Why I became a Clinical Adviser

Dr David Mummery, GP Research Lead North End Medical Centre (Imperial Research Hub Academic Practice)

"Life is lived forwards... but must be understood backwards", said the great Danish philosopher Soren Kierkegaard. Much the same can be said of research and progress in medicine, where we often stumble a few steps forwards and then a step backwards, and often don't get a fuller, clearer picture until later on when the project is over.

Primary care research is no exception to this, and the searching of the unknown, formulating and debating new questions and new research ideas is initially what attracted me to becoming more involved in general practice research. Also, as general practice is such a clinically intense speciality, dealing with the numerous problems of 30 - 40 people a day, research for me was something different, where I had a bit more time and space to reflect about the myriad opportunities and problems that present to us in practice.

Having been involved in a few interesting research projects in areas such as HIV testing and diabetes, I wanted to see what the RCGP was involved in. Looking for research-related activity on their website, I came across the Clinical Adviser programme and immediately signed up.

It soon became apparent that RCGP, via the Clinical Innovation and Research Centre (CIRC) was involved in a huge number of extremely interesting consultations, workshops, guideline development, NICE meetings and much more. I began to receive regular emails from the great CIRC team regarding research and other consultative activity that the RCGP was involved in which related to my specified areas of interest. To say that this covers a wide spectrum of medical and research activity is putting it mildly - anything from a NICE workshop on guidelines on multi-morbidity, to NICE hernia guidance, to monitoring of pre-term babies, to guidelines on child abuse and neglect - virtually everything seemed to need a GP voice! Rightly so, as it is primary care which conducts 90% of all consultations in the NHS and for most people is the "gateway" to see other specialities. As GPs we see an incredible array of medical, social, psychological and other problems, so for most research and guidelines there is a definite need for a general practice viewpoint.
 
Attending some of these workshops and meetings as a representative of the RCGP to me has been a fascinating, rewarding and informative experience. Out of the multitude of activities that the RCGP and CIRC are involved with, I spot the topics where I have an interest or some experience and email the Clinical Adviser team offering to attend a specific meeting or workshop if needed. For example, I attended a NICE scoping workshop on multi-morbidity, which is going to be an ever-increasing medical and social issue in the years and decades ahead. At the workshop a huge range of people including consultants, nurses, social workers and representatives from charities attended and discussed the various issues associated with multi-morbidity and debated what should be included in the guideline.

Attending these meetings brought home to me the pivotal role of the GP and primary care team in most of these issues. I believe GPs have realistic ideas of things that work and don't work in healthcare and know when things are useful or a waste of time: simply by seeing so many patients with clinical problems, we have evolved to become experts in knowing what is practical when it comes to medical interventions. Often there are representatives from "single issue" charities or support groups which, although have many wonderful ideas, sometimes don't seem to have a handle on what is practical, realistic or possible for GPs to do in short consultations. I felt a voice of primary care was desperately needed at some of these meetings to tell the other members what it is really like out there in general practice and what interventions are going to be of most value. I thoroughly enjoyed the discussions and debates at the workshops I attended and in fact felt very proud to represent the RCGP at these meetings. It is essential for general practice and the RCGP to be involved in the development of these guidelines and formulation of research as these will impact on us in primary care whether we like it or not, so our input is vital at an early stage.
 
As well as attending workshops and meetings, Clinical Advisers are often asked to respond to consultations (e.g. draft NICE guidelines) and asked to send comments back regarding these. Usually there is a comments pro-forma where you can comment on specific bits of the consultation, or the consultation as a whole, and this is then emailed back to CIRC who will then forward it to the agency involved after the Medical Director has reviewed it. Sometimes these consultations are dizzyingly long and complicated, (you may be asked to peruse a forty five page document on vitamin D deficiency!). Though they can provide good, varied, sometimes slightly dull and prolix reading, these consultations are always worth looking at, even if you completely disagree with what is being said. One of the advantages of being a Clinical Adviser is that if you disagree with any aspect, e.g. you think the consultation is too long and complicated (often!) you can say this in your comments and send it back to CIRC. Realistically, as GPs, not many of us are going to read a two hundred page document on gastro-oesophageal reflux, so often my comments were to suggest simplification and summaries of the guidelines to make them digestible (no pun intended) for a primary care audience. Again, I found looking, reading and responding to these consultations rewarding and interesting and a place where I felt a general practice viewpoint was not only desirable but essential.
 
As I have said, I have felt very proud representing the RCGP when I have been asked to and I would wholeheartedly encourage other GPs who are interested to sign up to be a Clinical Adviser and get involved with CIRC. There are almost certainly going to be topics that interest you and it is a rare chance to meet with other people from different fields and organisations to get together to discuss topics. The CIRC and Clinical Adviser team are fantastic and this is an outlet where you actually feel you can make a difference and try and articulate a voice for general practice on a multitude of issues. 

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