Volume 1
Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology.
- Great Britain. Parliament. House of Lords. Science and Technology Committee.
- Date:
- 1995
Licence: Open Government Licence
Credit: Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology. Source: Wellcome Collection.
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![money and ideas can be squandered by being scattered too wide. Professor Robert Boyd, the new Centre’s Chairman, stands up for it (Q519): “It is a good departmental initiative”. 8. The Scottish Chief Scientist believes that his version of the R&D Strategy has been good for the primary sector (Q1137). “The evidence is that, since the R&D document and the Strategy have been announced, there has been an improvement in the quantity and quality of research being undertaken from the teaching [GP] practices”. . Peer review 9. The Culyer report, in a section headed “Peer review” (paragraph 3.87), says, “Research is developing outside traditions of peer review in areas where a knowledge-based culture needs to develop further. Primary and community care, nursing and other professions will gain importance as health care focuses on degenerative diseases and disability, and shifts towards the community. The NHS will need research skills, groups, and links with research centres to develop effective high quality care in these areas. A premature insistence on peer review could stifle this research, though appropriate peer review in these fields should be the longer term objective”. 10. Several of our witnesses are opposed to the idea that research in emerging areas should be exempt from peer review. “GPs must compete for research funding on the same basis as others in the NHS and universities...primary care researchers themselves will have to compete for local and national project and programme research grant funding in open competition with others” (AUDGP p429). “Public money should be spent on the basis of rigorously-reviewed applications” (RCGP Q396) - “Same principles, same standards” (Q417). “The suggestion in 3.87 that [peer review] could be bypassed for primary and community care projects is totally contradictory to statements throughout the [Culyer] report about ensuring that only quality R&D is funded” (p442). 11. Professor Culyer stands by the recommendation that what he calls the “Cinderella disciplines” are “too underdeveloped to take the full rigour of peer scrutiny” (Q518). Professor Maggie Pearson rejected his terminology but agreed with his proposition: “In what I would describe as the rapidly developing research areas in the NHS R&D strategy, there is great enthusiasm for research where there was not hitherto, and we have to be careful not to dampen that by having an overly heavy, censorious atmosphere. I think there are very supportive mechanisms by which people interested in developing research can be prevented from doing poor quality research and getting disheartened, by having peer review mechanisms which may involve some component of mentorship, where they can be advised on where their research designs can be improved and then given some funding to develop it...Otherwise, what we will do is dampen the enthusiasm in precisely those areas we want to encourage”. B. GENERAL PRACTICE What is GP research? 12. “In general practice research the sciences of discovery meet the sciences of implementation”. The scope and potential contribution of research in general practice is well described in the evidence of the Association of University Departments of General Practice (p427). It focusses on conditions largely encountered or managed in the primary sector (eg mental illness, hypertension, depression, asthma, diabetes - QQ384, 422); on the configuration of primary care services; on epidemiology; and on the behaviour and responses of patients. The RCGP utters a warning (p132): “General practice is at risk of being seen only in relation to the secondary care services, eg the gatekeeper role or as an early discharge agency...General practice needs research in its own right...the elucidation through research of the nature and best means of developing these core aspects of general practice, for example primary assessment, early diagnosis, domiciliary care, family care, and continuity of care, is of increasing importance”. GP research follows “a people- intensive paradigm rather than a machinery one” (Q410); and multi-disciplinary research is “the model rather than the exception” (Q391). 13. Research in general practice has an honourable history going back into the nineteenth century and even earlier (p126). However academic general practice is a recent development, which has only achieved “critical mass” in the last 10 years (Q419). Professor Denis Pereira Gray, RCGP Chairman of Research, told us, ‘““We have changed the culture from something where there was an anti-intellectualism in general practice, alas, to a more neutral position”.](https://iiif.wellcomecollection.org/image/b32219337_0001_0114.jp2/full/800%2C/0/default.jpg)
