Routine GP work and Clinical Research
The RCGP defines a GP as follows:
A GP is a doctor who is a consultant in general practice. GPs have distinct expertise and experience in providing whole person medical care whilst managing the complexity, uncertainty and risk associated with the continuous care they provide. GPs work at the heart of their communities, striving to provide comprehensive and equitable care for everyone, taking into account their health care needs, stage of life and background. GPs work in, connect with and lead multidisciplinary teams that care for people and their families, respecting the context in which they live, aiming to ensure all of their physical and mental health needs are met.
In their routine clinical role, GPs engage with research primarily by staying up to date with the latest evidence and integrating it into everyday patient care. This involves critically appraising new research, following established clinical guidelines, and applying evidence-based recommendations to inform diagnosis, treatment, and management decisions. GPs facilitate informed, shared decision-making with patients, helping them understand the risks, benefits, and alternatives of different interventions. By doing so, they ensure that care is safe, effective, and aligned with the best available knowledge. This ongoing engagement with research underpins high-quality primary care and contributes to continual improvements in patient outcomes.
As increasingly more care is being delivered within primary care and community settings, there is a need for expansion of the capacity to carry out quality research within these settings to inform clinical practice.
Overview of the extended role
Definition of a GP with Extended Role (GPwER)
The RCGP defines a GP with Extended Role (GPwER) as a GP with a UK licence to practise, who is maintaining a primary care medical role while undertaking an activity that is beyond the scope of general practice and requires further training. A GPwER is not simply a ‘mini-secondary care specialist’ who has taken a different route to specialty practice. Extended roles are typically undertaken within a contract or setting that distinguishes them from standard general practice and may involve an activity offered for a fee outside the care provided to the registered practice population. GPwERs often receive referrals for assessment and treatment from outside their immediate practice and undertake work that attracts an additional or separate medical indemnity fee.
GP Clinical Academic versus GPwERRD
Clinical research typically progresses through a series of stages. It begins with the conception of research questions, often informed by gaps in knowledge or areas of unmet need. This is followed by the development of the study design, as well as the funding application. This highly competitive process requires clear justification, a robust methodology, and plans for impact. Once funding is secured, research moves into the implementation stage, which includes obtaining ethical approvals, setting up study sites, and recruiting participants. During a study, data are collected and analysed, after which findings are written up for publication. Finally, dissemination ensures results are shared widely with academic, clinical, and patient communities, with the aim of informing practice and policy.
GP Clinical Academics lead through all research stages, including conception, funding applications, protocol development, data analysis, publication, and dissemination, driving forward original research programmes that address key questions in primary care. The GPwER in Research Delivery (often acting as a clinical study Principal Investigator) plays a central role in the delivery stage, ensuring that studies designed by academic researchers are effectively delivered in practice. This includes identifying and recruiting suitable participants, overseeing study procedures within the practice, and ensuring adherence to research protocols, guidelines and to the regulation that governs research. They can work with GP Clinical Academics supporting appropriate study design to ensure successful study delivery.
Clinical academic careers in primary care are well-established and supported through UK organisations such as the SAPC, the NIHR SPCR and the Scottish School of Primary Care. This career path is described in the RCGP Research Engagement Hub. This document however focuses on the role of the GPwER in Research Delivery which remains relatively under-recognised and not well described despite its growing prevalence across UK general practice.
GPwER in Research Delivery: a growing and important role
With almost half of GP practices nationally engaged in research study delivery, there are now more than 2,000 GPs working in this capacity in England alone. Every research-active practice site is required to have a Principal Investigator overseeing each study, a responsibility most commonly undertaken by the GPwER in Research Delivery. In many practices, several GPs fulfil this role, reflecting its expanding importance in supporting the successful delivery of high-quality research within primary care.
There is a need to recognise the GPwER in Research Delivery as it is a growing role nationally and needs to be differentiated from the role of Principal Investigator. Although the GPwER does most commonly include the role of a Principal Investigator it also has several other key responsibilities and expertise. This framework will therefore also describe the responsibilities of a Principal Investigator within the GPwER.
Clinical research delivery is a varied, stimulating, and rewarding aspect of general practice. It offers GPs the opportunity to contribute directly to the advancement of clinical care, while engaging their practice teams in a broad spectrum of studies and an opportunity to offer their patients clinical research opportunities relevant to them as part of their primary healthcare. Research activity spans almost every area of health, ranging from straightforward PIC studies to observational research, through to complex interventional trials involving novel diagnostics or treatments. For many GPs, there is deep professional satisfaction in knowing they have played a part in the development of a therapy or diagnostic tool that ultimately becomes embedded in routine clinical care.
As a GPwER in Research Delivery, the GP assumes a pivotal role in leading the practice research team and ensuring the successful delivery of each study. They carry overall responsibility for the management and conduct of research, retaining accountability for all aspects of delivery while appropriately delegating specific tasks to members of the wider team. The GPwER is the leader of all research within the primary care organisation, responsible for the budget, collaborative alignment and strategic engagement with stakeholders. They can work with academic colleagues to advise on early study design and participant recruitment strategies, with study sponsors (representing their GP organisation), and with other research delivery colleagues (Principal Investigators, GPwERs, research organisations, to support study delivery both regionally and nationally. This leadership role is central to embedding high-quality research in primary care.