Our problem analysis revealed that a substantial number of barriers contribute to the low implementation of clinical research in German general practice. Some issues are deeply rooted in Germany’s health care and academic systems and traditions. However, new developments may facilitate change: the 2010 modification to German drug law emphasises the need for comparative effectiveness studies: within three months the majority of newly licensed drugs must be assessed for superiority compared to the current standard treatment for the particular condition [37, 38]. Pricing is then based on the results of this assessment. While this new legislation has the potential to boost comparative effectiveness studies, practical implications with regard to their organisation and funding still remain unclear.
Nevertheless, interest in general practice and general practice research is growing , fuelled by the need to provide health care to an ageing and increasingly multi-morbid population while containing costs. In the last 10 years, the German federal government has run a few successful programmes to build up research capacity in general practice. However, these have not been sustained. Nevertheless, with respect to health services research or quality improvement studies in particular, their structural  and scientific outputs [39, 41] have been remarkable. A recent publication of the German Advisory Council for the Assessment of Developments in the Health Care System points out the importance of strong primary care . The number of academic departments of general practice is slowly, but steadily increasing. Representation of GPs in decision-making and funding bodies is gradually improving: very recently, the German College of General Practitioners and Family Physicians was granted the right to propose candidates to the reviewer boards of the German Research Foundation and one candidate (EHP) was elected.
Some academic departments of general practice and participants of the network have published clinical studies that have received international attention [17, 19, 21, 43]. The first general practice-based study funded by the clinical trials programme has recently started . Despite the lack of funding or structural support, there are local initiatives to accredit research practices and create practice-based research networks . The network group has conducted a survey, which indicates that a substantial proportion of teaching GPs and those attending continuous professional development programmes run by the college or academic departments declare themselves motivated to participate in clinical trials . Within the context of one ongoing trial run by several members of the group, a concept of GCP training appropriate for general practice-based trials has been developed and piloted .
This problem analysis results from the work of a small network group with very limited, temporary funding. Our review of the international literature was conducted comprehensively and cannot be considered systematic, as relevant papers are not always easily identified due to often inconsistent or incomplete MeSH labeling . However, the network group collates considerable expertise with members from most research-active departments or institutes of general practice in Germany, and a track record of own clinical research. While this small group cannot address structural barriers, it can provide some of the procedural prerequisites named above. A systematic review of general practice-based clinical studies has been conducted . Key measures for general practice-based clinical trials as well as useful tools to prepare proposals and to conduct studies will be made available.
The first requirement of establishing inventories, providing materials, engaging practices interested in research and networking, and providing information and peer support has the potential to improve the quality and success of grant applications. The network group aims to further stimulate the development of additional research capacity and research strategies for clinical trials in general practice, and to be considered a research group eligible for (structural) funding by the German Research Foundation.
Ultimately, the network group aims to underpin cooperation with coordination centres and funding bodies by, for example, defining accreditation standards and rewards for participating practices. It could also act as a ‘clearing house’, reviewing study proposals and protocols, providing access to practices and facilitating bottom-up communication of research needs in primary care to funders and policy-making bodies .