For thousands of vulnerable people like ‘Alice’, whose GP is her only lifeline, the closures aren’t an inconvenience – they’re a matter of survival.
A month has passed since Melbourne non-profit community health service Cohealth announced it was scaling back GP and counselling services because they were financially unsustainable.
On Thursday it announced the GP services would be safe until the end of July next year thanks to a rescue package led by a $1.5 million lifeline from the federal government.
Cohealth has confirmed it is also making a “contribution” to the rescue package although has not revealed how much.
Federal health minister Mark Butler also announced that both the federal and state governments would commission an “independent review of Cohealth’s general practice service model, governance and finances” – a move welcomed by Cohealth and peak bodies.
Further details of this review are expected to be announced in the coming week.
Much has been said in public, in the media, in the Cohealth boardroom and clinics, in state and federal government meeting rooms and by peak bodies like the RACGP, the AMA Victoria, the Australian Nursing and Midwifery Federation and the Doctors Reform Society.
Cohealth has maintained that a mix of state and federal funding pressures has made the services financially unsustainable, and has circulated a community toolkit outlining the key issues and encouraging local advocacy.
While the GP services are safe for now, Cohealth is proceeding with the closure of counselling services next month, which was part of the original announcement. The closure of these services relates to changes in how the available funding can be claimed. The Collingwood pharmacy service will also close at this time, and in 2026 the Collingwood clinic, which provides other services, will close altogether.
The sentiment around the GP services in particular was pretty overwhelming – they must be saved. For the patients – many of them the most marginalised and disadvantaged people in the area – Cohealth is their lifeline.
It’s as simple as that.
Mental illness, homelessness, serious social disadvantage, addiction, chronic illness, trauma, refugee health, substance dependence and poverty are hard enough on their own, but these patients more often than not have multiple comorbidities.
So, while bureaucrats and boards work out what the future may or may not hold, in the homes of the 12,500 people (if they are lucky enough to have a home) who will be affected by the closures, they are thinking about what this means for them.
Among those is Alice (not her real name), who first reached out to The Medical Republic about a week after the news first broke.
In a late-night call the woman, whose complex health needs are considerable, including a history of decades of homelessness, C-PTSD, heart disease, type 1 diabetes, stage three cancer without the status of remission and physical disability, spoke of her devastation.
Alice’s GP is her connection to the world. She has no friends, no family – in fact her GP is listed as her emergency contact.
“I see my GP every four weeks without fail,” she told me. “My GP knows if I don’t turn up it means I’m dead. I know I’m not an ‘easy’ patient to have. I’m a traumatised person who doesn’t trust most people.
“I trust my GP more than anyone I’ve known in my life. That trust took years to build.”
This brave, self-educated and eloquent woman told me that losing her GP, would cost her her life.
“The closure of Cohealth means I can die two ways,” she said.
“I can suffer for a short while then die or just take my own life and not drag out the suffering.
“I’m not going to be able to find another bulk-billing GP who’s going to take on me with so many complex support needs.”
That was three weeks ago. I spoke to Alice again this week to see if her resolve has changed.
“No, nothing has changed,” she says.
“I still feel the same way. I will still end my life if that is the only option.”
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However, blinding anger joined the abject distress Alice feels about Cohealth’s decision – rage that the organisation found itself in such dire financial straits, and anger at the governments for not holding the board and administration more accountable for the state funds Cohealth is given to manage.
She also has anger on behalf of the other patients who will suffer deeply and the doctors who are powerless to change the decision.
“All these doctors do their job in this area, not because they’re salaried, because they’re passionate about what they do,” Alice says.
“They care enough to take the time, to spend the time to get to know who they’re working with. They are hurting too.
“I mean, it’s not all about just the patients.
“I think they’ve forgotten that these doctors are human beings, first and foremost. They have their own lives, and they have to struggle with the knowledge that many of their patients will fall through the cracks. Some won’t survive.”
Alice has returned to the clinic she attends for her second-last appointment before her services are due to cease. She was disappointed to see there was nothing in the clinic to help patients understand their options when Cohealth could no longer help them.
“There was someone sitting at a trestle table, with a face mask on, who was actively asking people to sign a petition to government asking for more funding,” Alice says.
“Where was the trestle table for people to get information about other services?
“And then I heard someone say that if they couldn’t see a doctor, they should go to the nearest [hospital] ED or call the nurse on-call helpline.
“The government’s going to be so p***ed off to know we’ve been told to do that.”
As Alice rightly observes, ED visits will cost far more, not to mention the role primary care plays in keeping people out of hospital. Then there are the people, like herself, who just won’t go.
“I hate hospitals. I just won’t go. And there are many who will feel the same,” she says.
“How is an ED going to help people with their prescriptions, especially pain medication? How will it help with their mental healthcare or addiction care?”
The big fear Alice has is that the Cohealth situation is nothing more than a political football, designed to hold the government to ransom for more funds.
“A lot of people, including some of the staff I have spoken to, are angry with the [Cohealth] board,” she says.
“They want to know why the GP services are unsustainable, especially when they’re opening a new place down in Tasmania. Where is the accountability?”
Alice isn’t the only one asking questions.
As reported by HSD last week, debate over who is responsible, and who should fix the mess, has escalated sharply in recent weeks.
A series of packed community meetings in Kensington and Fitzroy have made it clear that local anger is deep and growing.
Adjunct Associate Professor Dr Stephen Alomes from RMIT was on the board at the former Kensington Health Centre, then the Doutta Galla CHS which led into Cohealth.
In his opinion, Cohealth talks the talk, but its actions are in direct contrast. He reported that a motion of no confidence in the board was raised and carried unanimously at the Kensington meeting.
“Community health should be based on voluntary dedication and community action, co-health has thrown that all away,” he told HSD last week.
He said instead of reviewing the services, Cohealth has responded with more PR asking for money.
“Cohealth could do the right thing – rescind the closures, work with the Health Department on a review of the services, especially given the new financially positive bulk-billing Medicare rebates which began from 1 November,” he said.
In a statement, a Cohealth spokesperson said the board and organisation was “committed to ensuring a strong and sustainable community health service that delivers vital care across more than 30 sites and 50 services, and supports the health of communities, particularly the most vulnerable people, across Victoria and Tasmania”.
“The board takes its fiscal and governance responsibilities seriously,” they said.
“The closure of GP services at Collingwood, Fitzroy and Kensington reflects ongoing challenges to meet the complex needs of our clients, many of whom live with chronic illness, trauma, homelessness or family violence.
“While the closures are deeply regrettable, they reflect long-term structural challenges in the funding and infrastructure that underpin community health and are necessary to ensure that resources are managed responsibly to maintain the long-term sustainability of all of Cohealth’s services.”
For Alice, she wants to see more of a care factor from Cohealth.
“When I am in there, no one is asking if I am okay, do I need anything,” she says.
“I feel we are being used as pawns. We’re already broken people, how much more can we take? We are human beings. This is not just anger, it’s despair.
“The board has to go. They don’t deserve to run a service like this. These people deserve better. The government needs to act.”
