The National Primary Care Research and Development Centre (NPCRDC) is a multidisciplinary research centre, established by the Department of Health in 1995 with funding for a 10-year programme of policy-related research in primary care. Our centre is a collaboration between the University of Manchester and the Centre for Health Economics at York, with our main base at the University of Manchester.
We aim to:
- Deliver high quality research to support the development of primary healthcare
- Disseminate to appropriate audiences
- Inform health policy in primary care.
Our research is organised around three major themes:
- Theme 1 investigates the role of primary healthcare in reducing health inequalities.
- Theme 2 examines how primary healthcare organisations may best be organised to deliver high quality, cost-effective care.
- Theme 3 focuses on the assessment and improvement of quality in primary care.
Theme 1: Health inequalities
Leaders: Deborah Baker (convenor), Aneez Esmail, Hugh Gravelle, Martin Roland
People suffering economic or social deprivation often have poorer health than the rest of the population. Our research is focused on understanding how primary healthcare can be effective in reducing such inequalities.
In order to do this we had to construct a national database linking primary healthcare provision to population health and health needs. This is the National Database for Primary Care Groups/Trusts (PCG/Ts).
The National Database for Primary Care Groups/Trusts
The national database was developed not only to support NPCRDC research programmes, but also as a needs assessment tool for NHS users and a rich data resource for other primary care researchers.
The 'core' database links socio-economic and demographic population characteristics to details of the primary care workforce and services provided for each PCG in England.
These data are also available at regional and district authority level and for general practices within each PCG and PCT. The database is regularly updated and new datasets are added as and when they become available. NHS and academic users can access the database at http://www.primary-care-db.org.uk.
We are using the database to explore the relationship between service delivery and population need, and how this changes over time. Our research follows three lines of enquiry:
- We have focused on the availability of primary care in relation to need for locally based populations of PCG/Ts in England. To do this, we have developed area-based indicators of population need and matched this to the availability of primary care services.
- We have analysed the impact of primary care provision on health improvement and inequality in health. This longitudinal study, using data for health authority populations from 1990 to 2000, examines the relation between primary care provision and a number of specific health outcomes, particularly avoidable illness and death.
- We have moved away from a population approach to consider the way that primary care is delivered to, and used by, individual patients, particularly members of socially and economically disadvantaged groups. We ask whether and how these factors are linked to inequality in acute and chronic illness and mental health.
Theme 2: Primary care organisations
Leaders: Bonnie Sibbald (convenor), Linda Gask, Caroline Glendinning, Hugh Gravelle, Rod Sheaff, David Wilkin
This programme looks at how PCG/Ts need to be organised in order for them to achieve their key roles of improving primary and community services, commissioning hospital services, and delivering improvements in population health.
Structure, governance and budgets
Our research describes the structure and governance of PCG/Ts and how this shapes service development.
In partnership with the King's Fund we are evaluating the progress of a nationally representative sample of 15% of PCGs through our National Tracker Study.1 This annual survey covers all aspects of the work of these new organisations from organisational development to health improvement.
Specific projects allied to the Tracker Study focus on corporate governance structure, clinical governance arrangements, budget management and the role of information management and technology. Lay/user involvement in governance is a key theme of the projects concerned with corporate and clinical governance.
Our workforce research is concerned with the impact of new organisational developments on workforce morale and participation. Completed research has focused on GP recruitment, retention, distribution, and the factors which affect these.2,3
We have investigated potential solutions to GP workforce problems, including strategies for re-locating doctors to areas of need and the substitution of GPs for other health professionals to relieve workforce shortages.
Current work includes an evaluation of the impact of salaried GP contracts on GP behaviour in first wave personal medical services (PMS) pilots.4 We are also investigating the impact of organisational change on GP job satisfaction, the role of general practice managers, and community nurse recruitment and retention.
Work in this area focuses mainly on partnerships between primary care and local authority services, particularly social services.
In collaboration with the Nuffield Institute, Leeds, we are undertaking the national evaluation of the first of the Health Act flexibility sites which allow the NHS and local authorities to pool budgets, delegate a diversity of lead commissioning responsibilities, and develop integrated services for particular client groups.5
Other research examines how partnership working by PCG/Ts improves the development of services for older people,6 and how primary and community services are provided for older people in residential and nursing homes.
Finally, we have evaluated the Family Welfare Association's 'WellFamily' service which locates family support services in primary care settings.7
Theme 3: Quality of primary care
Leaders: Martin Roland (convenor), Judy Cantrill, Linda Gask, Hugh Gravelle, Martin Marshall, Anne Rogers, Bonnie Sibbald
Research in this area is driven by two simple questions:
- Can people access the primary healthcare they need?
- Is that care any good when they get there?
We believe that the NHS needs to provide more flexible means of access to care, which includes promoting patients' ability to care for their own health problems.
We have evaluated a number of initiatives for promoting access, including the placement of mental health specialists in general practice teams,8 NHS walk-in centres,9 and the provision of an 'internet clinic' in a general practice serving a deprived inner-city community. Often these have not proved as successful as anticipated by policy makers.
