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Getting the model right – A perspective from Red Kite Community Interest Company

We recently spent some time chatting with Siân Jones who is the Business Development Manager for Red Kite Health Solutions Community Interest Company (CIC) about the development and running one of the growing numbers of not-for-profit community interest companies in primary care in Wales.

Siân’s background is primary care. She started in general practice in 2008 as a receptionist and since then held numerous roles within general practice and joined the CIC in 2017.

Sian Jones
Sian Jones


Can you introduce to us what Red Kite Health Solutions is all about?

Red Kite Health Solutions is a social enterprise that delivers health and wellbeing services to the South Powys population. It is a non-profit organisation, set up as a collaboration of four GP practices in South Powys.

The organisation consists of four GP directors who sit on the board of Red Kite. Each of the directors is a partner in one of the four practices that makes up the South Powys cluster. The 46 remaining GP partners across the cluster area in South Powys are members of the organisation. At its inception the cluster wanted to really look at how they could scale up their objectives and move things at scale and pace which is where the idea came from to set up the CIC as a delivery vehicle for health and well-being services.

Our primary goal is to support the sustainability of primary care and offer services that improve the health and wellbeing of the population. We are able to fill gaps within the cluster working or offer alternative solutions where there are identified gaps in service provision. For example, if certain practices or contractors have problems, we can provide support and/or staff. We work across the cluster footprint; we are a delivery vehicle for services, and we share our staff, ideas and services across the cluster.

Can you tell us a little about the background about how and why Red Kite came into being?

In the period prior to the establishment of Red Kite, the four practices in South Powys had been working well together, even before cluster working fully developed. They did a lot of work around virtual wards and were quite central to the commissioning process. At the time they had quite a big say in what was commissioned and how things were commissioned.

Subsequently, there was a change in the Health Board structures and I suppose the GP’s really felt they’d lost their voice with the changes. They are quite an innovative group of GPs, so that prompted them to start to think a little bit outside the box and look at potential options for service delivery, perhaps where there were issues within practice or the health board, such as a lack of available staff. They approached the Welsh Cooperative and started looking into what kind of entities there were that could sit in this space, with potential options for funding opportunities and employment.

How did you go about establishing Red Kite as an organisation?

So once the conversations and discussions had taken place and the four practices decided to proceed it was a relatively straight forward process.

They established who their members were (the GP partners of the four practices) and agreed their vision and goals. They then produced a community interest statement outlining the business plan for the organisation and formed their articles of association. Then the CIC was registered online with Companies House. It is quite a simple process to do at a grand total cost of £27. We took advice from the Welsh Cooperative who guided us through the process, not just the legal side but also about starting conversations with key stakeholders.

What did this mean for the GMS contracts of the practices?

It was not about putting the GMS contracts of the practices into the CIC. The independent contractor status held by each of the four practices involved was maintained. Delivery of the GMS contract still sits with the practices, that’s their core business.

The CIC sits around the outside, it is about supporting cluster-based and community working and innovations. It is about having the ability to improve and deliver services and doing things differently.

For the services you provide, can you tell us how they are contracted for?

Our main contract that we have is for pharmacy support services, which has been contracted via an alternative provider medical services (APMS) contract with Powys Teaching Health Board. This was the first APMS in Wales, and a huge amount of work went into pulling that together with the Health Board. This contract has been in place since 2016. We can and have attached other services onto this APMS contract but moving forward we will have the new national APMS contract available for future contracts.

For other services we have service levels agreements (SLA) in place with the commissioner of the service.

Our funding will come from a variety of sources. We will bid for projects and delivery of services, so sometimes this will be through the Health Board but not always. I mentioned our main contract earlier which is the APMS contract for pharmacy support services with the Health Board. But there are other opportunities, such as the lottery or grant scheme funding and community funds.

What was the main driver for having an APMS contract in place for this service?

It was for the ability to employ staff in the health service space. For the pharmacy support services contract we employed pharmaceutical professionals, and to be able to attract clinical staff we had to be able to offer competitive terms and conditions which includes membership to the NHS pension scheme. The only way to access this is via the APMS contract.

Where we haven’t needed to employ staff directly, we have contracted through the SLA arrangement.

Can you give us some examples of the type of work Red Kite does?

