Clinical trials
in the UK

UK is falling behind other countries in the delivery of clinical research 

Recent years the UK has been falling behind in its commercial clinical trials activity. 

Numbers of patients enrolled onto commercially-led studies supported by the NIHR dropped by 44% between 2017 to 2018 and 2021 to 2022, according to Association of the British Pharmaceutical Industry (ABPI) research – from around 50,000 a year to around 28,000.

The number of trials initiated, particularly for phase 3 trials, with our relative ranking against other countries dropping from 4th to 10th best in the world in the same timeframe. Other countries, such as Poland, have been able to recruit high numbers of patients for each commercial trial, with an average of 61 participants in phase 2 and 3 trials compared to an average of 21 per trial in the UK between 2018 and 2020

Why is delivering more clinical research important to the NHS?



Firstly it reduces the opportunities of UK patients to have early access to innovative treatments that could improve, extend or even save their lives. Hospital consultants who take part in research studies are more likely to promote the uptake of innovative therapies or devices once they have been licensed, improving access for all patients. 

Secondly falling levels of commercial research create a significant opportunity cost for the NHS . Therapies and healthcare services that would otherwise have been funded by a pharmaceutical or technology company instead have to be funded by the taxpayer, research suggests that the total direct cost of the near halving of patients recruited to commercial research activity in the NHS over the last 5 years is in the region of £360 million

Third, it reduces the desirability of the UK as a destination for life science investment and impedes the uptake of health innovations. 

Independent Report: The Lord O’Shaughnessy review

To address this increasing concern an independent review of commercial clinical trials in the UK was published on 26 May 2023 Led by Lord James O’Shaughnessy, the independent review was commissioned by the UK Government and sets out 27 recommendations intended to deliver major, sustained growth in commercial trial activity.

The report sets a goal of doubling patients enrolled in commercial studies by 2025 and doubling the number again by 2027. Medica research addresses one of the key issues to meeting this target.


Problem statement 8: primary care is a negligible provider of clinical trial activity, despite the opportunities it provides for delivering population-scale trials, and there is too much reliance on hospital settings for the delivery of trials.


Primary care recommendations of Lord O'Shaughnessy report



Recommendation 22
Financial incentives should be introduced for GPs to take part in commercial trials

Recommendation 23
New primary care research networks should be introduced to increase the proportion of commercial trials taking place in primary care and ‘at home’ settings.

Recommendation 24
Regulators should produce guidance to support and promote innovative and decentralised trials.

Recommendation 25
The government and regulators should develop a strategy for the use of AI in clinical trial design and regulation.

What is the opportunity for research to be delivered in primary care?

Research is a key driver of innovation and improvement. In the NHS it is a vital tool in improving medicines, patient care and pathways, as well as staff wellbeing. The majority of research in the NHS is currently carried out in secondary care, with very little primary care involvement. As a result, the quality of research in the NHS can be restricted in its scope by a smaller patient base and the range of conditions and experiences which present in hospital settings

NHS Confederation (2023), Understanding the primary care research landscape: directory of research organisations.

General practice provides more than 300 million patient consultations each year. Primary care can play a significant role in the delivery of transformational clinical research, most recently evidenced by the PRINCIPLE public health study, a platform trial designed to evaluate treatments to improve recovery and reduce hospitalisation from COVID-19.

The UK is a leader for primary care research, in volume and citation rates of articles produced, when compared to international colleagues as research in general practice is an established discipline. However, prior to COVID-19, the number of GPs in England engaged in clinical research was in decline.