Measures in the recent Federal Budget are helping patients through the front door of health services. Now we need the architecture for care beyond it, according to the authors below, who contributed to a report released this week outlining key enablers for much-needed primary care reform.
Tristan Bouckley, Tracey Johnson and Stephen Jan write:
Few people find it easy to navigate the health system when they need care, especially when that care is complex and spans multiple services. Yet too little is being done to reduce the burden on patients and build a system that truly works around patients and communities.
As several recent reports have made clear (see links at end of this article), the health system needs reform to manage the conditions that now dominate disease burden, support an increasingly burnt-out workforce, and contain mounting pressure on the health budget.
System-wide reform and sustained political commitment are essential to ensure high-quality healthcare is delivered fairly and sustainably.
The Federal Government has recently shown strong commitment to improving access, with a focus on increasing general practice bulk-billing as well as recent budget investments in Medicare Urgent Care Clinics and additional hospital funding.
These measures strengthen the front door of the system, but they do not drive the team-based collaboration needed to meet the complex healthcare needs many patients face today. Instead, Australia continues to rely on an unsustainable service model that tries to meet modern-day health needs with a last-century system design.
What has been missing, until now, is a clear and practical path forward. A national roundtable held at The George Institute for Global Health brought together frontline clinicians, policymakers, consumers and researchers to confront a question the sector has been circling for years: if team-based care works, why is it not already standard practice?
The answer is not a lack of ambition. Participants – drawn from pioneering practices, including Aboriginal Community Controlled Health Organisations that have operated genuine multidisciplinary models for decades – agreed that the capability to deliver modern, team-based care already exists within the system.
What is missing is the architecture to support it.
The current fee-for-service model pays for individual GP consultations. It does not reward care coordination, preventive care or the work of a nurse managing a patient’s diabetes between visits. It does not fund the team meetings where complex cases are reviewed.
In practice, it works against the organised, proactive shared care that would ease pressure on GPs and deliver better outcomes for patients with chronic and complex conditions.
Nor does it create a system that rewards models of care that are genuinely GP-led, rather than GP-dependent, reducing fragmentation and enabling more effective team-based care.
Five ways forward
A new national report, ‘Progress by Design: Change Readiness and Breakthrough Innovation in Primary Care’, draws on the roundtable discussions to identify five practical enablers for reform that must be advanced simultaneously across primary care practices, regional organisations and government.
1. Adapt to a sustainable investment approach
Funding reform is the foundation. The Federal Government’s exploration of blended funding models is welcome, but the transition needs a clear roadmap: one that sets out how blended funding will operate, who can opt in, and how outcomes will be monitored. Without that certainty, practices that are ready to change cannot make informed decisions, and early momentum will stall.
2. Rework and integrate clinical governance
Clinical governance must be redesigned to reflect the reality of multidisciplinary care. The existing GP-centric contractor model concentrates risk on doctors and constrains delegation, limiting the ability of nurses, pharmacists and allied health practitioners to work to their full scope. National guidance on shared accountability structures, delegation frameworks and risk-sharing models is urgently needed.
3. Build digital and data infrastructure and quality improvement capability
Digital and data infrastructure remains a major gap. Effective team-based care depends on shared patient records, population-level data capability and interoperable systems. Many practices still lack the tools or workforce capability to use and share data with confidence. Investment in a national primary care digital backbone is not optional; it is a precondition for everything else.
4. Formalise support for change management in primary care
Change management support has been the missing ingredient in previous reform efforts. Practices have repeatedly been expected to deliver major transformation without the time, resourcing or implementation support required. The report calls for a national change management program that funds leadership roles, supports workflow redesign and builds genuine communities of practice across the sector.
5. Promote structural and cultural change towards a sustainable and integrated workforce
Workforce and cultural change may be the hardest and slowest of the five enablers, but it is also among the most consequential.
Call to action
Moving from GP-dependent to GP-led care requires not only structural reform, but also a genuine shift in how teams are built, how roles are defined, and how responsibility is shared. Regional organisations have a critical role to play as integrators, brokering workforce arrangements and commissioning multidisciplinary services that individual practices cannot sustain on their own.
The Federal Government has signalled a genuine commitment to system reform, and the political window is open.
What the sector needs now is an implementation plan and continued commitment that matches the ambition of that vision. The expertise, the evidence and the early adopters already exist. The task now is to build the system architecture that enables them to lead.
Relevant reports
- Australia’s Primary Health Care 10-year Plan 2022-2032
- Strengthening Medicare Taskforce Report (2022)
- RACGP Health of a Nation 2025
- The Review of General Practice Incentives 2024.
Author details
Dr Tristan Bouckley, Senior advisor and research fellow at The George Institute for Global Health, is a health system reform and evaluation specialist. He is a research fellow and senior advisor at the George Institute for Global Health and also currently working as a senior epidemiologist at the NSW Ministry of Health. He is involved in various health system reform development projects and evaluations across Australia, and brings a particular focus to embedding and operationalising health equity throughout the reform process. Formerly, he was a senior policy advisor within the Victorian Department of Health.
Tracey Johnson, CEO of Inala Primary Care, has a diverse background spanning banking, market research, tertiary education, business consultancy and development. All of these experiences came together when working with firms commercialising medical devices and healthcare solutions. Since then Johnson has pushed healthcare frontiers by creating the Office of Health and Medical Research within Queensland Health and directing the Queensland Government’s investment attraction strategy for global healthcare businesses. Her on-the-ground healthcare delivery experience includes establishing an integrated women’s healthcare centre and a decade ago becoming CEO of Inala Primary Care Ltd.
Professor Stephen Jan, Program Director Health Systems Science at The George Institute for Global Health, is Conjoint Professor of Health Economics at the University of New South Wales, and Professor of Health Systems at Imperial College London. He holds Adjunct Professorships at City University of Hong Kong and Walter Sisulu University in South Africa and is a Fellow of the Australian Academy of Health and Medical Sciences. His areas of expertise are health systems, economic evaluation, health financing, choice experiments and health sector priority setting.
See Croakey’s archive of articles on primary healthcare
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