Integrating research further into primary care
Meet Dr David Wingfield, who has been appointed as the NIHR Imperial Biomedical Research Centre's Primary Care Lead.
Tell us a bit about your background
I am a GP in Hammersmith and Fulham and am now focused on using my clinical experience to develop research opportunities for patients and staff in primary care.
What will your new role as the BRC’s primary care lead involve?
As part of the National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre (BRC), I will lead on the primary care elements for a portfolio of studies across cardiovascular disease (especially hypertension) and mild cognitive impairment leading to dementia. In particular, I will have a responsibility to encourage other GPs but also nurses and pharmacists to take on research projects and deliver studies within the NIHR infrastructure themselves.
Why is it so important to ensure research is integrated with primary care?
Research is most useful in healthcare when it is representative. The first port of call for all patients is their GP which means that there is a significant opportunity in primary care to contribute to research in terms of encouraging representative participation but also in actually delivering trials that benefit the community.
Over time, I hope that we can develop the capacity of primary care to deliver large-scale, fast-paced trials when called upon by industry, academic or national priorities. It will also support the pathway to translating core academic research into clinically relevant applications and enable primary care researchers to take on academic roles in line with the UKRI report on developing a clinician academic infrastructure.
What kind of responses do you get from your patients when you talk to them about research?
The responses are often surprisingly positive and patients do understand that to make advances in medicine clinical trials are necessary. We have an increasing number of patients who felt they had a good experience of research and so return to do subsequent studies after participating in a clinical trial.
Which partnerships are most key to research in primary care?
The central partnership is between the research team and the patient/participant. The confidence and trust that must underpin this relationship cannot be underestimated. Beyond this it is crucial that the GP practice, which is usually a partnership itself, embraces research and can meet the challenges it involves - including managing changes in activity and income levels as studies start and end.
The next most important partnership would be the sponsors, who fund research and must understand the key relationship between research and primary care. We often need to explain the primary care context – for example, we have a registered list of patients, no outpatient structure and there are differences in how we look after patients with multiple long term illnesses in a holistic manner.
Our relationships with the NIHR, who fund healthcare research in the UK with taxpayer money and the NIHR Regional Research Delivery Networks across the country whose staff support study delivery in hospitals and the community, are also key. In north west London, primary care works closely with the NIHR Imperial BRC, the NIHR Clinical Research Facility and Imperial College Health Partners to enhance their ability to perform cutting edge research and to translate these findings into clinical practice.
Finally, research is part of the wider agenda for ever closer working between GP practices, Imperial College Healthcare NHS Trust and other community and acute hospital NHS Trusts to create a seamless system for patient care.
What impact do you think primary care can have on the life sciences?
Patients need support in their communities as well as in hospital and technology is a key example of where life science innovation can partner directly with primary care to improve things for patients.
For example, one study funded by the MRC through the UK Dementia Research Institute, called MinderCare, has looked at the use of cutting-edge, at-home sensors for patients with dementia to provide data-driven information to their clinical teams. The benefit of this is that doctors can intervene more quickly with the care they need by using this data alongside their own clinical assessments. Ultimately improving the outcomes for those patients and keeping them at home, in their community, instead of in hospital.
Another example is the deployment of new technologies to diagnose rapidly and accurately the earliest signs of illness at the GP surgery. These range from deployment of proven equipment such as liver scanners to detect fibrosis of the liver (a risk of liver failure but also of cardiovascular disease) to new blood tests for detecting the presence of abnormal ‘amyloid’ proteins in the blood, a precursor to Alzheimer’s disease.
What are you most excited about in your new role?
I am privileged to have been appointed to this lead role for research, which is the first such GP appointment within a hospital trust. This unique opportunity offers the chance to create a true primary care contribution – influencing and supporting the translational research potential of the BRC. Beyond this, there are opportunities to promote adoption of innovative approaches to care and technology in clinical practice through the North West London Integrated Care Board which has to prioritise and deliver all NHS care.
