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The Wellcome Trust recently published its vision for a research and innovation-powered NHS. The report calls for a renewed focus on research and innovation to be at the heart of the future NHS, positioning ‘research to reality’ as a ‘fourth essential shift’ that needs to sit alongside the government’s much talked-about three shifts (from analogue to digital, sickness to prevention and hospital to community). 

The NHS has a proud history as a leading force for research and innovation, pioneering developments from ultrasound scans and genomics to Covid-19 vaccines. When thinking about the NHS as a global leader in research and innovation, what may well spring to mind first are the NHS teaching hospitals with global reputations for this – Imperial, Cambridge University Hospitals and Oxford University Hospitals, to name just a few. But what about research and innovation that takes place outside of hospital settings? 

There are two reasons that this really matters right now. The first is the ambition for the NHS to make a key strategic shift from hospital to community. This is the latest iteration of a longstanding policy ambition for the NHS to deliver more services in community settings, with primary care and community services at its heart. This shift is a key plank of the government’s vision for the NHS, and we can expect it to sit at the heart of the forthcoming 10 Year Health Plan. 

Second, many of the innovations that look likely to have the most transformative impact on health and care in the years and decades to come will largely be implemented outside of hospitals – whether that’s testing and rolling out promising treatments to support secondary prevention of the biggest killers, using new vaccines to prevent people from becoming unwell in the first place, embedding genomics and personalised medicine into care delivery, implementing the growing number of applications of AI to health care delivery, or scaling and spreading new care delivery models. The implementation of these will inevitably stretch well beyond hospitals.

This begs the question, how well equipped are community and primary care to support this? What would it look like to be world-leading in driving research and innovation in community health and care settings? How could the Wellcome Trust’s vision for a research and innovation-powered NHS be put into practice in these contexts? 

If government and health system leaders are serious about making the shift from hospital to community (alongside their ambitions for a thriving globally competitive life sciences industry to be at the heart of the UK economy), then this is a question that needs exploring. Of course, the issues and solutions might be different for different aspects of innovation – the considerations around discovery science or clinical trials are likely to look different to those around rolling out proven recommended treatments or spreading new models of service delivery. 

Key questions include whether the existing infrastructure to support research and innovation in the NHS offers the right support for community-based services, and whether other models could offer useful lessons (for example, approaches to supporting research in local authorities). There are also questions around how the features of community-based services – including less standardisation, greater clinical autonomy, plurality of providers, proximity to communities – could help or hinder innovation. And importantly, the reality that community and primary care services are often struggling to deliver the basics (partly due to many years of underinvestment in staffing and infrastructure compared to acute services), let alone finding the capacity and headspace required to drive research and innovation.

The King’s Fund would be interested to hear your thoughts on this. Perhaps you work in a community provider, a primary care network or a health innovation network and have examples of where this is happening already, or perhaps you’ve seen barriers to research and innovation in community settings playing out in practice. Perhaps you are from a medical research charity or patient group and have insights into how this is affecting the populations you represent. Or perhaps you are a researcher or work in a life sciences company and have experience of delivering research and innovation in community settings in the UK or overseas. If you have insights you would like to share, then please get in touch with me to help shape our thinking and plans for future work.