This letters was published in the journal Tuith Online in January 2002

Developing Research in Primary Care - the Scottish Approach

We know that most patient care takes place in community settings and is led or co-ordinated by a member of a primary care team. As such, primary care plays a pivotal role in NHS Scotland with high quality services a priority and a route to better outcomes. The development and delivery of high quality services depend on relevant and effective research evidence. However, in primary care the evidence base remains sparse whilst the capacity of the NHS and Higher Education sectors to undertake the necessary research remains under-developed. There simply are not enough high quality researchers to undertake all of the research and dissemination needed to enhance the delivery of primary care services. Primary Care remains a Cinderella area in relation to research and has not been able to get into the 'Research Ball'.

A peculiarly Scottish solution to this UK-wide problem has been to set up the Scottish School of Primary Care. The School was initiated in January 2000 in a two-year Foundation Phase, with the support of all professional organisations and the Scottish Executive Health Department. The most important aspect of the School's organisation is that it is 'virtual'. It is a 'School without Walls' in that a small central directorate works to stimulate and co-ordinate the activities of researchers and educators across Scotland. The Scottish School established early on in the Foundation Phase a very close working relationship with the Scottish Consortium for Development and Education in Dental Primary Care through the joint appointment of a Projects Officer, thereby providing an element of joint planning. One of the main initiatives of the Consortium has been the establishment of the Scottish Dental Practice Based Research Network (Scottish Dental PBRN). The Scottish Dental PBRN aims to promote research and the implementation of evidence based practice in Scotland. The Projects Officer currently works for the Consortium from two bases, the School and the DHSRU in Dundee.

The main aims of the School are to:

• Provide and interpret the high quality research evidence needed to inform decisions made by patients, practitioners, managers and policy makers;
• Increase research capacity and capability within Scotland through increasing the accessibility of education and training in primary care research.

These translate into three areas of activity: the development of programmes of research; the development and implementation of a strategy to increase capacity and capability; and a programme to develop a more synergistic relationship between research and service or policy development.

In relation to research the School has catalysed existing research activity in primary care to achieve substantial additional investment. By securing £1.2m from the Chief Scientist Office and the Scottish Higher Education Funding Council a programme of research in the organisation of primary care as been initiated. This programme includes the research project investigating the effect of remuneration and education on the implementation of research evidence to reduce inequalities in oral health, led by Dr Jan Clarkson as the Principle Investigator.

In relation to increasing capacity and capability for research the School has worked to encourage multi-professional involvement in Primary Care Research Networks, which offer opportunities to NHS staff for research training, mentoring, and peer-support. It has worked with Scottish Primary Care Trusts and Scottish Executive Health Department to identify funds for research fellowships through which primary care professionals can free up time to develop their skills and undertake a project that trains them in research. In addition it has brought together the range of educational opportunities in primary care research in Scotland through it web-site, and has organised key educational courses appropriate at national level who have been attended by dental practitioners.

Finally, in relation to the development of a more synergistic relationship between service development and research, the School is working with all of the Scottish Primary Care Trusts on a programme of work that brings experienced researchers to groups of professionals engaged in developing services across Scotland. The researchers bring research evidence and evaluative skills whilst the NHS staff bring experience of on the ground delivery of care to the service development process. One of the most exciting aspects of this programme is the opportunity it offers for mutual learning amongst NHS staff.

The School has worked with a range of Scottish organisations committed to improving the research base and effective practice amongst dentistry in Scotland, including DHSRU, the Scottish Consortium, and the Faculty of General Dental Practitioners. Real success is beginning to be achieved, with increasing amounts spent on primary care research and more primary care staff beginning to be interested in research. We hope that the next three years of the School's life, with funding from the Scottish Executive Health Department of around £225,000 pa for its core staff, will see Scottish primary care researchers not only going to the 'Research Ball' but going in style.

Sally Wyke (Director), Helena Chesser (Business Manager), and Heather Coupar (Projects Officer)
Scottish School of Primary Care