Dr Maureen Baker: ‘The college is up for the challenge’

‘Education, education, education.’ Dr Maureen Baker is not the first Scottish-born leader to stress the importance of academic endeavour. But in her case, unlike former Prime Minister Tony Blair, it’s a commitment very much backed up by her own story.

‘Education among people I grew up with was seen as really important – and highly valued.’

As the eldest of six children growing up in a deprived area in Wishaw, Lanarkshire, Dr Baker says her ‘very ordinary upbringing’ as the daughter of a steel worker and a teacher fostered ‘a strong emphasis’ on education. ‘Education among people I grew up with was seen as really important – and highly valued.’

So it is perhaps apt that, after decades forging a career in general practice, she has gone on to become the chair of the RCGP, a position she took up last month. 

As she replaces Professor Clare Gerada, who raised the profile of the role to unprecedented heights during her three-year tenure, it is tempting to compare Dr Baker to another Scottish leader – David Moyes, who has had to follow in the footsteps of Sir Alex Ferguson as manager of Manchester United this year.

But Dr Baker brushes aside any suggestion that it will be tough to take over from such a forceful personality. ‘I’m very shy and retiring!’ she exclaims with a smile, in a manner that is quite definitely neither shy nor retiring. She acknowledges, though, that there will be an inevitable change in approach. ‘I’m delighted Clare’s been such a strong figure. She’s stood up for the college, for GPs and patients. But I’m different, of course I am, and my style will be different.

‘All I can say is I’m very clear about what I feel I can do for the college and for general practice. As long as I give my best and we bring colleagues along with us, and we’re very clear that what we’re doing is working for good standards of care for patients, I think I will have done my job.’

But Dr Baker takes the helm at the college at a tricky time. She herself raises the delicate issue of the RCGP’s finances, which has forced it to make redundancies in the past year and rent out a floor of its shiny new headquarters at 30 Euston Square in central London. ‘We do have problems… we obviously need to have sound finances,’ she says frankly. ‘We’ve had a more difficult situation in the last year, as many families, practices and businesses have.

‘We’re moving on through that, so the college is in very good shape, and very up for the challenge of getting extra funding and resource into practices for the sake of patients.’

Optimism

Dr Baker’s optimism is built on the ‘fantastic body of people’ who make up the college, she says. ‘It’s not this building we are sitting in, or me and the officers. It’s all the people working in and around the college and our members, and what we do for standards of training and standards of care.’

Dr Baker’s big-ticket proposal is reform of the returners’ programme – making it easier for GPs to return to work after a career break. With the pressing need for more GPs, this would be a way to create a ‘surge’ in the GP workforce, she argues.

‘There is then great difficulty in taking up practice again in this country’

‘It’s very much one of my priorities. When you talk about more resources for general practice, the need for more GPs is very high on the list. Taxpayers in this country have paid half a million pounds to train each GP, and for various reasons – whether people may have been out of the country or taken a career break that lasts longer than two years – there is then great difficulty in taking up practice again in this country. If we were able, with others, to devise a safe, supported route back into practice, we could get a short-term surge in GPs coming back into the workforce.’

There are no recent figures on how many trained GPs are deterred from returning to work by the current restrictions, she concedes. But based on work she has done in the past, she estimates it could bring ‘potentially several hundred’ GPs into the system. Dr Baker adds: ‘In any case, the principle around safe return to practice should be in place almost regardless of the number of doctors who would need to go through that route.’

But for many GPs, the elephant in the room when it comes to the college’s oversight of training is the escalating row over the MRCGP’s Clinical Skills Assessment (CSA) – the differences in pass rates between white and non-white candidates, and between UK graduates and international medical graduates.

A recent study published in the BMJ by NHS racism expert Professor Aneez Esmail prompted an outcry with its conclusion that ‘subjective bias due to racial discrimination’ could be the cause of the differential pass rates – even though Professor Esmail’s official GMC-commissioned report, based on the same research, found that ‘the method of assessment is not a reason for the differential outcomes’.

Costly legal process

The college is now facing a judicial review brought by international doctors, which will rule on whether the CSA is ‘directly or indirectly discriminatory’ – a review the college has estimated could cost it almost £100,000 in legal expenses. And perhaps most worryingly of all, the BMA has now thrown its weight behind the legal challenge to the exam, contributing £20,000, as well as £5,000 worth of legal advice from a QC.

Given the difficulties in which the RCGP now finds itself embroiled – plus the fact that in a recent poll 58% of Pulse readers said the college had handled the row ‘poorly’ or ‘very poorly’ – what should it have done differently?

‘I don’t think it could have been handled any differently for the very clear reason that the college has to take advice from our lawyers that this area is the subject of judicial review and therefore we are very limited – on the advice of our lawyers – about what we can say,’ Dr Baker says.

But wasn’t the college’s bullish response to the BMJ report (Professor Gerada accused Professor Esmail of ‘misleadingly suggesting we are guilty of bias’) at odds with this stance?

‘I can’t comment on that,’ she says. ‘We have to be very careful not to make matters worse, regarding stories and speculation.’ Nor will she discuss the chances, or otherwise, of an out-of-court settlement. However, she promises: ‘After the judicial review, when we’re free to comment on the action the college has taken, we’ll be very keen to discuss that with all interested parties.’

‘We always have good relationships with the BMA and other bodies. It doesn’t mean you agree on everything.’

But the relationship with the BMA is an important point. The doctors’ trade union is directly funding legal action against the professional body for GPs. Doesn’t that affect the ability of the profession to present a united front?

Dr Baker doesn’t bite. ‘We always have good relationships with the BMA and other bodies. It doesn’t mean you agree on everything. You wouldn’t need different bodies if that was the case.’

Fittingly, we move on to the outcome of the 2014 GP contract talks. Dr Baker welcomes the agreement, which signals a return to a ‘consultation geared more to the patient’s agenda’, and insists it will give hard-pressed GPs ‘more flexibility and headroom’. But she adds: ‘In itself, I don’t know that it does anything to address resources and funding so that’s something we need to move on with.’

The relationship with the BMA will be vital if Dr Baker is to succeed with her ‘priority’ to ensure resources are moved into primary care. That relationship is sure to be tested in the coming months.