Dr Kizzy Gandy
The central question is no longer how to provide more care. It is how to organise care differently.
Australia built its health system around hospitals, specialists and episodic care. Yet the challenges driving demand today are increasingly chronic, complex and social. Loneliness, housing insecurity, disability, mental illness and workforce shortages cannot be solved through more specialist appointments alone. At the same time, governments are confronting a GP access crisis, growing waiting lists and rising out-of-pocket costs. The question is no longer how to provide more care. It is how to organise care differently.
The next decade will see a shift towards nursing-led models, multidisciplinary teams, social prescribing and stronger integration between health, disability, aged care and community services. NDIS reforms are accelerating this trend by forcing governments and providers to reconsider where responsibility sits and how services connect around people’s needs rather than organisational boundaries. The real challenge will not be designing potential new models. It will be generating the evidence needed to determine which approaches improve outcomes, reduce inequities, remain financially sustainable, and get backing from stakeholders.
Governments do not need more pilot projects that end without an understanding of the implementation trade-offs. They need confidence about what will happen if successful pilots are scaled across the system. The future of health reform belongs to those who can answer a simple question before billions of dollars and political capital are committed: what works, for whom, at what cost, in which contexts, and what are the system-wide consequences? This is where organisations like the Sax Institute – with the unique ability to connect evidence, real-world data and systems thinking – have an important role to play.
Four things we already know from Sax work
Alternative workforce models can restore access when the traditional GP model fails
Finding: In Western NSW, four towns (whose names all start with T) had lost local GP clinics. Sax evaluated the 4Ts single-employer model, which delivered care through local Multipurpose Service Centres. The evaluation drew on clinical and billing records, hospital and emergency department data, patient and staff surveys, interviews and financial analysis. It found improved access to bulk-billed GP care, fewer non-urgent hospital presentations and a substantial improvement in the model’s financial position compared with the previous year.
What this means for the next phase of health reform: The answer to the GP crisis is not simply more of the existing model. Redesigning employment, service settings and workforce roles can protect access while reducing avoidable pressure elsewhere in the system.
Truly integrated health and social care depends on changed relationships, behaviours and accountability across organisations
Finding: Sax’s evaluation of the Supporting Primary Care Pilot for family, domestic and sexual violence examined more than 8,500 interactions across primary care, community and specialist services. The pilot trained more than 3,700 primary care staff and generated more than 1,500 referrals to specialist services. Importantly, the evaluation identified a whole-of-practice cultural shift towards shared responsibility for recognising and responding to violence – an outcome that a single-service analysis would have missed. The Sax Institute has evaluated the Pilot since 2022, and findings have supported its expansion from six to 11 PHN regions across Australia.
What this means for the next phase of health reform: Integrated health and social care depends on changed relationships, behaviours and accountability across organisations. It cannot be achieved by adding another referral pathway to an otherwise unchanged system.
Workforce planning must account for the forces changing both labour supply and service demand
Finding: For the NSW Ministry of Health, Sax synthesised 100 papers on climate-related impacts on workforce supply and wellbeing, plus 13 further sources on changing demand for care. The work examined the issue from both sides of the equation: whether workers will be available and able to work, and how climate change will alter the volume and pattern of services communities need. The Ministry is using the findings to plan for changes to both workforce supply and demand.
What this means for the next phase of health reform: Workforce shortages cannot be solved through recruitment targets alone. Governments need models that connect workforce availability, population need, service design and external shocks, then test how changing one part affects the rest.
Successful scaling depends on local relationships, trust and power, not just a replicable program design
Finding: Sax’s work for the NSW Ministry of Health examined how collaborative care and place-based planning could be expanded in rural NSW. It identified four enabling conditions: community stakes and interests; trust and time; power and influence; and knowledge and expertise. The work concluded that the Regional Health Division should act as a facilitator, either establishing new collaborations or supporting existing ones, with its level of involvement changing over the life of each collaboration.
What this means for the next phase of health reform: Social prescribing and integrated care cannot be scaled as standardised products. They require an organising model that preserves local ownership while providing the infrastructure, evidence and support needed for coordinated action.
What this means for funders
| Named funder / buyer | Immediate challenge |
|---|---|
| Commonwealth Department of Health, Disability and Ageing | Redesign primary care, specialist access, and the interfaces between health, disability and aged care. |
| State health departments | Manage demand through new models of care rather than expanding hospital capacity alone. |
| Primary Health Networks | Strengthen community-based responses to chronic disease, mental health and prevention. |
| Aged care and disability providers | Maintain quality and sustainability in a constrained workforce environment. |
The common thread: each funder needs better evidence about how systems behave, how workforces can be redesigned, and how services can be integrated around people’s needs. These are precisely the questions Sax is already helping answer.
Sax’s unique value proposition
Most organisations help clients understand a program. Sax helps clients understand a system.
By combining evidence synthesis, evaluation, implementation science, economic analysis and systems modelling, Sax helps governments and providers test new models before scaling, understand cross-sector effects, design sustainable workforces, assess intended outcomes and anticipate unintended consequences.
