Peter Croft, Professor of Primary Care Epidemiology at Keele University, has seen a sea-change in research priorities in health in the last decade. "Prior to this time, relatively little primary care research was being done compared with other medical research. This is partly because the way we framed questions in medicine then was much more suited to secondary care – the key research questions were those asked either in the lab or at the hospital bedside. But it was also because primary care just did not have the culture or the resources to conduct research in the same way hospitals could. I came to this post at Keele in the mid-1990s when this situation was beginning to change."

Most illness in the UK is treated in primary care and, with ever-greater emphasis on evidence-based medicine, the arguments for developing research that is specific to the needs of this arena are compelling. There has also been a realisation that primary care is full of people who – given the right training and support – make excellent medical researchers. And of course there is plenty of room for good science in primary care – whether it is randomised controlled trials, epidemiology, social science, health services research or health economics.

All these factors have meant that Keele's primary care research, spearheaded by Professor Croft, began to grow very quickly. "It has been an organic process," says Professor Croft. "The university appointed the first UK consultant in community rheumatology, Dr Elaine Hay, followed by a Professor of Physiotherapy, Julius Sim. Then we have well-regarded social scientists with whom we collaborate such as Professor Pauline Ong. Several years ago we got together as a primary care research group and started to develop trials." The group began to specialise in the area of musculoskeletal pain, the second most common reason for visits to the GP (after coughs, colds and other respiratory problems) and the primary cause of disability in the UK.

In the late 1990s, primary care research began to be systematically resourced across the UK. The Keele area has received substantial investments from the North Staffordshire Health Authority and the NHS Executive (NHSE) West Midlands enabling local GP practices, with which the Keele group collaborates in all its research, to set up computerised recording systems of sufficient quality to form the basis for research.

"We work with 18 general practices in the North Staffordshire area," explains Professor Croft. "We agree a mutual programme of research and present it jointly to funders. There has been a sense, if you like, of pulling us down from our ivory tower to engage in a research agenda that is led by clinicians at the coalface. It has meant we have large enough studies to be robust – which general practices cannot do on their own – and also that there is less likely to be duplication. Our research is aimed at determining the most effective way to treat back, neck and joint pain in primary care. By primary care we mean all first access to care – general practitioners, physiotherapists, pharmacists, nurses, podiatrists and complementary therapists."

The team has embarked on a number of clinical research projects, funded by the Arthritis Research Campaign, Medical Research Council and the Wellcome Trust, among others, with infrastructure support from the NHSE West Midlands. The research concerns all aspects of musculoskeletal pain in primary care, and broadly divides into patterns of care use, the role of clinical diagnoses and randomised controlled trials of common treatments (see box below).

In 1998, the group was formally constituted as the Primary Care Sciences Research Centre, with a team of researchers, both clinical and non-clinical, with the broad mix of skills needed to look at primary care from the eclectic standpoint required for a generalist medical approach. "We have over 50 staff here now," says Professor Croft, "including senior lecturers, research fellows, research nurses and physiotherapists, GP research fellows and a wonderful management and support team."

However, the Centre has been working with a very dispersed structure, with sites on the university campus, university facilities at two local hospitals, and a number of general practices and health centres. The need for a single building to house the academics and research support staff, as well as a coordinating centre for the clinical networks, was becoming more and more apparent.

The new building for the Primary Care Sciences Research Centre will be built on a green field site on the campus complex – Keele's rural location outside Newcastle under Lyme gives it enviable space for expansion. Construction begins in the summer, and the building is due to open in late 2002. The Wellcome Trust grant – of just under £750 000 – will provide for the fitting out of the Centre, including skills laboratories for data analysis, a coordinating centre for population surveys, a reference library, seminar rooms and lecture theatre, and offices for the directorate and researchers.

Howie Scarffe, the Trust's Head of Programmes with responsibility for clinical initiatives, sees this grant as "one of the ways in which the Trust ensures the translation of scientific advances into clinical advances and improved patient care. If the Trust's involvement in the Human Genome Project represents one end of the spectrum of medical research, then initiatives such as the Keele Centre represent the other – grounded in clinical practice, and directly patient-focused."

Alongside the primary care centre will be a new undergraduate medical school. Keele, in tandem with the University of Manchester, made a successful bid to become an undergraduate school of medicine in 1999. There is scope for synergistic growth between Keele's various medical undergraduate, postgraduate and research centres; for example a Chair of General Practice, to be created in the next five years, will cover both the undergraduate school and the primary care research centre. As Professor Croft points out, the support of the university, and its desire to place Keele at the front of medical education and research, has been instrumental in making the primary care centre happen.

Co-location of the staff of the Primary Care Sciences Research Centre does more than increase the efficiency and effectiveness of project support. It also fosters the multidisciplinary collaboration that is such an important aspect of primary care research, and creates a visible focus for a primary care research programme that is of necessity dispersed across a network of general practices and research centres.

"We want to create a hub of excellence in primary care research," says Professor Croft. "We will be able to offer GPs quality training in research techniques, ongoing support and a stimulating intellectual atmosphere. We don’t want to pull all the GPs out of clinical work, of course, but we do want to be able to offer good quality research as part of the mix that GPs can choose from. This enables us to keep our clinical focus, and GPs to develop and maintain research skills. And of course the multidisciplinary mix of the Centre means we all benefit from our differing knowledge, experience and methodologies."

See also

• Clinical Research Facilities: Details of the venture

External links

• Primary Care Research Centre at Keele University
• Professor Peter Croft: Research interests
• Professor Julius Sim: Research interests
• Dr Elaine Hay: Research interests
• Keele University press release (30 March 2001): Medical School for Keele University
• Arthritis Research Campaign
• Medical Research Council

Further reading

Professor Peter Croft
Croft P R, Macfarlane G J, Papageorgiou A C, Thomas E, Silman A J (1998). The outcome of low back pain in general practice: A prospective study. BMJ 316:1356–1359.

Croft P (1999). Diagnosing regional pain: The view from primary care. Bailliere's Clinical Rheumatology 13(2):231–242.

Croft P R, Papageorgiou A C, Thomas E, Macfarlane G J, Silman A J (1999). Short-term physical risk factors for new episodes of low back pain. Spine 24:1556–1561.

Hay E M, Paterson S M, Lewis M, Hosie G, Croft P (1999). A pragmatic randomized controlled trial of local corticosteroid injection and nonsteroidal anti-inflammatory drugs for the treatment of lateral epicondylitis of the elbow in primary care. BMJ 319:964–968. (Also appeared in Evidence Based Medicine)

Ferry S, Hannaford P, Warskyj M, Croft P, Lewis A M (2000). Carpal Tunnel Syndrome: A nested case-control study of risk factors in women. Am. J. Epidemiol. 151 (6): 566–574.