When clinical research is discussed, the focus tends to fall on science: new treatments, new technologies and new discoveries. That is understandable, but it can obscure a more immediate constraint. In many cases, the issue is not a lack of innovation but a lack of access. Access shapes who is identified early enough, who meets the eligibility criteria, who can realistically participate, and how many potential participants fall away before enrolment.
There has been clear progress in recent years across sponsors, NHS research sites and regulators including the MHRA and the Health Research Authority to improve how studies are set up and delivered. Even so, the patient journey remains one of the most persistent points of friction. For too long, research has been designed around systems that expect patients to fit into them, rather than around the realities of how people live, work and engage with healthcare.
The pandemic challenged that model. Research moved faster not because standards were lowered, but because processes adapted. Remote consultations, digital onboarding, electronic consent and home-based participation became far more widely used, not as optional enhancements but as practical necessities. That shift made something important very clear: much of the friction that slows research is not inherent to scientific rigour. It is operational.
Mamedica does not run clinical trials, but it operates alongside this broader healthcare ecosystem through a fully digital patient pathway, from initial eligibility screening to specialist consultation and ongoing follow-up. That experience provides a useful view of how patients engage with care when barriers are reduced and processes are easier to navigate.
One of the clearest challenges is identification. Many pathways still depend on patients appearing in the right setting or being referred through routes that are often slow, fragmented or difficult to navigate. In practice, this means a significant number of people are lost before they ever reach the point of enrolment. Uncertainty around eligibility, a lack of clarity about where to begin and the sheer time involved in moving through the system all contribute to that drop-off.
This is particularly visible in overstretched parts of the system, where administrative complexity and capacity constraints can delay progress at an early stage. Digital screening can help create a clearer and more structured entry point, making it easier to assess patients sooner and direct them towards the right clinical input. At Mamedica, that means an initial eligibility check supported by a review of medical records, followed by a specialist-led consultation within defined clinical criteria. Those safeguards are there to protect patients, but they also make the pathway more navigable.
Participation is the next challenge. Traditional research models have often assumed that participation must be time-intensive, location-dependent and difficult to fit around everyday life. While some in-person interaction will always be necessary, recent experience has shown that this assumption does not always hold. Remote consultations, secure digital platforms and patient-reported outcomes can all reduce the practical burden on patients without weakening the quality of clinical engagement.
When participation is easier to manage alongside work, caring responsibilities and daily routines, it becomes accessible to a much broader group of people. That matters not only for convenience, but for recruitment, retention and representation. Delays in these areas do not simply affect study timelines; they affect the viability of research programmes and the UK’s competitiveness as a destination for clinical research.
Continuity also remains a major issue. Maintaining engagement over time can be difficult in both care and research, particularly where follow-up is fragmented or reliant on repeated in-person contact. Digitally enabled models can support more consistent communication through regular check-ins, structured monitoring and remote follow-up, creating a fuller picture of how patients respond over time rather than relying on occasional snapshots. From a provider perspective, this allows for a more rounded understanding of outcomes in real-world settings and can help identify where patient experience begins to diverge from expectation.
Capacity is another constraint that cannot be overlooked. Access is shaped not only by systems and processes but by the availability of trained specialists who can assess, recruit and manage patients effectively. In many areas, that capacity remains limited. However well designed a study may be, progress will remain slow if the workforce needed to support patients through the process is not available at scale.
This connects to a broader question about evidence. Clinical trials must remain the foundation for establishing safety and efficacy, and nothing should dilute that. At the same time, there are areas where the pace of evidence generation and the level of patient need are not always aligned. Understanding how treatments are experienced in routine care can therefore provide useful additional context. Ongoing patient engagement and structured follow-up can help show how outcomes develop over time, how consistently treatments perform, and where there may be variation between expectation and reality. These insights are not a substitute for trials, but they can strengthen the wider evidence base around patient experience and practical delivery.
There are valid concerns about how far decentralised approaches should go, particularly around oversight, data consistency and quality control. Those concerns matter and should be addressed carefully as models evolve. Even so, they should not become a reason to delay progress in areas where the benefits are already clear.
The UK has shown that it can move in this direction. The pandemic demonstrated that research can be made more flexible and inclusive when there is sufficient urgency, and recent regulatory changes are beginning to reflect that shift. Process reform on its own, however, will not be enough. If access remains difficult, participation disruptive and engagement inconsistent, research will continue to struggle with recruitment, retention and representation.
The priority now should be to simplify the patient journey by identifying people earlier, reducing unnecessary barriers to participation and supporting more consistent engagement over time. That also requires a change in mindset. For patients, research does not exist separately from care; it sits within a wider healthcare experience. Bringing those two areas into closer alignment would improve both.
Clinical research will not accelerate simply because science advances. It will move faster when participation becomes more accessible, more manageable and more reflective of how people actually live. Access is not a secondary issue in that equation. It is central to how quickly research can progress.
Jon Robson
Jon Robson is CEO of Mamedica, one of the UK’s leading digital healthcare platforms for medical cannabis. Since launching in 2022, Jon has led the business from startup to one of the fastest-growing private healthcare companies in Britain, supporting more than 15,000 patients nationwide with clinically-led access to cannabis-based medicines.
