Global Team Calls for Revolution in GP and Community Health and Care Trials

An international team, led by the Nuffield Department of Primary Care Health Sciences and Trinity Professorial Fellow Christopher Butler, is calling for a fundamental shift in how we conduct health research to better serve our real-world health and care needs.

The clinical trials that shape modern medicine often overlook the crucial frontline services people are most likely to use when they need healthcare – local GP surgeries and health centres. Now, an international team, led by the University of Oxford, is calling for a fundamental shift in how health research is conducted to better serve our real-world health and care needs.

In a new paper published in Lancet Global Health, a team of experts from Oxford's Nuffield Department of Primary Care Health Sciences, alongside colleagues from the University of Southampton, Stellenbosch University in South Africa, Kamuzu University of Health Sciences, Malawi, University of Zambia, The Chinese University of Hong Kong, and the World Health Organization, and other leading global partners, are making a powerful call to ‘democratise’ clinical trials.  

The paper’s authors want to ensure health research truly includes everyone, especially people who are often under-represented because of ethnicity, geography, or social circumstance. For example, the authors say trials should be co-designed with local communities, remove barriers like travel costs, and welcome those juggling multiple illnesses – so the resulting evidence genuinely reflects the diverse populations that most need it.  They note that achieving this ambition, however, will require firm policy commitments and funding reforms to address systemic barriers currently holding back primary care research.

Professor Christopher Butler, lead author of the report and based at the Nuffield Department of Primary Care Health Sciences, explains:

‘Clinical trials are the engine of progress in healthcare – they show us what works and what doesn’t, but, for too long, these trials have mainly focused on hospital settings. While this is undoubtedly important, focusing too much resource on only those kinds of trials means we’re missing crucial insights into how to improve the essential healthcare that most people rely on day-to-day in their communities.’

why this matters for healtchare

Most medical research happens in hospitals under carefully controlled conditions. But that's not how most people experience healthcare.  

When you visit your GP, you might have several health issues at once, not just one. Your lifestyle, where you live, and how easily you can see a doctor or healthcare professional all affect how well a treatment works. Much current, hospital-based, healthcare research misses this real-world complexity.

To address these challenges, the international team recommends three key changes: 

• Genuine partnership with communities: Rather than simply recruiting patients to trials, researchers should actively involve patients, carers, community groups, and local health and care professionals from the start. This ensures research addresses real needs and produces practical solutions that work in everyday settings.
• Smarter, more flexible trial designs: Moving beyond rigid, single-question studies, researchers should embrace innovative approaches like 'platform trials' that can test multiple treatments simultaneously and adapt quickly as new results and evidence emerges. These ‘pragmatic’ trials better reflect real-world care and provide directly applicable answers for busy primary care settings.
• Modernised regulations: Current rules can make community-based research unnecessarily complex and difficult to carry out. The team advocates streamlining ethical approvals and making it easier to use routine health data securely and ethically, and adapting consent processes to be more patient-centred and proportionate to risk, while maintaining robust safety standards. They also emphasise the need to align regulators, funding bodies, and policymakers to remove roadblocks and enable large-scale community trials.

‘Primary health care is the bedrock of health for individuals and for entire populations,’ emphasises Professor Butler. ‘It’s the health care delivery structures, and policies the first point of contact, the ongoing care, and the preventative work that keeps communities healthy.

‘To truly achieve “health for all”, as envisioned by the World Health Organization, we must urgently strengthen the evidence base for primary health care through research that is fit for purpose. By democratising clinical trials, making them more inclusive, relevant, and efficient, we can ensure that health research benefits everyone, reduces inequalities, and builds stronger, more resilient health systems worldwide.’

The paper also highlights how robust primary care research networks are essential for pandemic preparedness and global health security, enabling rapid evaluation of new treatments where they're needed most – in our communities, as exemplified by trials like PANORAMIC and PRINCIPLE during the COVID-19 pandemic.

By bringing clinical trials closer to everyday healthcare, and including  more representative populations in research studies, this approach promises more effective treatments, better patient outcomes, and healthcare innovations that work in the real world – not just in theory.  

The authors hope that these reforms, along with greater international coordination and investment, will pave the way for a new era in healthcare research – one that fully represents and serves local communities around the globe.