A new model of care and in‐house general practitioners for residential aged care facilities

In reply: The business decisions made by Bupa Aged Care subsequent to our trial were beyond the scope of our investigative team role in the trial’s design and evaluation; thus, we cannot comment further upon them. We do credit this organisation for being willing to investigate this new model of care and for actively partnering in this trial, and note how rarely a provider‐initiated trial of this nature emerges from the Australian residential aged care sector. This trial highlighted the skills deficit within many residential aged care facilities and how an organisation addressing this deficit (in this case by employing general practitioners directly) can potentially improve care outcomes.

The issues raised point toward the inherent difficulties in trying to identify a business model and employment arrangements that are acceptable to both GPs and aged care provider organisations. Our trial highlighted the difficulties encountered with trying to implement this model of care, with GPs not able to be employed at all in four of the 15 sites, and a further four sites having incomplete coverage during the intervention period. We agree that where a GP was able to be employed, our contamination‐adjusted intention‐to‐treat analyses indicate substantial improvement in a number of resident care outcomes. We also agree that aged care providers are important stakeholders with a key role in promoting the sustainable implementation of models of care such as the one we investigated, but note that there are many other stakeholders involved in this task. Models of primary care that efficiently support improved resident outcomes require funding models, employment arrangements, and regulatory oversight parameters that are acceptable to residents and consumers, GPs, aged care providers and their staff, and government. In our view, these stakeholder groups have a joint responsibility to coproduce these frameworks.