Improving care through imbedding general practitioners within residential aged care facilities

The intervention is a change in service delivery model. The key changes include: * Introduction of a facility-based general practitioner employed at each site. * A clinical co-ordinator will be appointed at each site from existing staff if possible, to co-ordinate interactions with the general practitioner. The role of the general practitioner at each site will be established and integrated with existing processes and procedures. Communications will be made with existing general practitioners of residents advising them of the change in model of care at each site. In addition to the GP, the additional staff roles being introduced are: * Care manager—“To manage the delivery of person centred care to residents, ensuring the highest standard of ongoing assessment, care planning, evaluation and clinical governance, helping them to live longer, healthier, happier lives.” They will have responsibility for ~40 beds. * Clinical manager—“To support the GP in managing the medical practice, providing expert health services to approximately 150 residents across one or more BUPA care homes. To provide the link between Care Manager and GP in delivery of collaborative, integrated healthcare including assessment, care planning and clinical intervention.” * Registered Nurse in charge—“To supervise the delivery of person centred care to residents, as delegated by the Care Manager, to ensure the highest standard of ongoing assessment, care planning, evaluation and clinical governance, helping residents to live longer, healthier, happier lives.” * Team leader—“To deliver highest quality person centred care to residents, as delegated by the Care Manager/RN in charge. Ensuring safe medication administration, best practice wound care and clinical support for residents within the unit.” Organisational change facilitators will facilitate change in service delivery model at each site within the trial over the initial 63 days of the intervention period. Support will continue to be provided by change facilitators to the respective facility staff over the time period of the intervention, and over the 365 days of prospective follow-up as required. The new GP role is not full time in all facilities, rather, it is proportional to the number of beds at the facility. The new nursing roles will go to current employees if appropriate. The positions will be full time but may include job sharing arrangements. The medications will no longer be delivered by a registered nurse, dispensing from a medication trolley, rather, they will be pre-packaged, kept in the resident’s room, and residents will be facilitated to take their medications by a personal care attendant. These Personal Care Attendants will be trained to undertake this role. The timing of medication distribution will transition from scheduled rounds at 8am, 12 midday, 6pm, (+ exceptions for particular medications), and towards scheduled rounds at 8am, 2pm, 8pm (+ exceptions for particular medications) with residents providing input where possible as to the timing of their medications.