Research: Five years and beyond for Primary Care Research Network


By Andy Kwan, Manager, Marketing Communication and Management, Communications and Outreach

LKCMedicine Professor Helen Smith (front row, middle) and her pcRn team at its 5th anniversary celebration event

The Primary Care Research Network (pcRn) at LKCMedicine marked its fifth anniversary in May 2022. Professor Helen Smith, the Professor of Family Medicine and Primary Care and Director of Centre for Primary Healthcare Research and Innovation, shares what the network has done and what it hopes to achieve moving forward.

Q: pcRn was set up in 2017. What were the objectives for this research network?

pcRn aims to support and expand the research landscape in family medicine in Singapore. Traditionally, very little research has been conducted in the primary care setting locally. I wanted to promote the use of research evidence amongst practitioners and to encourage them to become research active. Since the foundation of pcRn, we have provided training for the primary care team in research methods; supported the development of their research ideas into projects; coordinated multi-practice research where many practices contribute data; and developed a platform for practitioners to come together to share their research ideas and findings. 

You might ask, why do we need research in primary care when we have lots of clinical researchers working in tertiary care and based in organ-based specialties? Most evidence is generated in the pathology-rich arena of hospital medicine, but family practice is a distinct discipline. It includes working with patients who have unselected health problems, making decisions without access to sophisticated technology, providing care in the context of social and cultural norms and being attentive to disease prevention as well as treatment. These differences in case mix and the personal dimension of family practice would require evidence generated in the community. 

Single practice research can be limited in its representativeness but when more practices come together as a research network, studies with bigger samples can be generated more quickly, avoiding data collection fatigue and generating evidence that is rigorous and generalisable.   

Q: What would you say is the most significant achievement for pcRn to date?

When I first proposed the idea of a primary care research network for Singapore, some people expressed their concern that there would be no interest or enthusiasm for such an initiative. I was fortunate that LKCMedicine was happy to take a risk and invest in a network that could work across all three healthcare clusters and serve the whole of Singapore.  

I would think that the sustained growth of a network of primary healthcare professionals into a vibrant forum of like-minded researchers must be our top achievement. I am indebted to the members of the network’s Advisory Board for helping me understand the organisation of healthcare locally and their ideas to develop our network within the local context. 

Q: What are some of the on-going and upcoming projects at pcRn and how involved are our GPs / family physicians in these projects?

The pcRn provides opportunities for members to be involved in research in many ways. For example, they can lead projects or collaborate. In the multi-practice projects, each practice contributes data to generate a large and rigorous analysis. As an example, a recent study focusing on reducing inappropriate antibiotic prescription to patients with respiratory tract infections collected data from 50 practices. Another recently concluded study involved only six practices but with greater time commitment. The latter was a feasibility study of the utility of pharmacogenetics in primary care so that the prescribing of medications is tailored to the individual and the risk of adverse drug reactions minimised. Our findings were very encouraging and we are now applying for research funds to conduct a definitive randomised controlled trial.  

Q: If you have a free play in getting additional resources for pcRn, what would be on top of your list?

At the top of my list has to be ongoing, long-term funding for the support and educational functions of the network.  Research activity and change in culture cannot be achieved instantly as these are activities that need nurturing over time to achieve better outcomes for our patients. pcRn funding needs to match the growth in pcRn membership so we can build on the progress we have made in the last five years.   

A recent independent evaluation of the pcRn confirmed members’ appreciation and support for a research network for primary care in Singapore, whilst also highlighting ways to increase its effectiveness and practicality. The pcRn team hopes to improve the internal environment of the network with changes to our educational activities and methods of communication between members. 

In the social science literature, a network is described as being characterised by four features: a flat organisational form, informal relations between members, a common ethos and outlook, and trust and cooperation between members. pcRn combines these characteristics in a bicycle wheel-like structure with central coordination at the hub and members on the spokes. From the feedback of our members, we now want to consider a more complex model for pcRn, one that enables the development of satellite clusters, for example the development of special interest groups that could foster more interactions between members. 

However, we are aware that some of the major barriers to undertaking research in family medicine are beyond our control as they lie within the remit of the government and national funding agencies. Therefore, pcRn needs to become an advocate for national change in research career development and research funding for primary care, working more closely with professional bodies, national research funding bodies and relevant government ministries.  

Q: You have set up similar networks in Europe. What can we learn from the experiences of these countries?

In developing the pcRn for Singapore I tapped on my experiences in developing networks in three regions of the UK, developing a UK Federation of PCRNs, and a Global Federation of Primary Care Networks on behalf of WONCA (World Organization of Family Doctors). We can learn lots from the experiences in other countries, for example, how in the UK small scale informal networks were developed and now form a key part of the country’s National Health Service’s research and development strategy. There are of course differences between the organisation of healthcare in different countries, but the fundamental principles of developing a successful research network that can improve the amount of research activity and promote a research culture are very similar. 

Q: Based on your understanding of primary care in Singapore, what do you think are the missing links for primary care doctors? 

The network’s success in enthusing practitioners about research and upskilling has been commendable. However, this evaluation has also highlighted that for practitioners to develop their research ideas into reality, major changes are needed in research funding mechanisms. The structural challenges of doing research in the community need the cooperation of the Ministry of Health and research funding bodies. There are initiatives in other countries that Singapore can use to develop its own supportive examples to promote research and development in primary care. 

Q: What are some of the feedbacks from pcRn members?

The pcRn members we spoke with were conversant with the rationale and reasons for the development of such a network for Singapore. They perceive the benefits for their patients in terms of improved quality of care, and for themselves as a professional with widening personal knowledge and collaboration opportunities. Ultimately, these will contribute to the success of the family medicine discipline and, where relevant, for their business too.  

Refinement and development suggestions include broadening our educational programmes, introducing more advanced workshops and a greater structure that would enable certification of training. In parallel with a more comprehensive education programme, there were also requests for mentoring and apprenticeships. The introduction of special interest groups in different clinical topics could also facilitate greater interaction, nurture collaboration, and develop multi-practice projects with enhanced power and generalisabilty.