The NIHR Clinical Research Network is the research delivery arm of the NHS, and AMRC members use its service to recruit patients into charity-funded clinical studies. The structure of the Network will be evolving over the next year. Louise Wood, Head of Communications at NIHR CRN, asks Dr Jonathan Sheffield why they are changing, and how AMRC members can be involved in the process through the CRN’s recently-published consultation on Network clinical themes.
What’s happening at the NIHR Clinical Research Network?
In essence, we are making some changes to the structure of the Clinical Research Network so we can keep improving our service, and make it easier for our researchers and funders to work with us.
The NIHR Clinical Research Network has been very successful. We’re proud of the fact that we’ve doubled the number of NHS patients taking part in clinical research studies over the last five years, and that our ability to deliver studies to time and target keeps getting better . But we can’t sit on our laurels. We have reached a point where we need to adapt the way we’re organized, if we are to meet the challenge of delivering research efficiently in a changing NHS.
What changes are you making, and why?
If you look back at our history, the various Networks were set up as separate (albeit linked) bodies, at different times. That has given us strength, because it has allowed us to develop in-depth expertise in delivering clinical studies in specific therapy areas – but it has also resulted in a very complicated picture on the ground.
Right now we have more than 100 local networks, some that specialize in particular therapy areas, and others that cover a whole range of diseases. The geographical boundaries of these networks overlap in some places, but don’t in others. In other words, it is quite difficult for charity funders, and individual researchers, to make sense of it all – not to mention causing headaches for the NHS finance directors who have to keep track of the funds for this infrastructure. As well as this, being organized into so many separate sections makes it hard for us to move resources around to where they are needed as delivery priorities change.
Between now and spring 2014, we will be simplifying our structure, so that we have just 15 Local Clinical Research Networks. Together they will cover the whole of England, with the same boundaries as the emerging Academic Health Research Networks (although we do have very different roles in the research system). Each one of our Local Clinical Research Networks will be responsible for the efficient delivery of clinical studies on their patch.
One of the big advantages is that each of the 15 area-based Networks will deliver studies across all the different therapy areas or “themes” as we’re now calling them, so we will build on our ability to deliver clinical trials across the whole of the country.
What will these changes mean for research charities?
In some ways, very little. Our role is to make sure that the studies funded by research charities recruit the number of patients required to answer the research question, within the timescale available. That role has not changed, and we will still keep on working with the charity sector to do that job as well as we possibly can. But having a more unified, simpler Network structure will mean we can make improvements that would be much more difficult to achieve in a more fragmented organization. For example, we can standardize and streamline our processes – where it is relevant to do so – to make research set-up and delivery quicker and slicker. We can be more consistent in the service we provide across the country, which is something researchers have asked us to do. And we can be flexible. So we can put the people and resources where they really need to be.
So although it is very much “business as usual” in many respects, we believe that moving to this simpler structure will help us to deliver our business better.
The biggest change for the Research Charities comes through the introduction of AcoRD which is an opportunity for the charities to have an even better relationship with the Network. Early consultation on new clinical research projects will allow us to assess feasibility for the study across the whole of NHS England. We now have data going back over five years which shows where successful patient recruitment has occurred across the whole spectrum of our Portfolio – last year alone that was 595,000 recruits and more than 2,500 different studies. By working with us, charity-funded researchers should be able to select sites where delivery of studies has been most effective.
The NIHR Clinical Research Network has asked the AMRC to give a view, on behalf of its members, about these clinical “themes”? What’s the consultation all about?
At the moment the NIHR Clinical Research Network has six “topic” networks (cancer, diabetes, dementias/neurodegenerative diseases, medicines for children, mental health and stroke). It then has a Primary Care Research Network, and a “Comprehensive” Research Network that covers all the other disease areas, and which includes more than twenty “specialty groups”. The experts who work in these different bodies are essential to the work we do, because they understand the different care pathways, they have a detailed knowledge of the resources available in the NHS, and they drive through the delivery of each study. But again, the structure is complicated, and there are some artificial divisions that we think could be streamlined and made to work better.
We wanted to take a fresh look at how we organize our specialist expertise across the Network, so that we bring the right people together, and make it easier for researchers to get access to very specific knowledge about research delivery in a particular disease area. Rather than “topics” or “specialty groups”, we are calling these specialist knowledge areas “themes”.
So to give you an example, where we used to have one group for dementia /neurodegenerative diseases, and another for nervous disorder diseases, we are suggesting that – in our new structure – we would have one expert theme that covers all of these things, since those areas of clinical expertise seem to sit naturally together.
In the consultation document we have shared our ideas about the different themes, and which therapy areas they cover. We are very interested in hearing from the charity sector – through the AMRC funders – about whether these themes are grouped sensibly, whether the research community can relate to them, and whether there are any particular issues or concerns that charity funders would want us to take into account, as we move towards this simpler theme structure.
Are there any other factors in the research environment, that will shape how the Network operates?
The Network has to adapt and change the way it works as we see new approaches to clinical research and how trials are delivered. Right now, the growth of stratified medicines is important for rare diseases, but as diagnostic biomarkers improve, many previously common diseases will be divided into better defined sub-types. That means therapies will be better targeted, but it also means that individual trial sites will have fewer patients, so the NHS has to get better at recruiting patients into studies across its whole geography. I am confident that our new structures will make this much easier to achieve. We also have to embrace the information revolution with more real time studies using data embedded in patient records. Standardisation of data collection will make delivery far more efficient.
How long will this reorganization take, and will it affect your ability to deliver charity-funded clinical trials whilst it is happening?
Although changing an organisation’s structure sounds dramatic, the changes we are making are largely about creating a better way to administer and manage what we do. We are not looking to reduce our resources on the ground, and we are absolutely committed to “business as usual” while we make the changes. Our senior management team right across the whole of the NIHR Clinical Research Network is working really hard to make sure we get this right, and we are aiming to have our new structure in place in the first half of 2014. That is a quick pace, because we want to get on with the day-job as quickly as possible, but long enough for us to consult with our stakeholders on key decisions (such as how we arrange our “themes”) along the way.
Where can charities find out about the NIHR Clinical Research Network transition over this next year?
Very soon we will be launching a section on our website where we will post the latest developments, and we will be covering the transition in our monthly E-NET newsletter. You can sign up for that on the homepage of our website. We will also be talking about these changes at the AMRC clinical research workshop on 20 March 2013.