Life on the exponential curve--time to rattle the academic cage? A view from the street

The history of health service research has been characterized by an overwhelming volume of literature that has little impact on those who actually get on and do the work. The focus has been on an examination of why evidence is not accommodated into practice and how the barriers to implementation can be reduced. The fact that the evidence-based product may not be relevant to those at whom it is directed had not until recently been considered a possibility. Over the past 20 years there has been a consolidation of two cultures in the National Health Service--the academic/researcher and the clinician/practitioner. This paper sets the two cultures within the context of a community of practice framework and argues that the emphasis should move away from managing the interface to a fundamental reappraisal of the health service academic community.