More promising have been initiatives to improve patient self-care. We have developed self-help manuals for people with bowel conditions10,11 and shown that they can improve the quality of care and reduce costs when used in conjunction with health services that have been redeveloped to give patients more control over the delivery of care.
We are continuing to develop this line of research for other bowel conditions and for mental health.
Our research into the quality of care has three main strands. These are to:
- Develop indicators of the quality of care in general practice
- Measure and explain variations in quality
- Develop methods to improve quality.
We have developed and evaluated a wide range of quality indicators for chronic and preventive care in general practice. In addition we have developed and tested a questionnaire, the General Practice Assessment Survey (GPAS), for measuring patients' assessments of the quality of care they receive.
These measures of quality have been used to describe variations in the quality of care provided by a representative sample of general practices across England, and to investigate the relationship of quality to practice structure and teamworking.
Over the next 3 years, we plan to identify the ways in which the benefits of sharing information on quality of care with the public can be maximised and the potential negative effects reduced to a minimum.
Allied to this research, we have produced a series of handbooks on quality improvement for NHS providers and managers,12-14 and introduced a service for assessing the quality of care using GPAS (accessible at http://www.gpas.co.uk).
Effective communication is a vital part of our work. At NPCRDC we have a communications unit whose remit includes ensuring that our findings reach clinicians, policy makers, managers and academic peers. We disseminate our research findings as widely as possible through journals and books and our own publications such as the Quality Handbook Series.
We aim to target key audiences with publications that are relevant, useful and easily accessible. Further information about all the work mentioned in this article is available from the communications unit, and many of the publications can be downloaded from our website: http://www.npcrdc.man.ac.uk (see Figure 1, below).
|Figure 1: Home page of the NPCRDC website|
National Primary Care Research and Development Centre
|Objectives||To support the development of primary healthcare through high quality research and dissemination.|
|Funding||Ten-year grant from the policy division of the Department of Health, supplemented by funds from the NHS Executive North West and successful research bids to a variety of organisations.|
|Key personnel||Director:||Professor Martin Roland|
|Deputy Director:||Professor Bonnie Sibbald|
|Director of Communications:||Laura Blake|
|Centre Manager:||Andrea Hutcheson|
National Primary Care Research and Development Centre,
|Tel:||0161 275 7601|
|Fax:||0161 275 7600|
- Wilkin D, Gillam S, Coleman A (Eds). The National Tracker Survey of Primary Care Groups and Trusts 2000/2001: Modernising the NHS? Manchester: NPCRDC, 2001.
- Sibbald B, Leese B, Young R. GP Recruitment and Retention 1 – Why do GP principals leave practice? Executive Summary 18. Manchester: NPCRDC, 2000.
- Sibbald B, Leese B, Young R. GP Recruitment and Retention 2 – Improving GP Recruitment and Retention. Executive Summary 19. Manchester: NPCRDC, 2000.
- PMS National Evaluation Team. National Evaluation of First Wave NHS Personal Medical Services Pilots. Manchester: NPCRDC, 2000.
- Hudson B, Glendinning C, Hardy B, Young R. Evaluating the 1999 Health Act flexibilities: interim report. Executive Summary 22. Manchester: NPCRDC, 2001.
- Rummery K, Glendinning C. Primary Care and Social Services: Developing New Partnerships for Older People. Abingdon: Radcliffe Medical Press, 2000.
- Clarke K, Glendinning C. Providing family support in primary care: evaluation of the WellFamily service. Executive Summary 23. Manchester: NPCRDC, 2001.
- Bower P, Sibbald B. Systematic review of the effect of on-site mental health professionals on the clinical behaviour of general practitioners. Br Med J 2000; 320: 614-7.
- Chapple A, Sibbald B, Rogers A, Roland M. Citizen's expectations and likely use of a NHS Walk-in Centre: results of a survey and qualitative methods of research. Health Expectations 2001; 4: 38-47.
- Kennedy A, Robinson A. A Handy Guide to Managing Irritable Bowel Syndrome. Southampton: RTFB Publishing, 2000 [Contact email: email@example.com]
- Kennedy A, Robinson A, Buckley P. A Handy Guide to Managing Crohn's Disease. Southampton: RTFB Publishing, 2000 [Contact email: firstname.lastname@example.org]
- Roland M, Holden J, Campbell S. Quality Assessment for General Practice: Supporting Clinical Governance in Primary Care Groups. Manchester: NPCRDC, 1998.
- Cantrill J, Devlin M, Jackson C, Queenborough R. Improving Quality in Primary Care: Supporting Pharmacies Working in Primary Care Groups and Trusts. Manchester: NPCRDC, 1999.
- Gask L, Rogers A, Roland M, Morris, D. Improving Quality in Primary Care: A Practical Guide to the National Service Framework for Mental Health. Manchester: NPCRDC, 2000.