhat a great day, what a success story. Having worked with Richard Hobbs, director of the School of Primary Care Research, on the original primary care research capacity building initiative many years ago, it was wonderful to see the downstream results of this initiative. The progression has been incremental so it may be difficult for those who were part of the day to day evolution to see the overall picture. Taking a global view, the National Institute for Health Research School of Primary Care Research in England has been a triumph.

This was the second showcase meeting and marked the first five years of the school. Funding is a perennial issue but, to be fair, Dame Sally Davies has done a superb job at ring fencing research funding. David Cox continues to give great support and it was a pleasure to chat to him briefly before the meeting. At this stage in the development of the school, the aim is to support larger and more complex work not just focusing on the individuals, but increasing synergy. It has now funded 175 projects ranging in cost from £4k to £2m, there is international external review of funding applications, and there has been an extraordinary output.

As a champion of primary care research, I particularly enjoyed two success stories, presented as keynotes. The first, by Evan Kontopantelis described work from Manchester on their analysis of financial incentives and performance indicators—QOF—and their effect on general practice. The second, by the irrepressible Debbie Sharp, charted work developed by Willie Hamilton from Exeter on cancer diagnosis and, in particular, ovarian cancer. These programmes of work illustrated the very best high quality research of both immediate relevance to doctors and international importance.

As an editor, the papers by David Reeves from Manchester on the validity of primary care databases and by Sarah Stevens, under Richard Stephens guidance, from Oxford on diagnosis and risk prediction were particularly relevant. With an increasing volume of database studies, editors and readers have difficulty knowing how to identify high quality studies and weigh their validity. Among databases from the UK are Q research using EMIS, the Thin database using Vision, the CPRD, DIN-Link, and a number of smaller databases, but we see many international studies at the BMJ that use a range of databases. Editors need to know if asking the same research question will give the same answer across different databases—and we look forward to the results of David’s work. Sarah highlighted the problems of accuracy of diagnosis and what they really mean, when coded in different databases. Sitting in the consultation I know how difficult it can be to code diagnoses. If it is guesswork at one end, it is no surprise there are uncertainties at the other.

As a clinician, I was particularly interested in work by Deborah McCahon on the dissonance between symptoms and laboratory diagnosis of thyroid disease in older people. Thyroid disease taught me an important lesson in the past about a downside of continuity of care—when a new partner identified thyroid disease in a number of patients in whom we had not recognised the slow and subtle changes. I was intrigued by a paper identifying a link between childhood sleeping disorder and subsequent depression and reminded to think about the risk factors of cardiovascular disease paper in patients with gout.

Time to take stock. Primary care research has progressed. During the final panel discussion Roger Jones, editor of the British Journal of General Practice, suggested that we need to move on from introspective soft focus self analysis to addressing important clinical questions (not his exact words) and I agree. We are no longer looking just at general practice or primary care. What this meeting demonstrated is that we are now in the business of applied clinical research looking across boundaries and specialties. But, we must continue to value our proximity to patients. So, lets leave the last word to Ailsa Donnelly chair of PRIMER, a patient involvement group, when she reminded us of what was written in the introduction to the meeting and highlighted the responsibilities of researchers: “We are all custodians of focused public funding….”

Domhnall MacAuley is primary care editor, BMJ