If Mohammed won't come to the mountain, the mountain must go to Mohammed

unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. EDITORIALS If Mohammed won't come to the mountain, the mountain must go to Mohammed The health care of nursing home residents causes deep unease in every practitioner who works with older people. The problem for frail older people in many western countries is that once they move out of the community and into a residential facility, for a range of complex reasons, their access to consistent high-quality medical care and multidisciplinary teams (palliative, geriatric and rehabilitation) dramatically diminishes [1, 2]. The solution to this problem vexes many western countries. In January 2011, the Australian Productivity Commission released a Draft Report 'Caring for Older Australians' calling for an overhaul of Australia's aged care system and whilst not their main focus, they identified access to appropriate health care as a problem [3]. A submission from the Australian Medical Association summarised the obstacles to providing reasonable medical care in residential aged care settings, including a lack of registered nurses with whom to coordinate care, increasing use of agency staff with a concomitant absence of continuity of care, an absence of information technology including software appropriate to GPs needs, strong financial disincentives to provide care in the setting, poorly equiped clinical treatment rooms which limited the treatments that could be provided. The Productivity Commission has recommended (Draft Recommendation 8.5) that subject to further evaluation an expansion should occur of 'the use of in-reach services and the development of regionally or locally based visiting multidisciplinary health care teams'. Will this work? Or, in the language of industrial redesign , are specialist outreach (or inreach) models essentially a 'workaround'. i.e. a temporary fix that implies a genuine solution? Are they a creative way of dealing with the reluctance of medical and allied health staff to work in residential care settings and with complex frail older patients? While often creative, 'workarounds' [4] are brittle and do not respond well to further pressures. An Irish group provides one of the few 'real life' ran-domised evaluations of a regular structured specialist geria-tric outreach programme being provided by a hospital clinician group into continuing care wards [5]. Their approach highlights the problems of outreach for clinical departments who are at the coal face of priority setting. When allocating specialised workforce resources across acute, rehabilitation and continuing care settings, there is a complex decision about …