The Brisbane International Initiative: fostering leadership and international collaboration in primary care research

Primary care is where most patients receive most of their health care. It makes a greater contribution to the community’s health than specialty practice.1,2 Yet research in primary care lags far behind that in the specialties; it is a “Cinderella”, criticised for its comparatively small output and its lack of relevance and methodological rigour.3-6 This discordance has focused attention on the need to strengthen primary care research infrastructure and capacity.7,8 In Australia, the federal government responded with the Primary Health Care Research, Evaluation and Development program.9

The Brisbane International Initiative (BII) is another approach with similar — but international — objectives. Wide-ranging and ambitious, it was founded at a Brisbane meeting of leaders in primary care research from eight countries in 2002.10 Its aim is to develop expertise in primary care through promoting capacity and fostering excellence in primary care research. It now operates within the World Organization of Family Doctors (WONCA). Originally a collaboration of 14 university departments of general practice (in North America, the United Kingdom, Europe and Australia), the BII has since expanded and promotes primary care research capacity-building through a range of activities (Box 1).

One of these activities is the convening of postdoctoral peer-learning cohorts in a 2-year program of development for research leadership administered at the University of Oxford in the UK. We were among the second (2007) cohort of 12 researchers (Box 2): two of us are Australian (P J M and J S F), and the third (M L v D), originally from the University of Ghent, has since taken up an academic position in Australia. The 2-year program has a flexible overall structure but begins and concludes with meetings at the host institution. The initial meeting for our cohort was held on 3–6 September 2007 at St Hugh’s College, Oxford (Box 3).

The meeting had a conventional structure — seminars, talks and workshops — but stood out for the quality of its content. It was designed and seamlessly facilitated by Alison Ward (Research Support Director, Department of Primary Health Care, University of Oxford). Box 4 outlines the material covered and the impressive range of presenters. However, the meeting had a further agenda: the smallness of the group, the cloistered surroundings, and the privileged access to distinguished and influential people in the field of primary care research instilled in us a sense of responsibility; the meeting also introduced us to international peers at a similar career stage and, specifically, gave us an opportunity to plan collaborations.

The BII has high aims. A major objective of the week in Oxford was to bring the cohort together and foster collaborations. But was it just a talk fest for a privileged few? The proof is in the pudding. What matters is what we achieve as a group from coming together. Already there are good signs. The 2007 cohort will organise a workshop at the Society for Academic Primary Care conference in Galway, Ireland, in 2008, focusing on developing measures of research output for departments of general practice. The group (led by J S F) has written an article on future directions in primary-care research and submitted it to a peer-reviewed journal.

The Australian BII participants are developing other collaborations. These include an article on journal impact factors and their influence on research and researchers (lead author, M L v D).11 P J M has developed a collaboration to study GP referral patterns for transient ischaemic attack and is exchanging ideas with another group member on parallel projects on inappropriate prescribing in older people. Undergraduate students from the University of Aberdeen, Scotland, may be offered the opportunity to complete an elective research term in a collaborating department at the University of Newcastle, Australia. P J M will also make short visits, facilitated by colleagues at Keele University, the University of Sheffield, the University of East Anglia and University College London, to study the organisation and functioning of British research networks of general practices. In addition, the Australian-based BII participants hosted a breakfast meeting at the national General Practice and Primary Health Care Research Conference in Hobart in June to explore the possibility of local Australian postdoctoral peer-learning groups. These may be modelled on the experience of Andrew Farmer (Lecturer in General Practice, University of Oxford) who spoke at the BII meeting of his experience as a member of a Medical Research Council peer-learning group of postdoctoral primary care researchers.

It is still quite early in the 2007 cohort’s BII program, but it is proving to be an exciting and potentially productive exercise. We urge Australian postdoctoral (or near to doctoral submission) primary care researchers to consider applying for subsequent cohorts. Applicants must be nominated by their department. If they are selected, the department agrees to become a partner institution of the BII. This involves providing financial support for their participants to complete their BII obligations (except for accommodation and expenses at the Oxford meetings, which are funded by the University of Oxford), and agreeing to host BII participants from partner institutions. We feel strongly that this would prove a sound investment in research capacity-building for the departments involved.

2 Some of the participants at the 2007 meeting

Left to right: Chris Del Mar (Visiting Professor of General Practice, University of Oxford), Parker Magin (Senior Lecturer, University of Newcastle), Mieke van Driel (Senior Lecturer and Research Fellow, University of Ghent), Caroline Mitchell (Senior Lecturer, University of Sheffield), John Furler (Senior Research Fellow, University of Melbourne), Umesh Kadam (GP Epidemiologist, Keele University), Barbara Hanratty (Senior Lecturer in Population and Community Health, University of Liverpool), Greta Rait (Senior Clinical Lecturer, Royal Free and University College Medical School), Jennifer Cleland (Clinical Senior Lecturer in Primary Care and Medical Education, University of Aberdeen), and Colin McCowen (MRC Training Fellow, University of Dundee).

3 St Hugh’s College, Oxford, venue of the meeting