Searching for Utopia: emerging models for primary care in 21st century Australia

Background Medicare, Australia's universal healthcare coverage system, has been described as unfit for modern purposes. Its predominantly fee-for-service payment model penalises longer, more complex consultations, and does not adequately remunerate non-physician healthcare workers. To address issues of access for marginalised groups, the Community Health Program was introduced by the Whitlam government in 1973. After federal funding was withdrawn, Victoria remained the only state to continue generalist, non-government, community health centres. Notwithstanding the success of the community health model in Victoria, primary care nationally predominantly occurs in private general practices with no programmatic funding from state governments. The federal government has recently brought to the table a swathe of proposals to modernise Medicare to make it accessible for society's most vulnerable, regardless of whether they receive their care in a community health centre or not. Methods This paper presents a case study of a private, not-for-profit primary care centre. The clinic aims to replicate elements of the community health model within the private sector. The case study will examine interventions implemented by the clinic to provide primary care for groups living in vulnerable circumstances. Results The case study demonstrates innovations usually seen in community health centres adopted in a private primary care service such as use of navigators, improved primary-secondary care interface, purpose-driven care, task-shifting, trust-building, tailored services and community engagement. Conclusions The case study represents a unique model of care that replicates elements of community health services in a private setting. Medicare reform must support multi-disciplinary care, rebates that actually reflect the cost of providing care, adequate remuneration for non-physician healthcare professionals and address the pay disparity between primary care physicians and non-GP specialists.