Dr Maureen Baker CBE explains why she feels practice managers are the beating heart of general practice
The new chair of the Royal College of General Practitioners (RCGP) has a healthy respect for practice managers. When Management in Practice caught up with Dr Maureen Baker CBE at the annual RCGP conference, we were surprised with her enthusiasm for a profession in which she has never worked. In fact, in her words, managers are the “unsung heroes of general practice”.
Dr Baker, who will take over the role November, knows through her work with the General Practice Forum that the value of practice managers lies not just in organisational prowess and promoting good business practice, but in ensuring patient safety.
Eyes sparkling, she explains: “They intimate, they co-ordinate, and they help set the culture in a practice. They have achieved great things, and where we are today is a great credit to practice managers. [But] I still think there are more things that they can do.”
As the former director of primary care at the National Patient Safety Agency and the current clinical director for patient safety at the Health and Social Care Information Centre, it’s safe to say that Maureen is a patient safety advocate.
“Just think about the way in which systems in the practice are organised for prescribing, or looking at results – all sorts of things! Practice managers do tend to either design those, or feed into them,” she enthuses. “These systems are what make practices safe.”
“I’d quite like to shine that spotlight on their work, get practice managers the patient safety label so that it’s an area that practice managers as a group can take pride in and develop, in order to see themselves as patient safety champions in the practice.”
Collaboration is key for Dr Baker, who describes it as her “default position”. It’s unsurprising, therefore, that part of her vision for general practice includes a greater contribution from practice staff. For her, the RCGP is not just about GPs themselves – it’s about the team. “We have great general practice teams, including practice nurses, receptionists, healthcare assistants and sometimes pharmacy. They’re part of what makes general practice the fantastic service that it is. The more we can flag that up, highlight it, thank people and ask for more contribution, the better.”
But Maureen’s interest in patient safety does not make her blind to the other issues currently affecting general practice – far from it. With more than one million consultations carried out in surgeries across England every day, over one billion prescriptions prescribed each year, and with primary care operating on 9% of the NHS budget but carrying out 90% of the patient contacts, it’s clear that something has to give.
What with the £400 million “black hole” in general practice funding due to consecutive cuts, it’s surprising that Maureen isn’t calling for an immediate cash injection, much like the one recently given to accident and emergency departments.
“The important thing is the health of individuals and communities. My worry is that when an initiative comes along and it’s a good idea with a good intention, more resources are directed away to different initiatives, making mainstream general practice more and more destabilised,” she says.
It’s not that Dr Baker doesn’t want a short-term cash injection for general practice, to deliver primary care as it has always been delivered. It’s just that to do more, to innovate, general practice needs to be sustainable.
Leaning forward conspiratorially, Maureen says: “There is a lot more that general practice could do, and maybe should do – in looking after the vulnerable elderly and management of multiple morbidities, for example. We need sustainable general practice, which is properly funded, with an adequate workforce able to provide the essential infrastructure service that we currently do.
“But in order to develop, transform and innovate, we really need more GPs and better resources, because when people are working very long, intense hours, they get tired. They lose the head space for innovation and development.”
And the quality and outcomes framework (QOF), introduced in the 2004 GP contract to improve healthcare by rewarding practices for good practice, hasn’t exactly improved things, Maureen believes. Like many others, she believes QOF has seen better days.
“I think QOF is a bit of a good idea gone too far. QOF demands are intruding on the consultation too much just now. With the idea of ten minutes or 12 minutes with the patient, by the time you’ve done all of your QOF requirements, is that then considered five or six minutes with the patient?”
For Dr Baker, that’s just not good enough.
She rattles furiously: “The patient has lost half of their personal time – they have not come to do QOF stuff, they have come because they have an issue, a problem an illness. We really need to make QOF more proportionate and less intrusive into the consultation.”
Now that Dr Baker has started on a topic that touches a nerve, her eyes develop a steely glaze.
Despite government promises that half of the current medical students will become GPs, waiting for them all to finish their training will take far too long. And, at the same time, the College, along with the British Medical Association, is calling for an additional year of specialist GP training.
Dr Baker said: “I have a particular view that we can’t wait seven years. We will have a whole new set of problems in seven years’ time. So, I strongly believe that in addition to the planned medium-term production line for new GPs, I think we need some short-term work as well.
“That would be around retention of the doctors we have already, and making the most of the trained GP workforce.”
When asked – perhaps cheekily – how she thinks she will compare to current RCGP chair Dr Clare Gerada, Dr Baker appears both amused and taken aback.
“We’re both quite direct people who say what we think, but I would much prefer to collaborate if possible. When it’s not possible, or when you really need to stand up and say difficult things, I think both Clare and I are both perfectly able to do so.”
So, asks Management in Practice, shall we expect a strong leader?
Dr Maureen Baker: “Let’s hope so.”