{"id":48436,"date":"2020-08-26T20:55:27","date_gmt":"2020-08-26T19:55:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48436"},"modified":"2020-08-28T15:54:02","modified_gmt":"2020-08-28T14:54:02","slug":"building-back-better-research-post-covid-19","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/26\/building-back-better-research-post-covid-19\/","title":{"rendered":"Building back better research post covid-19"},"content":{"rendered":"

During the covid-19 pandemic, the public focus has been on the remarkable performance of the NHS and its dedicated workforce in coping with the huge influx of covid-19 patients, led by centralised clinical guidance and rapid local reorganisation of services. The outpouring of public affection for the NHS has been a welcome and well-deserved recognition of its place at the heart of the nation. Yet there is an equally remarkable, but much less publicised success story to be told\u2014that of the UK research sector\u2019s response to covid-19, partly due to the preparedness of the National Institute for Health Research (NIHR) in England and parallel research systems in Scotland, Wales, and Northern Ireland.\u00a0<\/span><\/p>\n

With 100% of NHS Trusts previously involved in research supported by the NIHR\u2019s Clinical Research Network (CRN), research delivery teams and processes were already in place to support the NHS and enable widespread recruitment for covid-19 studies. Equally, the redirection of NHS services to covid-19 reduced the capacity for non-covid research, much of which had to be paused during the acute phase and is trying to restart now for the benefit of patients and the research funders.<\/span><\/p>\n

The NIHR CRN activated its pre-existing plan for research in a pandemic, resulting in 640 NHS research sites ready to deliver studies. Urgent Public Health Studies (UPHS) were prioritised by the Chief Medical Officer to yield key evidence. Simplified and pragmatic research design like that of the RECOVERY platform study, enabled NHS staff, even if unfamiliar with research, to rapidly get involved.<\/span><\/p>\n

Coupled with unparalleled speed in regulatory assessments, over 130,000 participants were recruited to covid-19 studies, including 10,000 patients entered into the RECOVERY study in 8 weeks. This yielded positive results for dexamethasone in patients receiving oxygen\/ventilatory support and UK research out-performed other European countries in both publicly-funded and life sciences COVID-19 international studies. [1]<\/span> <\/i>Going forward, the UK\u2019s chief medical officers have signalled their intention that every eligible patient is offered enrolment into a covid-19 trial. [2]<\/span><\/p>\n

A signature feature of the RECOVERY trial recruitment was the disproportionately high contribution of many smaller hospitals supported by clinicians not previously engaged in research. This welcome development is one that we must continue for several reasons. We know that patients fare better in research-active hospitals regardless of other factors, and that clinicians are attracted to roles that have research potential, but need support to be able to fulfil these roles. [3]<\/span><\/p>\n

Yet there is more that can be done to build from this success, from further top-level direction from NHSE, involving UKRI, the research funders and regulators, building on technological and digital advances to drive the scale and pace of research across the whole country, enabling clinicians to engage in research, and reducing bureaucracy to speed the set-up, delivery and translation of research together.<\/span><\/p>\n

As the Royal College of Physicians (RCP) publishes its own research strategy, here we look at how we can build on that success outside the framework of covid-19 and support clinicians to be more active in research. [4]<\/span>\u00a0<\/span><\/p>\n

A recent RCP survey of consultant physicians shows that clinicians working in NHS trusts have a very positive attitude towards participating in research, but struggle to become involved\u2014for over half this was primarily due to a lack of time. [5] <\/span>67% of respondents said having dedicated time for research would make them more likely to apply for a role. Other barriers identified were a perceived lack of skills and supportive culture in their organisation.\u00a0 We need to harness the appreciation that managers, commissioners, and the public have shown for the NHS as a whole during covid-19 to reach into the research culture, because research-active trusts have better patient and staff outcomes.<\/span><\/p>\n

There are several practical steps to better integrate research into clinical care, as highlighted by the RCP\u2019s research strategy:<\/span><\/p>\n

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