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Long read

Aligning research with care closer to home

The case for expanding community‑based research

  • 20 Jan 2026
  • 19-min read

Authors

Introduction

In 2025, we asked what the shift from hospital to community could mean for research and innovation in the NHS. We invited people to get in touch and share their thoughts and ideas.

There are some topics that you can be fairly certain will capture people’s attention and generate a sizeable response if you write about them. We didn’t expect that the inner workings of the NHS research landscape would be one of them, but we were proved wrong. Thanks to a wave of enthusiastic readers getting in touch, we had the privilege of hearing views on this topic from a host of people involved in different ways in health and care research. They painted a fascinating picture of the current landscape and offered a raft of ideas for how things might be changed for the better. We also hosted wider conversations on the topic at two of our autumn conferences and convened a workshop to unpack the ideas further.

This long read sets out what we heard and offers a menu of ideas for future action. Our hope is that this will help continue the conversation and provoke further discussion on how research and innovation can be brought closer to communities and community settings in support of better, fairer health and care.

What’s the issue?

The NHS has committed to shifting care from hospitals to community settings, a priority reinforced in the recent 10 Year Health Plan. Research and innovation are also central to the plan’s vision. However, there is a disconnect between policy intent and practice. Although policy promotes prevention and care closer to home, the reality is that research and innovation often reinforce hospital-centric models, contributing to the ‘right drift’ described by Lord Darzi rather than the desired ‘left shift’ towards community care.

Recent analysis by The Strategy Unit for the Health Foundation shows that technological and pharmaceutical innovation has disproportionately driven growth in acute care. And hospitals – with their concentration of infrastructure, data and expertise – have become magnets for research. Although the vast majority of patient interactions happen in primary and community settings, around 95% of National Institute for Health and Care Research (NIHR) delivery funding goes to hospitals (although there has been a recent commitment to bring this down to 92%). There is a similar imbalance in commercially funded research, highlighted in Lord O’Shaughnessy’s review  into commercial clinical trials.

Although research in hospitals is vital for driving innovation and improvements in care, the discrepancy between where care is delivered (and will increasingly be delivered), and where research is conducted, is significant.

This imbalance matters for several reasons. First, it risks undermining the NHS’s ambition to shift the centre of gravity of care towards community-based, preventive care. Second, many transformative innovations (such as genomics, artificial intelligence (AI), personalised medicine, and new vaccines) will involve implementation outside hospitals. Their success will depend on strong community-based research and delivery infrastructure. Yet funding and infrastructure for research remains concentrated around acute hospitals, leaving community organisations under-resourced, under-represented, and poorly equipped to support this.

Equity and inclusion also demand attention. Community-based research can help fill knowledge gaps in less well-researched areas, test innovations in real-world settings, and ensure that diverse populations are represented in studies and that the benefits of research are shared more widely.

If policy-makers are serious about reorienting the system, rebalancing research must be part of the solution. This means focusing research on where people live and receive care, not just where the labs, scanners and specialists are.

Understanding the research landscape

The health and care research landscape in England is complex and technical (explained in detail here). The box below provides a brief overview as context to this long read.

In contrast to clinical research, public health research already tends to focus on communities and community settings. This long read therefore focuses primarily on the opportunities to expand other types of health and care research into community and primary care settings, while recognising the critical role of (and need to learn from) public health research. 

The case for expanding research in community settings

During our workshop and stakeholder discussions, participants shared a compelling vision for expanding research in community settings (including in community health settings, primary care settings and residential care settings). They emphasised that this could make research more relevant, inclusive and equitable, while also strengthening community-based services and improving outcomes and experiences for individuals and staff alike.

Based on participants’ insights, we identified seven key reasons for expanding community-based research.

  1. Supporting representative, accessible research. Most patient interactions take place in primary and community settings, so these settings offer opportunities to recruit larger and more diverse participant groups. Locating research closer to where people live can also reduce barriers such as travel, time and cost, making participation more accessible.

  2. Maximising impact and relevance for local populations. Research that is aligned with community needs – rather than driven solely by academic or clinical priorities – is more likely to be meaningful, impactful and responsive to real-world challenges.

