Is primary care research important and relevant to GPs?
INTRODUCTION Insufficient investment in primary care services, even in high-income countries, is challenging health systems, for example, through pressures on the primary care workforce from rising workloads, ageing practitioner profiles, and declining interest in primary care careers from young practitioners. Failure to invest in research to guide better practice, raising quality and reducing variations in care, may be a further risk. But is primary care research really that important? IMPORTANCE AND DOMINANCE OF BASIC SCIENCE MEDICAL RESEARCH Most biomedical research has historically been centred on basic science and the pursuit of discovery, for example, on the mechanisms of disease and their amelioration. Until latterly, the application of this science was seen merely as a professional responsibility — why don’t practitioners just get on and apply the important findings? But such implementation delays may be more to do with incomplete evidence than clinical inertia, hence one argument for more applied research evidence to inform discovery science. A century of serial multi-billion-dollar investments in basic and discovery science generated the interventions we use today. But this investment is being challenged by the dawning recognition by health systems that they need a better evidence base to inform the structure and provision of care, and how to apply the findings of much of this extraordinary biomedical science. Despite basic research consuming most of the global health research investment, much of health care remains empirical and non-evidence based. And, even when evidence gives a clear directive on what to do, slow translation into clinical practice may be as often due to uncertainties as to how to apply the data than on professional inertia. Belated recognition of such barriers to implementation has led to the introduction of a more applied clinical research focus in many countries with developed healthcare systems, such as the NHS, that complements basic science and discovery research. First came the science around evidence-based medicine (EBM), for 20 years developing and employing better methods of synthesising and presenting the totality of quality evidence and thereby reducing uncertainty. Latterly an investment in applied health research, and the capacity to better deliver this, has gathered impetus internationally, for example, via the main driver for such applied research in the UK, the National Institute for Health Research (NIHR). Primary care and primary care academics have steadily contributed to many aspects of health research, but it has been particularly important in applied research at the structural and inspirational levels.