- David Jones
- May 6
- 6 min read
How Leading UK Stakeholders Are Tackling Resource Constraints, Site Selection, and Performance in Clinical Trials
Clinical research in the UK is at a pivotal moment. While the number of registered trials is on the rise, recruitment rates are dropping, and resource limitations, fragmented processes, and the focus on high-performing sites remain major obstacles. This COG UK panel session brought together operational leaders from pharma, biotech, CROs, academic, and patient advocacy perspectives to analyze the shifting landscape and outline actionable solutions.
These insights are for sponsors, CROs, biotech teams, and vendor management professionals who are optimizing clinical trial outsourcing strategies, refining CRO selection, or seeking practical ways to improve study performance in the UK.
Speaker Context: Leadership Perspectives from Across the Clinical Research Ecosystem
This session featured a multi-stakeholder panel moderated by Sverre Bengtsson, with participants including:
The live panel, recorded at COG UK, focused on clinical study optimization, with an emphasis on resource allocation, support models, performance metrics, sponsor–site relationships, and how sites (NHS and private) can deliver more effectively in an increasingly complex trial environment.
Clinical Research in the UK: Momentum and Contradictions
The session opened with a review of recent UK clinical trials data: more studies are being initiated, but participant recruitment is falling. Fiona Shields highlighted the latest ABPI report showing this paradox, noting that even as post-pandemic trial volume recovers, insufficient participant numbers compromise study completion and downstream patient access.
Sarah Dealey provided an NHS perspective, describing how risk-averse site target setting has become a self-perpetuating cycle: conservative patient enrollment goals lead to smaller allocations from sponsors, further reducing opportunities for UK sites. This dynamic, driven by performance-based KPIs, means the “reliable, high-volume performer” mindset is undermining the broader system’s ability to scale up.
Key facts:
Most UK sites are now allocated only 5 patients per study, making missed recruitment a greater threat and discouraging under-resourced—or new—sites from participating.
Countries like Spain have successfully reversed this trend, prioritizing resource provision and more aggressive site engagement to increase national trial output.
The Site Resource Challenge: Consistency, Accountability, and Practical Barriers
Resource shortages—not just in research teams, but across imaging, pharmacy, and support departments—are a recurring bottleneck. Several panelists emphasized that simply opening more studies or looking to new sites does not translate to improved recruitment or delivery unless resource gaps are addressed.
Divya Chadha Manek, speaking from a small biotech perspective, underscored the operational reality: sites lacking trained, available staff cannot accept studies without risking data quality or timelines. She noted that for sponsors, especially in early-phase or data-driven trials, resource reliability surpasses cost as a selection criterion. “If you are faster, people will not care about the expense… But it’s the time,” she stressed.
Both Fiona Shields and Sarah Dealey mapped operational solutions in development:
Virtual “patient waiting rooms” for advanced prescreening
Flexible resource top-up funding, with sites given more authority over how additional headcount is deployed
Focused support for primary care and non-traditional research centers, learning from UK investments that built out research capacity in these settings
Yet, operational fragmentation remains. Both NHS and industry representatives called for more unified national frameworks—not just ad hoc pilot projects—and greater “holding everyone to account” for bottlenecks in contract negotiation, IT setup, and multi-departmental approvals.
Site Selection and “Winner’s Curse”: Reinforcing or Reimagining the Network?
A recurring theme was the persistent over-reliance on a small subset of high-performing UK sites. Multiple participants described the “winner’s curse”: sponsors and CROs circle the same locations for confidence in delivery, further excluding smaller or less experienced centers.
For sponsors, this is not simply inertia. Divya Chadha Manek described commercial and reputational drivers, critical for global trial listings and investor milestones—as major factors sustaining repetitive site selection. However, she and others acknowledged that moving beyond the top 5% of sites requires substantial operational support, both during site selection and throughout delivery.
Site diversity was called out as not just an equity issue, but an essential driver for clinical outsourcing best practice.