  3. Strengthening inclusion and engagement. Trusted community organisations can play a role in engaging under-served or marginalised populations who are often under-represented in research. Community-based approaches can also support co-production, ensuring that research is shaped by, and for, the communities it aims to serve.

  4. Improving patient experiences and outcomes. Evidence shows that research-active organisations often deliver better patient experiences and outcomes, with benefits extending beyond those directly involved in studies. Expanding research into community settings could replicate these gains. Individuals may also benefit from early access to new treatments and feel empowered through their participation.

  5. Driving local service improvement. Research conducted in ‘real-world’ community settings can generate insights that are directly applicable to service delivery and more readily translated into practice. Research also provides a route to attract additional investment into under-funded primary and community care.

  6. Supporting the workforce. Research involvement can bring variety to roles, support skills development, and enhance job satisfaction and wellbeing. Research activity has also been shown to contribute to improvements in recruitment and retention for some staff groups. Stakeholders highlighted that research engagement can enhance professional identity and provide a sense of prestige and progression. This is particularly important, as community roles have often been perceived as lower status compared with careers in hospitals, and numbers in some key staff groups have declined sharply in recent years. Expanding opportunities to deliver and lead research could therefore play an important role in elevating the status and appeal of community careers.

  7. Facilitating strategic shifts in health and care. Community-based research supports a focus on prevention, long-term conditions, and the wider determinants of health – areas that are often less suited to hospital-based studies. In addition, aligning research efforts behind the transition from hospital-centric to community-based care could support efforts to redirect more of the total share of available funding, workforce and innovation to community settings.

Unpacking the barriers

Despite growing recognition of the value of research in primary and community care, those we spoke to described a powerful set of financial, structural and cultural barriers that make it challenging to shift research into these settings.

Funding flows and processes don’t support community-based research

Securing funding remains one of the biggest barriers. We heard how grants often come with rigid requirements around infrastructure, processes and scale that are challenging for community settings to meet. Hospitals are better positioned to navigate these processes and secure funding as they have dedicated research teams, protected clinical time, and well-established governance structures. Smaller providers may face disproportionate administrative burdens and struggle to access grants that are too large for or misaligned with their needs or context, limiting their funding options. Participants also highlighted that funding panels often lack representation from those with expertise in community settings or from communities themselves, which can further disadvantage applications from these areas.

A lack of a track record compounds the challenge; without prior research experience it is hard to secure funding, and without funding, it is difficult to build experience. This creates a ‘snowball effect’ that reinforces investment in hospital-based research.

Research infrastructure is limited and fragmented in community settings

Community and primary care settings often lack the infrastructure needed to support research, including capital investment, administrative systems, and research support staff (although we heard some examples where operating at greater scale is helping to address this – for example, through GP networks or federations). Fragmentation adds another layer of complexity, as research infrastructure across different parts of the NHS and local authorities often operates in silos, with limited incentives for collaboration. Competitive funding environments further discourage joint working, making it harder to build a more joined-up and effective research ecosystem. We also heard about particular challenges around commercial research: although interest in community-based trials is growing, particularly in areas such as vaccine development and remote monitoring, delivery is hampered by poor adaptation of trial designs to community settings and a lack of standardised infrastructure for large trials to ‘dock into’.

Community staff are not well-equipped or supported to lead and deliver research

Staff in community and primary care settings are often overstretched, with little time, training or support to engage in research. Although hospital staff face similar pressures, research is more commonly embedded in their roles and job plans – something rarely seen in community settings. For staff in community and primary care settings, access to development opportunities and protected time are limited, and managers may lack the resources or incentives to enable staff participation. As a result, even when individuals are motivated, the wider system often fails to support their involvement. We also heard that historically, there has been little expectation or culture of research involvement among some professional groups leading community-based services (although this is less true for primary care).

In summary, research in hospitals benefits from a deeply embedded infrastructure, established expertise, and a strong track record – factors that create a self-reinforcing system of investment and capability. This concentration of resources and attention makes it extremely challenging to shift research activity into community and primary care settings. Without targeted and sustained efforts to address these structural imbalances, community and primary care research will continue to lag behind.

