Community health centre closures must be stopped
Community members and workers across the health and community sectors have been reeling over the last fortnight following the sudden news that some of the longest running community health centres in the country are closing their doors.
The decision by Cohealth to close its general practice services in the Melbourne suburbs of Collingwood, Fitzroy and Kensington by the end of 2025, and to shut the Collingwood site entirely by mid-2026, will leave around 12,500 people without a GP. The closure will also cut off pharmacy services, including opioid replacement programs, as well as nursing, counselling and allied health care.
Thousands of people depend on these clinics for their everyday health and survival, including some of the most vulnerable in the community: refugees, newly arrived migrants, people experiencing homelessness, those living with disabilities, and patients managing complex chronic illnesses.
Staff at Cohealth received notification of the closures via email on the same day the public announcement was made. There was no warning, no consultation and no plan to ensure continuity of care. For the communities affected, this is not just a policy change: it is a devastating loss of a vital lifeline.
Having spent eight years working as a doctor in public hospitals before moving to general practice and community health, I thought I understood what strain looked like in our system. I have sat through ward meetings where doctors debated who was “least sick” and could be discharged to make room for new patients who had been waiting in the emergency department for days. I have seen people essentially bedbound for months waiting for “non-urgent” elective surgeries.
But the crisis in general practice is different—quieter, more personal, and in many ways more insidious. I’ve had patients tell me not to bother taking their blood pressure because they know it will be high, but that the ensuing discussion will mean their appointment will run over the standard consultation time and they can’t afford the extra fee. I’ve had women ask whether a follow-up appointment after a medical termination of pregnancy is really necessary, because the cost of the medication already means they’ll be short on food for the week.
These are the realities of general practice. Medicare’s promise of universal care has become increasingly hollow. A recent report from the Royal Australian College of General Practitioners found that only 12 percent of GPs now bulk bill all their patients, while 40 percent bulk bill few or none. Even in Victoria, one of the better performing states, the bulk-billing rate for non-concession card holders is an abysmal 19 percent.
It is no surprise, then, that 9 percent of Australians delayed or skipped seeing a GP because of cost in 2023–24, up from 7 percent the year before. But those figures don’t fully capture the damage. Preventive care—the invisible work of managing risk factors and detecting illness early—is what keeps people well, and reduces overall disease burden. The positive effects of this sort of care are hard to measure—the absence of disease where it might have otherwise occurred—and long term, which is also hard to quantify and politically less rewarding for governments. When people delay seeing a GP because of cost, prevention disappears from the picture.
The Australian government’s own Department of Health and Aged Care admits that every dollar invested in preventive health saves an estimated $14.30 in future healthcare and social costs. Yet Medicare rebates have stagnated for years, pushing more and more clinics to pass costs onto patients, while those who can’t pay fall through the cracks.
For a time, community health centres held the line. We were able to offer bulk-billed services, integrated care and enough time to address the complex needs of patients in crisis. But now even that last line of defence is being dismantled.
In addition to the Cohealth closures, the Age reports that two more community health centres are on the brink of closure. Many more of the surrounding clinics have closed their books to new patients because they are already at capacity, with wait times of two to three weeks for an appointment.
Part of the problem lies in the fragmented way our healthcare system is funded. The federal government funds general practice through Medicare, while public hospitals are jointly funded by federal and state governments. This creates absurd incentives. When the federal government keeps Medicare rebates low to save money, the result is more people ending up in hospital—which costs the states (and taxpayers) far more. A non-urgent emergency department visit costs over $500, compared to $42 for a GP consultation. Yet Canberra continues to starve general practice funding, leaving states to mop up the fallout.
The rollout of Urgent Care Centres is the latest example of patchwork policy masquerading as reform. These centres provide episodic, walk-in treatment for minor emergencies. They relieve some of the pressure on hospitals—but at five times the cost of a GP visit. They don’t support preventative health, continuity of care, or long-term management of chronic disease. And they further fragment and complicate the health system.
Meanwhile, the federal government has trumpeted its new Bulk-Billing Practice Incentive Program, which began on 1 November. It offers a 12.5 percent incentive payment to clinics that bulk bill all eligible patients for certain services. On paper, it looks like progress. In practice, it’s a drop in the ocean.
The flat 12.5 percent incentive does not scale with consultation complexity or length, incentivising short, frequent consults and penalising clinics that care for complex patients. Many community health services also rely on a mix of bulk-billing and small private fees from those who can afford to pay. These organisations may opt out of the program to preserve this income, as the incentive payment may not offset the loss from private billings.
The government claims these changes will increase the number of fully bulk-billing practices to around 4,800 by 2029, with 90 percent of visits bulk billed by 2030. However, an analysis conducted by the healthcare accessibility organisation Cleanbill suggests that the real number of new fully bulk-billing clinics is likely to be closer to 740. So far, according to the government’s own figures, only 622 of the 4720 metropolitan practices have expressed interest in changing from mixed billing to the new bulk-billing system, despite months of government campaigning.
The deep sense of anger and betrayal from the communities of Fitzroy, Collingwood and Kensington has been palpable. Hundreds have flooded mass meetings to voice their outrage, directed at the Labor government and the Cohealth board in equal measure. The people here have a strong memory of what community-controlled healthcare once meant.
North Yarra Community Health, one of the precursors to Cohealth, was run by a board elected by the community: bi-monthly community meetings were attended by hundreds and interpreted into ten languages. Annual general meetings were held in tents, not boardrooms.
When North Yarra merged with Western Region Health and Doutta Galla to become Cohealth, that democratic model was dismantled. The board became incorporated, community membership was abolished, and decision-making drifted away from those it affected most. The current crisis is a direct outcome of that shift. Today, unelected board members can decide to close clinics, terminate staff and sell off community assets without answering to the people affected.
This fight is about more than one organisation. Australia’s public health system is at breaking point. Hospitals are overflowing, ambulance ramping has become routine, and exhausted healthcare workers are being pushed to their limit. Every year brings new promises of reform, yet the underlying issues—underfunding, privatisation, and the widening gap between rich and poor—remain untouched.
If governments are serious about fixing the system, they must start with the basics: guaranteeing access to healthcare for all, fully funding preventive and community health services and returning control of those services to the people they serve. We must end the profiteering that treats health care as a commodity and rebuild a universal public health system—one in which healthcare is free, accessible and guaranteed as a human right for every person.
On Saturday 8 November, community members and healthcare workers will rally outside the office of federal Labor MP Sarah Witty to demand just that—immediate intervention by the Victorian and federal governments to stop the Cohealth closures with no interruption to services, as well as a commitment to a public, fully-funded community health system—free, universal and democratically controlled by the communities it serves.
