CCGs are key to research in the NHS but they cannot do it by themselves

Posted on June 4, 2013 by

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Following the launch of AMRC’s vision for research in the NHS, GP Dr Peter Brindle explains how the new commissioners of health services need to be supported to ensure research reaches every part of the NHS. 

Why is research important for the NHS? Well, superficially this may seem pretty obvious. It’s vital for patient care. Without research we won’t know anything about the prevention, diagnosis, and management of  health conditions. Doing research gives us evidence. Evidence to do things that help us deliver a better health care system and to stop us from doing things that don’t help.

But more than that, being research active is a marker of quality. Being involved in research is being part of a questioning culture. To research, I would add service evaluation. Too often services are commissioned and never properly evaluated to see that they are doing what was expected of them in terms of cost effectiveness, patient acceptability, and safety.  Too often we see what I call ‘belief based commissioning’  – commissioning services on the belief they will work as we hope they will. So research and evaluation are all part of a questioning culture that is about asking “is this the best way of doing things and if not, what is the best way – how can we make things better?”

We all want an excellent NHS, and a key ingredient of an excellent NHS is that culture of research and evaluation. The culture of questioning.  The culture of quality.  Now, effective commissioning is meant to drive the NHS, therefore it follows that we need our healthcare commissioners to drive this expectation of quality from their providers through research and evaluation.

The Health and Social Care Act brings with it many challenges. It also brings with it a significant opportunity, for the first time our commissioners have a duty to promote research and the use of evidence. We have a new breed of clinical commissioner, who in their training will have been exposed to research and the need for evidence. Experience is showing  that these new clinical commissioners  may be more understanding of the need to conduct patient-relevant research and evaluation than perhaps their predecessors were. Hence the research charities and other key funders such as the NIHR, have a great opportunity to engage with the NHS in a way that perhaps has not been possible before. We also have new organisations that are not set in their ways and are open to new and better ways of working. While it is an opportunity to engage these new commissioners in driving research within the NHS, I would say it much more than an opportunity. It is an absolute necessity.

One of the challenges of the Health and Social Act is the push towards increased competition and widening the provider base to include more “Any Qualified Providers”. Most of the new providers, unlike their traditional competitors – the acute trusts and mental health trusts – will have no tradition of research. If commissioners launch procurements  and award contracts without any thought to research and evaluation, then it is most likely that the provider will not offer opportunities for patients to take part in studies, and research will not happen. There are already examples of where high quality research is under threat due to a change in provider. It is therefore essential that commissioners include the requirement in their tender documents and service specifications that providers have processes in place to facilitate the recruitment of patients into studies. I am pleased to say that Bristol CCG, which is in the midst of recommissioning all their mental health and dementia services, will be including this requirement in their service specifications and tender evaluation processes. However, the most efficient way to do this, would be to modify the Standard NHS Contract for all services.

So how to engage commissioners into driving this culture of quality from their providers? CCGs are struggling with a newly fragmented health system, long held networks of relationships are broken, and have myriad of new responsibilities to address. It is very tough just keeping the show on the road. So the way not to engage with them is to wave sticks at them and tell them they should be doing this or doing that in the field of research. They really don’t need any more sticks. So instead of sticks, what should we use? Well, the research community need to put themselves in the shoes of these commissioners while remembering they are providing a product – evidence for the NHS to use. Researchers and their funders need to work with commissioners and work hard to demonstrate their value. There are a number of ways they can do this, for example:

  • Academic expertise can be offered to commissioners to do quick evidence reviews and help them evaluate their services.
  • Real efforts need to be made to identify and promote commissioner’s priorities for research.
  • Commissioners need to be included as co-applicants on grants and properly costed in.
  • Research findings need be packaged in a way that is accessible and useful, especially systematic reviews.
  • Researchers need to work hard to ensure that their research actually improves things for the better – that it has impact.

In return, academics gain real NHS partners, a source of relevant ideas and better chance that their evidence will used to make a difference. They will also find they have allies who value services that recruit patients to studies.

I’ll finish with this message:  We want the NHS to offer the best service in the world.  Research activity is marker of quality, and our new commissioners are key to ensuring that research activity reaches every part of the NHS.  But they cannot do it by themselves.

Dr Peter Brindle is a GP and the commissioning lead for dementia services for Bristol CCG. He is also the R&D director for Bristol, North Somerset and South Gloucestershire CCGs and for one day a week the Director of the NIHR  South West Dementia and Neurodegenerative Diseases research Network, more easily known as DeNDRoN.

Posted in: Policy