A synthesis: What works to deliver optimal health outcomes for UK care home residents

The detailed reviews, interviews and subsequent longitudinal case studies structured around a unifying realist analytical framework allowed us to establish a theory of commissioning for health care provision to care homes, which proposes that health care services will work better when: staff are explicitly tasked to work with care homes at an institutional level as well as individual residents; healthcare and care home staff are empowered to co-design their working models; where explicit expertise in dementia care is available; the role of GP as medical provider is supported by access to a wider array of services and they incorporate care management. There was no evidence from our study that a short-term focus on avoiding admissions to acute hospitals from care homes added any value to service specification or care delivery.