In this senior officer blog feature, the RCP’s academic vice president Professor Ramesh Arasaradnam discusses the barriers that doctors face in accessing clinical research and what can be done to improve opportunities.
The events of the pandemic illustrated not only the fundamental importance of clinical research in healthcare, but also the UK’s status as a world leader in it. The development of the Oxford-Astra Zeneca vaccine and the discovery of dexamethasone as an effective treatment for patients who were seriously ill with COVID-19 both took place in the UK and have gone on to save millions of lives globally.
But the challenges that the UK faces in maintaining its position at the forefront of clinical research are becoming ever clearer. An inquiry earlier this year by the House of Commons’ Science and Technology Committee highlighted significant concerns about the future of the research workforce, with the number of consultant clinical academics who lead research programmes in the NHS set to decline in the coming years. A report from the Academy of Medical Sciences has also emphasised the need for co-ordinated action to secure a sustainable future for research, including to improve career structures and culture within the UK research system to ensure that people from a diverse range of backgrounds and with diverse expertise can contribute.
Separately, former health minister Lord O’Shaughnessy has undertaken a major review of the UK’s commercial clinical trial landscape. It followed a report by the Association of the British Pharmaceutical Industry which found that the number of patients recruited to commercial clinical trials in the UK fell 44% between 2017 and 2021. The review found that doctors, nurses and NHS organisations lack incentives to take part in research, especially when they are commercially funded. It recommended that income generated by commercial sponsors should be used to provide direct financial incentives to take part in commercial trials. It also said the NHS should establish a Clinical Trials Career Path for training critical roles for research. The government has since responded to the review and it is positive to see that they are taking many of the recommendations on board, with planned actions to implement them, including for building the clinical research workforce. This includes a commitment that DHSC will develop and publish a workforce plan in support of the vision for clinical research delivery during 2024. NHS England will also publish a multi-professional practice-based research practicality framework that can be used by healthcare professionals in Spring 2024. It is important that everyone working in healthcare has the opportunity to undertake research and the support needed to do so.
Clinical research has been a major policy focus for the Royal College of Physicians (RCP) for a number of years. We are committed to a vision of making ‘research for all’ so that every clinician in the NHS has the opportunity to be involved in research. Embedding research in everyday practice for all clinicians will not only help to ensure that the NHS has the research capacity it needs but can also play an important part in improving job satisfaction and contribute to staff retention. At the start of 2020 the RCP conducted a survey of its members to understand levels of clinician participation in research. This found that 57% of consultant physicians wanted to be more involved in research, with 78% saying that they found research appealing because it would bring more variety to their job and make it more enjoyable. However, lack of time was identified as a barrier to engaging with research by over half of physicians. The survey also revealed that access to research opportunities is not equal, with women physicians and those working in rural hospitals participating in research in disproportionately lower numbers despite expressing an interest in doing so.
To understand how these trends have developed since the pandemic, the RCP revisited the issue of clinician participation in research in its latest annual census of physicians, which took place at the end of 2022. This found that 40% of respondents were involved in undertaking research, while 60% were not. Amongst the latter group, 38% were interested in undertaking research but highlighted obstacles including lack of time within their job plan, barriers to research within their NHS organisation, uncertainty about how to take research proposals forward and a lack of confidence. The census also revealed that inequalities in access to research opportunities have persisted, with analysis of the data showing that physicians were less likely to be involved in research if they were women, based outside London, worked less than full time or were in a specialty which contributes to acute or general internal medicine. For example, our 2022 census found that male consultants were 1.6 times more likely to undertake research than their female counterparts. This suggests that many of the structural and cultural barriers that prevented physicians from engaging with research before the pandemic remain problems today.
It is vital that we address these issues and support clinicians to engage with research, particularly those at an early stage in their careers, to ensure the NHS has the expertise it needs to drive research and innovation in future. To help inform this, the RCP and the National Institute for Health and Care Research published a joint position statement last year – Making research everybody’s business – which set out a range of recommendations for stakeholders across the health and care system. An important strand of these proposals was around job planning which is crucial to tackling one of the major obstacles to greater engagement, the lack of sufficient time to undertake research. The statement called on integrated care systems and NHS trusts to encourage support for research to be recognised as part of direct clinical activity, and to ringfence time for research in job plans of those who want to have a substantive research leadership role. It also emphasised the need for multidisciplinary workforce planning to encompass those who support research and made a number of further recommendations for promoting research, including for NHS England, regulators and funding bodies.
The RCP’s latest annual census demonstrates that there continues to be a strong appetite amongst physicians to be involved in research, and it is essential that we capitalise on this for the benefit of the NHS and patients. By improving the effectiveness and efficiency of treatment, research improves patient outcomes and can play a key role in reducing the pressure on the NHS and bringing down waiting lists. It is ultimately fundamental to how we move healthcare forward as a discipline – we need to recognise it as such and maximise opportunities for everyone in the NHS to play their part.