The Human Cost of Gaps in Primary Care

The imminent closure of community health services in inner city Melbourne should be a wakeup call for all of us that have a role to play in our health system.

More than 12,000 people in Collingwood, Fitzroy and Kensington face the prospect of being without a GP, and limited access to pharmacy and counselling services, due to the inability to secure a sustainable funding model. 

This is just the surface. Every clinic that closes and every primary care practitioner we lose now will widen disparities in our health system — and those cracks will be harder to repair tomorrow. 

Community health centres like cohealth help stabilise the broader health system because they provide a wide range of services in one place, often with a focus on making care accessible and affordable for the local community they serve. 

Their loss creates ripple effects across emergency, mental health, housing, and social services — widening gaps that more vulnerable people will likely fall through. At the heart of these closures are severed doctor - patient relationships, breaking the continuity of care and trust that takes years to build. 

This is not just a funding issue — it’s a sign we’ve lost sight of what integrated care truly means. It’s not about the number of services offered in one place. What really matters is recognition and understanding that care is a journey – not a single step. Care needs to be flexible, relational, and deeply human. It shouldn’t be constrained by systemic gaps in access and service design limitations. 

Bulk billing reforms are a start, but they don’t address the real cost of delivering care to those with complex needs. The future of primary care depends on our ability to think differently and collectively about how we coordinate and deliver services – and how we reach those who have increasingly fewer options to access affordable care. 

For example, when different organisations work together to plan and fund services for a community instead of each group making decisions on their own – through a model known as collaborative commissioning – there’s a real opportunity to better pool and share resources, information and set priorities to ensure care services are better coordinated and meet local needs.  

Genuine collaborative commissioning isn’t just a structural tweak; it’s a fundamental shift in how we design and fund care, and importantly – it’s about making progress on workforce sustainability across the care and support economy. 

Patient complexity is not an exception — it’s the reality shaping demand across the system. Yet funding and service design often ignore this, leaving GPs and community health teams to absorb the pressure without the resources or flexibility they need. This disconnect drives burnout and accelerates workforce attrition. 

In Victoria, Primary Health Networks (PHNs) already use a commissioning model to support chronic and complex care. But without strategic backing to shift toward genuine collaborative commissioning at scale, these models will keep falling short of their potential. Collaborative commissioning must embed shared accountability, pooled resources, joint decision-making, and prioritise capability development — not only to fund care properly but to sustain the workforce delivering it. 

Collaborative commissioning, when done right, aligns incentives, funding, and service delivery around what patients actually need – and what providers need to deliver that care safely and sustainably.

This means empowering GPs and community health providers with flexible funding, team-based models, and the ability to innovate locally. We’ve seen this work in regions where PHNs and local health services co-commission multidisciplinary teams: outcomes improve through better medication management, reduced hospital admissions, and stronger continuity of care.

Evidence backs this approach – multidisciplinary teams, particularly those including pharmacists, improve outcomes for people with chronic and complex conditions and can deliver cost benefit. Co-commissioning of multidisciplinary teams is not only clinically effective and economically viable but should be a logical next step for Australian primary care. 

Above all, it’s about breaking down barriers between primary and acute care so that early, low-barrier interventions can prevent things from escalating — not because their condition has worsened, but because the system failed to meet them where they were. 

The urgency to get collaborative commissioning embedded as standard practice is clear – every clinic closure, every primary care practitioner lost will deepen the cracks in the system. Collaborative commissioning isn’t new, nor should it be optional. It’s the only way forward that keeps care responsive and equitable – and keeps the workforce in the right place at the right time.