The UK’s complex, stratified patient populations demand new models to spread studies more widely, including:
Leveraging regional strengths (e.g., Birmingham’s leadership in pediatric and rare disease trials)
Supporting site readiness with targeted funding, IT support, and cross-department collaboration
Piloting centralised research infrastructures where appropriate, inspired by Spanish and German models
The Role of Technology, Data, and Emerging Models
Modernizing UK clinical research relies as much on data and digital innovation as operational reform. Panelists highlighted the potential impact of:
New Health Data Research Service initiatives for better patient identification
Use of AI and digital tools in trial design, screening, and patient engagement, especially in large-scale primary prevention and vaccine studies
Janette Rawlinson and Lucy Clossick Thomson brought forward the rapidly growing evidence that technology-enabled approaches—wearables, electronic outcome tracking, and cross-sector data sharing—can change the pool and pace of eligible participants, but only when embedded early in trial planning and contracting.
Importantly, the adoption of technology and sophisticated data models must be paired with stronger sponsor–site collaboration and trust, not imposed as external pressure. The panel agreed that UK research culture is moving in this direction, evidenced by broader stakeholder involvement, patient advocates in protocol review, and new industry-payer-regulator pilots incentivizing greater national trial participation.
Evolving Roles of Private and Public Sites: Hybrid Models and Mindset Shifts
The discussion also explored the contributions and limitations of private sites in the UK system. While private centers can provide faster turnaround and greater recruitment capacity for some indications (for example, dementia research), all panelists agreed public NHS sites must remain central to national trial strategy.
Critically, what distinguishes the most effective sites—public or private—is not setting but mindset. Sites that “treat research as a business”—with clear timelines, dedicated research administration, and strong accountability—outperform their peers regardless of sector or funding. The best operational models blend NHS strengths in access and continuity with private sites’ responsiveness and focus on delivery.
However, Sarah Dealey noted challenges in moving NHS research into private clinics, as staff are less likely to take trials with them when shifting care settings, limiting patient access . The panel called for cultural as well as structural reforms to close these gaps, citing the need for NHS physician training to emphasize research engagement across all career stages.
What This Means in Practice
Evaluate site selection and clinical outsourcing models for resource reality, not just “track record.” Prioritize operational capacity and cross-department readiness.
Support new and “emerging” sites with resource top-ups, practical training, and IT support—don’t default to established sites without real evidence.
Build multi-stakeholder feasibility processes, integrating patient advocates, primary care, tech leaders, and academic partners earlier.
Hold all partners accountable for bottlenecks in setup, contracts, and delivery—avoid “handoff culture” and clarify roles for each part of the chain.
Pilot or adopt technology-enabled patient identification and matching tools (e.g., AI prescreening, virtual waiting rooms) in collaboration with sites, not just as sponsor-driven initiatives.
Expand CRO selection criteria to include flexibility in supporting resource-constrained or novice sites, not just “first-to-file” high-volume locations.
Consider hybrid public-private models where appropriate, but reinforce business-minded approaches within NHS sites and invest in ongoing research capacity building.
Key Takeaways
Operational resources and site readiness are the limiting factors in clinical study optimization—not national patient pools or enthusiasm for participation.
Systemic accountability across sponsors, CROs, and site leadership is vital to move past fragmented delivery and inconsistent results.
Relying on a narrow network of “winner” sites suppresses trial growth and diversity—the UK must scale support for less-resourced centers.
Technology platforms, advanced data initiatives, and cross-industry partnerships hold promise, but only when paired with stakeholder buy-in and tailored resourcing.
Prioritizing transparent communication and collaborative planning—across departments, organizations, and sectors—is essential for high-quality, timely trials.
Selected Quotes
“If you are faster, people will not care about the expense… But it’s the time. And to do that you need resources.”— Divya Chadha Manek
“When you look at other countries, they have that very strong accountability line of who goes in, who holds the sites to account, who has those difficult conversations. And I really struggle that we talk a lot about sites, and industry, because at the end of the day, we are one to make all these trials happen.”— Suki Balendra
“The experience you have of activating a site or recruiting at a site is all directly correlated to the people that you're interacting with… Everyone's well motivated to help patients, but the practicalities really do cause part of the problem.”— Lucy Clossick Thomson
“There are NHS sites that behave exactly like [business-minded private sites] as well.”— Fiona Shields
Links & References
The COG Review: Building Better Clinical Studies offers ongoing peer-led insight into real-world clinical trial operations and outsourcing, with actionable strategies for optimizing sponsor–CRO partnerships and site delivery. Stay tuned for future panels tackling emerging technologies, decentralized models, and operational efficiency across the global clinical research landscape.
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