I have already mentioned the pharmacy support services contract, but in addition to this we have implemented and supported several services in primary care including Nurse Triage, MSK Physiotherapy, opportunistic testing for Atrial Fibrillation and a primary care pain management service. During COVID-19, we were able to secure a community fund lottery grant to supply a welfare service to shielding and vulnerable patients.

In addition to this we have collaborated with a number of third sector organisations to provide services around mental health and obesity and we are also able to purchase equipment. For example, in 2018, we gifted eight c-reactive protein (CRP) testing machines to practices to aid clinical staff with the antibiotic treatment of lower respiratory tract infections and in 2021 we pledged to fund health and wellbeing sessions for practice staff. We are also available for training of staff where applicable

Are there benefits for patients?

Yes, most definitely. I believe what sets the CIC apart and it is something that we were very keen to make a priority was reporting on clinical outcomes and patient improvements. We’ve been able to fully evaluate our services to assess the benefits to the patient. We’ve spent a lot of time creating clinical templates that are standardised across the cluster, which supports the staff and patients with our understanding.

We also engage with patients via feedback and service reporting, not just one group of patients, but across the practice populations.

We also can adapt services or even end services if we if deem then not to be successful. We report on and review all services, which gives us the knowledge to be able to adapt if necessary.

Because we can spend so much time looking at all aspects of delivery, you learn not just what’s important to the practices, but what’s important to the patient. We are able to discuss areas that are particularly relevant in rural areas, such as transport links, loneliness and isolation.

What do you see as your successes?

The positive outcomes we have achieved for patients and the close working relationships that have enabled us to do this, right across the board. A huge amount of my time goes into facilitating and nurturing relationships and creating connections. So, I go off and make friends with people and look to see how we can work together to bridge any gaps across the sectors. That’s what I do because you have to build that trust between all the parties.

It about bringing people together and having candid conversations and saying, well, look, this isn’t about us being better than anybody else. This is about saying, what is it that we can do to support your patient services, to actually make them even better or easier to deliver than they are already? That’s all it is. And I think once you get over that, people are far more supportive of the concept.

What have been the biggest challenges?

In terms of set-up, we were lucky there wasn’t many challenges for us because we had support from Health Board at the time. That said, there was a huge amount of work that went into talking to the practices, lots of back and forth with the practices to make sure that everybody understood the purpose and intentions of the establishment of the CIC. Both relationships require nurturing, as people and departments change. It could be challenge if you’ve got practices/contractors that maybe aren’t on board. But you don’t have to have every contractor in the CIC, you could just move forward with those who are interested.

One of the biggest challenges probably has been around the APMS contract, but that was mostly due to the fact that we were the first in Wales to hold such a contract. Our initial contract was in place for three years, and there were challenges with the extension of this at times. The way our APMS contract has been constructed is that there is a huge amount of negotiation goes into adapting it. There’s no inflationary uplift in our contract. So, every time we need to make a change, we go back to the Health Board. I hope the new national APMS contract will alleviate some of this, but I think it’s really key that the Health Boards understand what an APMS contract is, and how it works. Additionally, indemnity of staff has been an issue. We do have access to the Wales National Workforce Reporting System which resolves some of these issues but whereas historical indemnity was rectified for GPs, this has not been the case for other clinical staff, and we still have to maintain a large proportion of funding for this.

We have also faced a number of challenges around operating in an open business market, often against larger organisations. We carry the same risk as any other companies – we still have tax liabilities.

I think in the early days particularly we faced quite a bit of cynicism around the fact we were a not-for-profit business and what that meant. I do think that has improved in recent years as Community Interest Companies have been around since 2005, but I think there still is a way to go with the general understanding what those terms and its operations mean.

It can also be challenging when further opportunities come up that may not fit within what your social goal.

Where would you like to see Red Kite in five years’ time?

We are a homegrown CIC, and I don’t think we have any aspirations to take over the world. I think we aspire to provide the best services for our patients in South Powys and our neighbouring clusters should they want that support. I know we will stay true to what our mission statement is, by continuing to focus on improving the health and wellbeing of patients and do the best that we can for them and to support the cluster. I would like to see us further develop our APMS contract and expand the services we are able to offer, which will make us more sustainable long term.

So, if we’re still able to that in the next five years we’ll be in a good place.

Last Updated on 31 January 2023