People have asked the question before whether Community Interest Companies (CICs) will survive in the long-term. This concern is perhaps enhanced as the integration agenda continues to develop and shines a spot-light on the presence of CICs and whether they can continue to be as relevant to patients as they have been in the past. After all, people might question what place there is for social business in the context of the Long Term Plan, where there is an express focus on public statutory providers being the lead-provider or integrator of choice.
There is no doubt it is a tough market out there, with CICs struggling in some areas to ensure that they can provide the required quality service for the available contract price, particularly in traditional GP-led primary care services. However there is evidence to show that CICs are succeeding in this tough and difficult market. Firstly, they are winning new high value core community health contracts, secondly, they are expanding beyond their traditional service portfolios and, thirdly, they are becoming an integral part of some local integration plans given the breadth of services they provide and their skill-sets, including being able to connect people and services across the primary, community and acute sectors. I look at these aspects further below.
The history of health CICs goes back many years but they were “fuel-injected” into the health system when the old Primary Care Trusts were required to divest themselves of their provider portfolios, to focus on commissioning, and some of these provider services were transferred to CICs. CICs are companies that are required to have a social purpose, they cannot be charities, they can raise surplus funds but these generally need to be ploughed back into the business and they have more freedoms and flexibilities than public bodies. Organisations like Your Healthcare CIC in Kingston, London, were created in 2010 and others in the years that followed, like Anglian Community Enterprise (ACE) CIC in North East Essex, Medway CIC, Provide CIC in Mid-Essex and Bromley CIC in 2011.
Track Record of CICs
CICs have been doing some of the heavy lifting in adult and children’s community services in their areas for nearly 10 years now. They have shown how employee-owned and run organisations, staffed and managed by people with a health service background, and who have an NHS ethos even if those people are not now employed by the NHS, can run successful businesses over considerable periods of time with the patient, and their employees, at the heart of what they do.
The Long Term Plan
Despite the focus on public bodies as lead integrators in the Long Term Plan (LTP), that same plan states that the NHS will continue to commission, partner with and champion local charities, social enterprises and community interest companies providing services and support to vulnerable and at-risk groups. The LTP recognises that these organisations are leading innovators in their field and that this innovation will need to be encouraged and supported by Integrated Care Systems to address health inequalities in their populations.
Core Business Expansion.
There some good news stories out there for CICs at the moment too with Sirona Care & Health CIC having being confirmed in September by Bristol, North Somerset and South Gloucestershire CCG to provide community health services for adults across the local area. The contract is for more than £1bn over ten years. This is an important recent story for CICs and illustrates how they can show both how they can deliver quality services but also how they can adapt to new tender situations and where CCGs are looking to procure new ways of delivering services.
Expanding Traditional Portfolios.
CICs are very much developing the range of their services. In particular well-being and related services such as osteopathy, chiropractor , physiotherapy and massage services. Often these sorts of services are run by the private sector but recently CICs have been looking to step-up their involvement in such services and to expand their role in these markets. Expansion in these areas is being looked at through, in particular, the acquisition of existing companies and businesses through either share purchase or business transfer agreements. Care needs to be taken with such acquisition activity because you can buy problems as well as assets, and so an excellent due diligence process becomes absolutely vital.
Some of the CICs are playing a very important role in their local integration plans including getting involved with Primary Care Networks, where groups of GPs come together to work in a more coordinated way to provide better services, Integrated Care Partnerships and Integrated Care Systems, where a range of organisations commissioning and providing local health and care come together to work in the most efficient and effective way. A number of the CICs cover primary and community services and are in a unique position to provide support to these crucial developments and CCGs should be working hard to understand just what they and other similar organisations can contribute.
It is a challenging time for CICs, particularly the smaller organisations, as they continue to articulate just how patient-centric their services are and the benefits they have brought to their locality over the past ten years. There is room for discussion about exactly how best they might fit into their local plan in the future and, of course, CICs have always been more flexible and adaptable than many health service organisations and so this discussion should be something they are up for. However commissioners and NHS bodies also need to do their part, and be open to and listen to the story being told. It is an exciting and passionate story and one which we do not want to end here.
Resolving Together Limited