Moving to action

Progress is being made

Work is already under way to support more inclusive, community-focused research across a range of settings. This includes:

There are also many examples of local areas that have made significant strides towards a more community-focused approach to research in their localities. For example, in Bristol, community-focused research has been prioritised over a number of years, with significant growth in activity and capability as a result and ambitions to grow this further. In central and north-west London, various initiatives are under way to bolster community research, including a local GP federation building up infrastructure and capability to enable this, and an acute trust and BRC growing their support for research in community and primary care settings. Similar collaborations have developed in Sheffield, with a particular focus on involving under-served groups in research. These are just a few of the many examples shared with us.

We heard that in places where community-based research is more established, a ‘virtuous cycle’ often emerges: initial investments in infrastructure and capability help build a track record, which in turn attracts further funding and strengthens local research capacity over time.

A menu of ideas to accelerate progress

Building on this progress, there is now a case to go further and faster to rebalance research more widely. Importantly, this needs to be done in a way that does not compromise the quality of research by diluting existing capability, or duplicate capacity in ways that are inefficient or unsustainable.

Participants at our workshop offered a range of suggestions for actions to make this happen (outlined below). Ideas ranged from relatively targeted measures that could deliver ‘quick wins’ to more radical changes in how research is funded, supported and delivered. Although some ideas would require new approaches, many would extend or build on initiatives that are already under way (such as those set out above).

We offer these suggestions as a menu of options to consider (rather than a list of recommendations to be followed) in the hope that they provide a useful tool to provoke discussion and further exploration across the research community, and invite stakeholders to consider how, and by whom, these could be taken forward to achieve maximum impact.

The suggestions above reflect in broad terms the discussions around research in community settings. But, of course, the issues and solutions will differ depending on the type of research – for example, considerations around clinical trials are likely to look different from those around testing new models of service delivery – and the same is true for different settings. This highlights the need for dedicated work focused on particular types of research and specific settings – for example, to bolster research capacity in primary care or in care homes that builds on existing initiatives.

Closing reflections

If policy-makers are serious about shifting the health system’s focus from hospitals to communities, and about strengthening research and innovation, then expanding research in community settings must be a priority.

Achieving this shift will require co-ordinated action across the system. Funders – not just government bodies such as NIHR, but also major grant-giving organisations, commercial funders and the third sector – can help align incentives to support research in community settings. National bodies can set strategic direction, and professional organisations and local leaders across different types of providers have an essential role to play in embedding research into everyday practice.

There is also a need to fill gaps in data, particularly around where research is happening, who is involved, and what infrastructure exists. This will be essential for tracking progress and holding the system to account. There is also more to be done to systematically learn from areas already leading the way. This could include building stronger connections with public health research and learning from the perspectives and methodologies it employs.

Encouragingly, there are many examples of progress. NIHR’s agile research delivery team, their wider care settings funding, and new Primary Care Commercial Research Delivery Centres are helping to build momentum. But alongside dedicated programmes, systemic changes to remove barriers and enable cross-setting collaboration could help make community-based research the norm rather than the exception.

High-quality research remains essential, and it is important not to lose sight of the infrastructure and capability required to sustain it. The goal is not to dilute excellence, but to build on existing strengths, share expertise, and extend support across wider settings. Investing in inclusive, well-supported research closer to where people live and receive care offers the promise to unlock better outcomes, empower communities, and shape a more equitable, resilient and effective health and care system.

Acknowledgements

We are grateful to everyone who shared their insights and ideas with us, and to those who contributed through scoping conversations and workshops. This work has benefited from the perspectives of people across health and care and the research ecosystem, including funders (public sector, third sector and commercial), policy leads, those bringing patient and carer perspectives, academics, research-active clinicians, and others involved in research delivery and support.

We are particularly thankful to Shera Chok and Adam Briggs from NIHR, and Fraser Battye from The Strategy Unit, for their helpful comments on earlier versions of this draft. We would also like to thank Paul Roy, Chair of the R&D Forum’s Primary Care and Commissioning Working Group and research lead for the Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Board, for presenting learnings from Bristol at our workshop.

Finally, we are grateful for the support of our colleagues CJ Nwasike, Siva Anandaciva, Alex Baylis, Gemma Umali, Megan Price, Frank Rigby and Kate Pearce for their support with the development, analysis and publication of this work.

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