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Integrating clinical research into care: a community healthcare perspective

Dr Rachel Hall, head of research at Bridgewater Community Healthcare NHS Foundation Trust, describes how her trust built up research infrastructure and the impact this has had on patients and staff.

Are there particular challenges being research active as a community healthcare provider?

When I took up the newly created role of Head of Research back in 2013, we had very little formalised research activity or infrastructure. We are a leading provider of community health and dental services in the North West of England. Most of our services are delivered in patients’ homes or at locations close to where they live, such as clinics, health centres, GP practices, community centres and schools.

Community healthcare providers still do not fit the traditional view of “go to” places for research. A lot of effort and persistence has been spent working with research teams, partners, National Institute for Health Research (NIHR) networks, and funders to show that we are in fact an ideal place to conduct research due to our varied patient contacts spanning many conditions, delivered by a range of health professionals. We have repeatedly shown that we can deliver studies to time, and target.

What progress has been made at Bridgewater?

Research should be part of core business activity, and we have worked hard to build up our research infrastructure, capacity, engagement and relevance. Clinical trials are just one type of research. The trust intentionally adopted a flexible definition of research that acknowledges the myriad ways in which our workforce engage in and use research in their work.

Other studies might be aimed at finding out how a procedure could be improved, or to collect the views of our workforce regarding service delivery, development and improvement.

Research is also carried out through reading and appraising evidence, papers and source material (desk research), assisting in recruiting patients into studies, and demonstrating our suitability as a provider in tender applications. ​​

Our research portfolio reflects this, we currently support over 30 studies, a mixture of national portfolio and own account. For some studies, we are the only community trust acting as a site.

What’s the impact of this shift been?

Thanks to research activity in the trust, our patients benefit on many levels: from accessing new and highly specialist treatments to improvements in service delivery. Staff gain valuable skills through research activity and training which are transferrable into their clinical work.

Research activity has also brought reputational gains. We have been crowned winners on a number of occasions at our local NIHR Research Network’s annual awards for our research in the community setting.

Notable highlights are the trust topping the annual NIHR league table for achieving the highest percentage increase in the number of studies recruited to, and having the third highest percentage increase in recruitment by a trust in England – all this with a very modest research infrastructure.

How has the pandemic changed your research activity?

COVID-19 has been extremely challenging for research. Back in March 2020, we suspended all our non-COVID-19 research, meaning that many of our trials and studies were paused mid-intervention or recruitment. But over the last 10 months, we have been able to support many of the national urgent public health priority COVID-19 studies, sometimes as the only community healthcare trust. 

The most memorable has to be our support for the development of the Oxford/AstraZeneca vaccine, where a number of Bridgewater colleagues took part in the trial.

The last 10 months have seen immense pressures placed on NHS colleagues. The trust has supported priority research measuring the NHS workforce’s mental health and wellbeing, most notably our BAME colleagues, so that appropriate support packages can be developed and introduced.

Our immediate plans are to re-start our pre-COVID-19 research and expand our dental research portfolio. Continuing building up relationships with key networks, via for example, our membership of the North West Coast Applied Research Collaboration is also a priority.  

Is there any advice you’d give to clinicians wanting to become involved in research?

  • Embrace your curiosity. Research active clinicians are brave, often asking difficult questions, challenging current treatments and searching to improve practice.
  • Opportunities exist right across experience levels within medical, nursing and AHP teams, from the novice who may initially support research by assisting with recruitment, to principal investigators running a study.  
  • A good starting point is to seek out your trust’s Research & Development Team, they can provide training and funding opportunities and connect you with the wider research community.