British medical schools have been given a mixed report card on their efforts to establish alliances and research networks involving local trusts funded by the National Health Service (NHS)—something they were instructed to do under reforms introduced five years ago.

Annual NHS expenditure on R&D is around £163;500 million (US$800 million). The reforms, whose primary aim was to raise the quality of research funded through the NHS, partly by making medical researchers more accountable to their funding bodies, were based on the recommendations of a committee headed by Tony Culyer, professor of economics at the University of York.

A report published last month by the Joint Medical Advisory Committee to the four UK higher education funding councils—one of the bodies set up under the reforms to help promote collaborative R&D programs within the NHS—describes successful efforts to achieve this at a number of British medical schools. Those quoted as models of good practice include University College London, where a Clinical Research Network has established an integrated database and website containing profiles of more than 1,000 researchers, a move that, says the report, "is leading to increased collaboration and has reduced the duplication of research effort."

But the report states that responses to the changes have been "patchy" across the country. Without identifying problem locations by name, a survey found that "some universities had established strong alliances and research networks, while others had been slow to develop collaborative approaches."

These conclusions are echoed in a separate survey of university medical schools and NHS trusts on the implementation of the Culyer reforms carried out by Nuffield Trust. One response to the survey by a Scottish group expressed concern that research is "increasingly abrogated from the NHS agenda," whereas an unnamed university was worried that "basic science would suffer under joint arrangements".

Michael Powell, executive secretary of the Council of Heads of Medical Schools, says that despite the success stories, medical schools agree in general that "there is certainly room for improvement." Powell adds that a chief concern reflected in the Nuffield survey is that research assessment processes carried out by the funding councils are different to those executed under the Culyer reforms, "which can result in an institution receiving completely different ratings on the same R&D portfolio."