Developing a Sustainable Workforce Through a CIC Model

Red Kite Health Solutions CIC

The problem:

The four practices in South Powys had been meeting for a number of years to develop cluster working, and were keen to develop services further through a multi-disciplinary approach that benefited patient outcomes and the cluster as a whole. With 80% of GP partners in South Powys aged 50+ and with current low levels of interest when aiming to recruit new GPs, it is imperative that GP time is spent on those patients who clinically need to see a doctor, to improve access and care for those patients accessing services.

The county of Powys is very diverse and spread out geographically with no district general hospital, often necessitating different solutions to patient care and services for patients to be seen closer to home. Finding it increasingly difficult to commission and provide services they wished to implement at pace, the GP representatives from the practices agreed to collectively proceed with the establishment of a formal joint-working relationship based on a social enterprise model.

The Bright Idea:

In 2015, Red Kite Health Solutions community interest company was created, with the four GP representatives sitting as directors and the remaining 40 cluster GP partners becoming members of the company. The ethos behind this was having a separate engine to source and commission services based on the cluster priorities, thus allowing a number of sourcing and funding options becoming accessible, employment opportunities that were removed from the financial obligation of the practices and a separate entity to be able to integrate new services at pace. A social enterprise would also be open and transparent and incorporate relations with all sectors across primary, community and social care as well as with patients.

In 2015 the cluster prioritised a number of innovations they wished to take forward,

following closely with what was then known as the emerging model of primary care and Welsh Government priorities. This included the introduction the following:

  • Telephone first – Nurse triage
  • Call lists triaged for urgent on the day appointment requests
  • Call lists triaged for routine appointment requests in one practice
  • Remote Triage – cluster practices providing Triage remotely for neighbouring practices
  • Pharmaceutical team –The employment of eight Red Kite Pharmaceutical employees, providing chronic disease management clinics , medicines reconciliation and cost savings
  • MSK Service – On the day, Physiotherapy sessions are available within the cluster practices for acute MSK issues. Patients presenting with acute pain issues can be triaged directly in to a Physiotherapist usually within a few days
  • MIND – The introduction of active monitoring in-house, treating low level mental health issues in-house
  • Point of care CRP testing supplied to cluster for the antibiotic prescribing of upper respiratory tract infections

All of these services have taken substantial input from the practices in terms of time and mentorship to set up, monitor and supervise. Five members of the practice nurse team have undertaking the minor illness course, with two undertaking their independent prescribing qualification. In addition to two of the Red Kite Pharmacists completed their independent prescribing qualifications with another studying for a diploma in diabetes management and one technician undertaking a degree in pain management. Further training is being undertaken at various points including GP mentorship and practice support. Where possible, Red Kite looks to fund these courses as a cluster initiative if in line with the cluster priorities and the new model of primary care.

The impact:

  • Other: Cluster reports are generated monthly/quarterly to the practices to evaluate services. All staff have worked tremendously well with a very different approach to how many have worked in the past. Staff morale has improved greatly and it has further supported relations between the cluster practices who now look to provide services and create opportunities as a group and how this can be shared between all 45,000 patients within South Powys.

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