Comprehensive Local Research Networks (CLRNs) are designed to support high quality clinical research throughout the UK. This article aims to give you a better understanding of how they came into being, how they are organised, how they assist research and how they may influence you, as a geriatric medicine trainee.
Where did CLRNs come from?
The National Institute for Health Research (NIHR) was set up in 2006 by the Department of Health. Central to the NIHR is the Comprehensive Clinical Research Network (CCRN). Its primary goal was to create a world-class research infrastructure within the NHS. This infrastructure is designed to support participation in high quality clinical research and hoped to subsequently improve both the health and the wealth of the nation. The CCRN is made up of 25 Comprehensive Local Research Networks (CLRNs) which divide the UK into regions.
So-called ‘topic networks’ have also been established in cancer, dementias and neurodegenerative diseases, diabetes, medicines for children, mental health, primary care and stroke. These networks are spread over larger geographical areas than the CLRNs but share the same goal; their focus is however on coordination of studies relating to their specific speciality.
What do CLRNs do?
CLRNs work locally to try to assist research in their area. To this end they have a range of resources available. CLRNs have teams of research support staff that include research nurses and other health professionals. These staff members are often able to assist with identification, recruitment and data collection from patients during a research project. CLRN staff members are also able to assist with clinical governance issues that underpin getting a study up and running. They are also often able to assist with the interaction between allied health professionals that are vital to the smooth running of research (e.g. pharmacy, pathology, and radiology). Critically only studies that are registered on the NIHR CRN’s ‘portfolio’ are eligible for such support.
What is a ‘portfolio’ study?
Getting a study on the portfolio is the gateway to accessing the support that the CLRNs can offer. Essentially, studies that have obtained funding via a competitive application process, that includes peer review, are deemed to be of sufficient quality to be placed on the portfolio. Portfolio studies may be commercial or non-commercial studies. NHS Research Ethics Committee approval of the study is obviously mandatory for inclusion. The NIHR coordinated system for gaining NHS permission (NIHR CSP) is the route via which application for a study to be on the portfolio should be made. There is a database of the UK CRN Portfolio studies that is freely accessible and searchable on-line and can found here (http://public.ukcrn.org.uk/search). Critically for each CLRN, a large proportion of their annual funding is calculated on their recent ‘activity’, as judged by recruitment numbers to portfolio studies (an allowance is made for the complexity of each particular study).
Have they worked?
A study of numbers of participants in NIHR portfolio studies in the Northumberland, Tyne and Wear (NTW) CLRN over the five years to 2012 showed a year on year increase in the number of people taking part. National figures have also shown that the number of NHS patients participating in clinical research has increased; rising by over 110,000 between 2009-10 and 2010-11 (454,138 to 564,698). These figures suggest the CLRNs are succeeding, with increasing throughput of patients, but cannot truly answer whether or not the ‘health and wealth of the nation’ has improved as a result.
What does it mean for me?
If you are planning to take out of programme (OOP) time to undertake a research project of your own I would strongly recommend that you consider applying for your study to be on the portfolio. Getting portfolio status will give you access to wide-ranging support (and also training) that will make the process of both setting up and running the study easier. It is important to be aware that the NIHR CSP no longer accepts applications for portfolio status for studies that have already commenced patient recruitment – be prepared!
The NIHR has a well-established pathway of integrated training for junior doctors who aspire to a career in academic medicine. For trainees wishing to explore research, but who aspire to a full time clinical career, the pathway is not always so clear. The Northumberland, Tyne and Wear CLRN have aimed to address this problem by introducing a unique scheme that led to the creation of clinical research associate (CRA) posts. These posts are one year in duration and provide trainees with the opportunity to get involved with portfolio studies at all stages of their delivery. The CRA post also provides funding for formal research training; the Masters of Clinical Research (MClinRes) at Newcastle University. The scheme was first established in 2010 and 10 CRAs were appointed at this time.
My experience of the NTW CLRN
As someone who had not previously considered a career in research, this post came at the perfect time for me to gain some research experience. The MClinRes has given me a solid understanding of research governance issues and the practicalities of setting up a research project. Being involved on a day-to-day basis with multiple portfolio studies has provided invaluable insight into the research process from set-up of a project through to delivery. As trainee representative for the 2010 and 2011 cohorts of CRAs, I can report that the feedback on the scheme has been overwhelmingly positive. The majority of the cohort plan to incorporate research into their role as a consultant later in their careers; several have gone on to study for a higher research degree.
Will CRA posts be available in other CLRNs?
Currently the CRA post is unique to the NTW CLRN. If you would like further information about these posts the best point of contact is Professor Julia Newton, NTW CLRN Executive lead for Training.
If trainees are keen to see similar schemes rolled out across other CLRNs then both Professor Newton and I would be really keen to hear from you. Professor Newton has commented that she would be more than happy to lobby other CLRNs to consider such a scheme and would be willing to liaise with other CLRNs about NTW’s experiences with the CRA scheme.
