Matters Arising R&D in general practice: time to move forwardAn editorial in the General Practice Issue (MJA, 17 July 2000) called for leadership and vision to guide Australian general practice MJA 2000; 173: 668-669
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Comment: Despite a range of initiatives over the past decade,
Australian general practice still suffers low morale.1 The causes are
complex, but diminishing rewards and status, income disparity with
specialists, and a sense of isolation from colleagues and the rest of
the health service, appear to be at the heart of this malaise. General
practitioners around the world describe a sense of loss of control,
and increasing pressures from government and other sources to
provide more services for less reward.
An important component of any strategy to reverse these trends is investment in research. Other disciplines enjoy a strong culture of research, but, in general practice, our research base is modest, and it is difficult to attract funds. The bulk of healthcare decision making occurs in primary care, but this is not reflected in the research and development (R&D) budget. In the United Kingdom, total annual expenditure on R&D in primary care (by the National Health Service and the Department of Health) is only about 7% of total expenditure.2 There are calls for workforce capacity building -- as Dickinson suggests, the current academic general practice workforce in Australia is inadequate to provide effective leadership and guidance at a time when these are needed to inform policy and future directions. Of course, funding more academics is not a popular option. Academic general practice is often criticised for being out of touch with the daily realities of general practice.3 Yet, effective, practice-level research will invariably lack rigour without access to the protected time, training and skills of an academic environment. General practice does seem to be struggling with the concept of partnerships, and for too long there has been a lack of synergy between "grassroots" general practice, training institutions for GPs and academic departments. Partnerships are a feature of the new Primary Health Care Research, Evaluation and Development Strategy in Australia, and will ultimately determine its success.4 In Scotland, there is a similar flurry of interest in primary care R&D investment, with the release of a new strategy5 and the establishment of a Scottish School of Primary Care. In common with Australia, no one is quite sure where this will lead, but it is underpinned by the concept of a primary care-led health service, and acknowledgement that without an adequately resourced academic workforce both policy and practice will continue to suffer. Australian general practice has come some way in the last decade: the Divisions and the General Practice Evaluation Program have helped identify the structure and potential of general practice, and how things might change. The General Practice Strategy Review6 contains a number of recommendations to confront the continuing endemic problems of general practice, including investment in the academic workforce. It is time for urgent collective enterprise. From government, we need carefully planned, sustainable investment in research infrastructure, and a capacity to formulate primary care policy based on evidence and previous experience. From general practice, we need an assurance that this investment will be wisely used, and that meaningful partnerships can be developed to produce both high quality and relevant research and new leaders. We are making some progress in these directions, but let's hope that in 2010 we can say unequivocally that we've moved on. David P Weller
©MJA 2000
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