Just before Christmas I was lucky enough to visit the Greater Manchester Comprehensive Local Research Network (GMCLRN – even the acronym is a mouthful!) to see for myself how NHS Primary Care Trusts, hospitals, universities and industry can link together to deliver world-class research. I was blown away by the enthusiasm and efficiency of the team up there. They really have built a culture of research that is delivering what the NHS and UK need if we are to improve the care patients receive and attract investment to maintain Britain’s world-leading position in medical research.
I arrived, bleary-eyed on the 7.20 from Euston to a very wet Manchester – oh how I miss it from my uni days! – joined by Lord Turnberg (Chair of the APPG on Medical Research and AMRC’s scientific adviser), Catherine Luckin from the Academy of Medical Sciences, Rebecca Sarfas from Breast Cancer Campaign and Will Greenacre from the Wellcome Trust. You could call it the inaugural AMRC policy day trip, (I hope there are more to come).
A team effort
We were welcomed to GMCLRN by the Director, Professor Martin Gibson, at their base at Wythenshawe Hospital. The CLRN is made up of 24 different organisations, including primary care trusts, universities and even the ambulance trust. That’s a diverse group of organisations who have to work together. Which is where a small team of about 30 staff, based in a non-descript NIHR building at the hospital, come in. They work behind the scenes to ensure research can happen as quickly and smoothly as possible across the Greater Manchester region.
The first team we met had responsibility for coordinating R&D permissions – a long standing source of frustration for researchers requiring ethical and feasibility approval in every individual NHS organisation. There have been reported past-cases in England of projects taking over a year to get approved and the government have set a target of 70 days to address the problem. Some trials in Manchester have been approved within eight days! They have achieved that quite astounding feat by individually talking to the people on the ground and those responsible for approving research to find out what’s causing delays and removing hurdles such as unnecessary paperwork.
We were then introduced to the patient recruitment team, who have helped develop a very impressive computer system called FARSITE. With this system, researchers can find out how many patients in the area would qualify to take part in their trial, allowing them to plan their projects better and set realistic targets. FARSITE allows users to search a database of all the GP surgeries in Manchester to identify patients suitable for trials – for example, all women over the age of 50 with arthritis and on statins. In a few minutes, requirements could be entered and results given. Crucially, both the user and researcher could only see numbers – no identifiable patient data. The GP is then informed and makes contact with the patient. But again it was the personal contact between the GMCLRN team and GPs and research nurses – who are the ones who actually talk to patients and know them – that ensured realistic recruitment targets were set and problems smoothed over. With dedication and attention to detail, the GMCLRN is the best recruiting network in the country – between 1 April and 26 November 2012, they recruited 1,776 participants into a total of 108 commercial studies. Manchester also has England’s highest ratio of commercial to academic trials (81% academic versus 19% commercial – the national average for commercial is 14%).
We then met with David Dalton and Maxine Power who have been overseeing the establishment of the Greater Manchester Academic Health Science Network (GMAHSN). As you might remember from this blog a few months ago, AHSNs have been launched by the government to speed up the diffusion and uptake of innovation across the NHS. They sit towards the end of the technology-development pathway and are designed to ensure the products of research are put to good use by linking those with first-hand experience of patient care with those conducting research. This also means that researchers can get feedback to help identify the important research questions and needs of the NHS.
The AHSN has set itself high level objectives of improved health outcomes – reductions in premature deaths from cancer, cardiovascular and circulatory disease for example – that will be achieved through its linking up strategy across the region. Networks from across the country are currently having their proposals assessed by the Department of Health, which is expected to announce successful applicants early in the New Year. AHSNs successful in this first round will be expected to be operational around April 2013 along with the new NHS organisations (CCGs etc.). There will be further rounds of applications for those not successful or for new bids.
Industry research in the NHS
On the other side of Manchester in Salford we were introduced to a truly revolutionary way of doing clinical research with large populations. The Salford Lung Study has been set up by GlaxoSmithKline to test the safety and effectiveness of a new treatment for asthma and chronic obstructive pulmonary disease (COPD).
The study is being run by a research collaborative called North West e-Health (they are also behind the FARSITE system), which is part of Salford Royal NHS Foundation Trust and the University of Manchester. They have developed an electronic system that allows patients to report their experiences – good or bad – of taking the medication from their own home online. It also tracks and links GP appointments and hospital or pharmacy visits, allowing huge amounts of data to be collected on consenting participants as they go about their normal lives. We met with the research nurses that monitor the reports and track each patient to ensure they get home visits or are checked over at their local GP. The team has also had to train all the pharmacists in Salford so that they could dispense the experimental treatment.
The universal healthcare provided by the NHS, combined with a nationally-representative population and advanced e-health systems meant that Salford was basically the only place in the world where such a study could take place we were told.
Bringing it all together
All regions have lots of different organsiations contributing to the health of the local population. Greater Manchester has a population of about 2.68 million people so it’s no surprise that there’s a bewildering array of NHS care providers. But from what we saw they really are doing a fantastic job of bringing it all together to deliver a streamlined research service. But they are certainly not alone, we have heard of lots of regions doing similarly impressive stuff.
Here at AMRC we have a major strand of work looking at how the new NHS structures are coming together to meet their duty to promote research. We’ve already held a workshop bringing together research funders and individuals working at all levels of the NHS to start to look at what’s already happening to support research, and we are holding a breakfast in parliament in January to give MPs and peers a chance to feed in. The outcomes of both meetings will help shape a Vision for research in the NHS, helping us to engage with new and existing NHS organisations to ensure research is at the heart of their mission to improve the health and wellbeing of their patients.