First published by SAPC on 9 October 2020.
Andrew Farmer is a former member of the SAPC Executive Committee. He has recently taken on the role of Programme Director for the NIHR Health Technology Assessment Programme, the largest funder of NHS facing clinical trials.
For the first 20 years of my career as a GP, I lived in fear of seeing another patient with Bell’s palsy! Early in my career I had seen a man, in his mid-forties, in my evening surgery with a 24-hour onset, typical Bell’s palsy. After appropriate examination and a phone call to the hospital, I gave him a course of steroids, safety netted and arranged a follow up appointment. Two days later he turned up again and proceeded to tell me the NHS was lousy and – with finely tuned barrage of insults – left me wishing that I was somewhere else. Over the next few weeks (he had a good recovery of the paralysis – complete within three months), he told me that his behaviour was completely out of character. He had experienced a mood disturbance as a reaction to the steroids.
Up until 2007, there were only a small number of trials and major uncertainty about the benefit of steroids treatment in Bell’s palsy. Mild to moderate reactions to steroids are reasonably common, and I didn’t have any evidence that the benefits of treatment were likely to exceed the harm. So, what would I do next time? However, in October 2007 a primary care led team published a trial, funded in response to a call by the NIHR Health Technology Assessment (HTA) Programme, for definitive evidence about treatment for the condition. Steroids are now recommended as standard treatment if given within 72 hours of onset of the condition. And I treated my next patient with a Bell’s Palsy (in 2008) with much greater confidence (and no adverse reaction to steroids).
I didn’t anticipate then, that I would add to my roles of GP and researcher, that of Programme Director for the NIHR HTA Programme. I’m taking on responsibility for ensuring that the pipeline of research evidence about drugs, tests, therapies and other interventions that has produced so much evidence underpinning NHS treatment to date, continues into the future. Even in the last few weeks, NIHR HTA studies have provided a wealth of high quality evidence including best options for treating shoulder pain and the value of intravenous antibiotics in cystic fibrosis: studies that are likely to guide recommendations in NICE guidelines and change practice.
HTA currently has over 400 active studies and is the largest funder of NHS facing clinical trials. Over half of these studies are commissioned by the HTA Programme to answer important clinical questions. These questions come from a range of sources including NHS England, NICE, and the James Lind Alliance. The questions (usually in the PICO format) identify evidence gaps or uncertainties around important treatments, tests or other therapies. The HTA Programme works up around seventy of these questions into calls for research each year, with patients and clinicians involved every step of the way to determine priorities and ensure that the research commissioned will answer patient needs.
Primary care clinicians and researchers are in a very strong place to identify unmet needs, and identify treatments that could be delivered in the NHS if there were stronger evidence that they are effective. The HTA Programme welcomes research suggestions from individuals and from groups of researchers and clinicians who can get together to focus research priorities carefully. There is an on-line form to submit clinical questions (in the PICO format) to the HTA Programme.
Primary and community care researchers are represented on all three HTA funding committees and the two topic prioritisation committees. The committees are interdisciplinary with a balance of methodologists, clinicians and patients. Advertisements for committee membership will come out in the New Year. NIHR trainees have a special opportunity to apply for membership of one the committees through the NIHR Reviewer Development scheme. NIHR HTA is absolutely committed to diversity in every aspect of its work. We want to see the widest possible range of people applying for membership of funding committees. We also want to see research applications addressing the needs and issues experienced by people who have been less well-served by research: whether it is through where the research takes place, or through the questions research studies are trying to answer.
HTA is part of the NIHR with which it works closely, – but it is unique in commissioning and funding studies to address NHS and social care needs around the value of treatments, tests and therapies. Thank you if you are already involved in NIHR HTA Programme work - it couldn’t happen without the wide support of so many people. And if you aren’t already, please do get involved.