Duckett review recommends sacking Cohealth board

Recommendations have finally been (officially) released. The authors don’t have a lot of confidence in Cohealth’s ability to change, however.

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After Health Services Daily broke the leaked Cohealth draft report yesterday, the final official version of the Duckett review, including recommendations, has finally been released publicly.

The final version of the report — led by health economist Professor Stephen Duckett — was provided to the Department of Health, Disability and Ageing, and the Victorian Department of Health, on 17 March 2026.

The released version has some redactions, with commercial financial details and personal information, missing from public view.

Included are 13 recommendations for Cohealth, the Commonwealth Government and the Victorian Government, as well as a recommendation that the board of the community health organisation be sacked.

The report gave the Victorian Department of Health the choice of two options:

• Option 1: Give Cohealth an opportunity to improve itself; or
• Option 2: Refresh Cohealth with new governance and potentially, new management. This is done by standing down the Board and appointing an Administrator (section 57A of the Act) in its stead.

“It will be a matter of judgement,” the report stated, and should be based on what was best for the long-term interest of Cohealth’s clients and Victorians. 

“Option 1 is less disruptive, but it assumes that ‘the leopard can change its spots’: that is, that the existing governance and management teams can heed the lessons of this Review, learn, and change their modus operandi,” the report said.

“Option 2 is more disruptive. It would involve bringing in a ‘new broom’ at the top of the organisation: effectively, a new individual (or group) would assume the responsibilities of the Board,” they wrote.

The report authors noted that, so far, there had been little recognition from the Board or from Cohealth’s management that poor internal governance or management had contributed to Cohealth’s situation.

“Cohealth has acknowledged that there are lessons to be learned, both in its submission to this Review and in our discussions with the Board and management,” said Professor Duckett and his colleagues.

“But the lessons Cohealth has described as needing to be learned are the easy ones: failures around poor ‘engagement’ and ‘consultation’.

“No lesson needs to be learned, apparently, about culture, internal management, or governance.

“There seems to be no acknowledgement that there have been fundamental failures of governance, including failures as measured against the Performance Standards.

“We therefore have limited confidence that the Board of cohealth will engage with or correct the underlying issues.

“It is our view that there needs to be fundamental change in the way cohealth is governed. This goes well beyond the general practice and related services,” the report said.

Although not part of the official recommendations, the report made it clear:

“For general practice services to continue, let alone become viable, there needs to be a significant culture change involving medical staff, practice managers, and management.

“This is not a trivial exercise and will take time. Given the evidence provided, we have limited confidence the existing management can be effective in undertaking this task.

“In the end we have decided to recommend the more transformational of the two future governance options: that the Victorian Minister for Health commence the processes under section 57A of the Victorian Health Services Act to dismiss the Board of Cohealth and appoint an Administrator to take over the Board’s function,” the report said.

Other recommendations for Cohealth

The report noted a significant disconnect between the executive management of Cohealth and its medical staff, which contributed to the financial situation.

To help counter this, the report recommend Cohealth employ a sessional medically qualified Director of Primary Medical Care.

It also recommended Cohealth management co-design (with clinical staff) a single model of care for all of Cohealth’s GP clinics that would ensure practice viability in the context of the new revenue streams.

As detailed in HSD’s exclusive interview with Dr Simon Wilding, this is already underway.

The report also recommended Cohealth management set clear revenue targets for GPs that were consistent with the revenue streams and the new model of care, and could cover GP salaries, support staff, and a contribution to legitimate overheads.

“In the absence of clear performance indicators and revenue expectations, it is no wonder that vague ‘targets’ are not met, or that the clinics are in a poor financial state,” Professor Duckett and his colleagues wrote.

The report recommended Cohealth resubmit its proposal for redevelopment of the Hoddle St Collingwood site for a GP clinic with social housing above.

The reviewers noted that Cohealth has a higher rate of overheads than is typical in other community health services in Victoria.

“This contributes to the financial loss incurred by the GP clinics,” they said.

They recommended “Cohealth rigorously review levels of overheads and develop a strategy to reduce them in line with levels seen in other Victorian community health services”.

“Overheads should be allocated on a basis more clearly aligned with use.”

The final recommendation was one that will be personal for many of the community members and Cohealth patients HSD has spoken to in recent months.

“Submissions received by this Review demonstrated the very negative sentiment toward the existing Cohealth management from members of the community. Community confidence will take some time to rebuild.”

The report recommended “Cohealth formally acknowledge the trauma caused over the last few months to both the communities it serves and its staff, and (a) undertake a review of its local engagement processes with a view to rebuilding trust and reestablishing strong local links, and (b) develop new mechanisms for staff engagement.”

Other recommendations to the Victorian government

The first few recommendations are for the Victorian Minister for Health to formally provide a copy of the report to Cohealth and invite them to show cause why the minister should not form the view that the organisation is ineffectually managed and/or has failed to meet one of or more of the performance standards.

The report said that if the recommendation to appoint an Administrator was rejected, then the secretary of the Department of Health should initiate the alternative self-improvement process outlined in Section 54 of the Health Services Act.

“With clear performance targets, enforced through conditions on Victorian government funding of Cohealth, perhaps a refresh of some of the Board membership, and more detailed oversight of Cohealth’s operations,” the report suggested.

The report also recommended the government agree to allow Cohealth to pool some of its current community health funding with proposed new Commonwealth multidisciplinary team funding in primary care.

The final recommendation for the Victorian government was to reconsider the proposal by Cohealth to redevelop the Hoddle St Collingwood site which involved GP clinic facilities and new social housing.

Recommendations to the Commonwealth government

“There are MBS issues too, which will take time to negotiate, design, and implement,” said the report.

“It is now well accepted that there needs to be a different approach to funding multidisciplinary care in significantly disadvantaged communities.

“We have argued … that Cohealth’s current model of care is not financially viable partly because of current MBS funding design,” the report said.

Unfortunately, Cohealth needed help now, which was why the authors recommended the Commonwealth government extended its support to Cohealth for another two years.

In this time, a new funding basis could be introduced, with the authors recommending the Commonwealth consider Cohealth as a pilot for a new approach to funding multidisciplinary teams in primary medical services.

Specifically, the report recommended that:

• “The Commonwealth Minister for Health and Ageing provide a Health Program Grant to Cohealth under Part IV of Health Insurance Act in lieu of Medicare rebates and the full bulk-billing incentive payments.
• “The basis for the grant would be rebates calculated according to the cost to the government if services provided by Cohealth GPs were billed on Medicare. That is, services provided by Cohealth would be notified to the Commonwealth as currently, with the Health Program Grant being based on those notifications.
• “The grant would be conditional on Cohealth not charging any co-payments for medical services, and
• “appropriate accountability to North Western Melbourne PHN.”

The multidisciplinary team payment would allow a shift from a GP-led approach to an approach centred around primary care teams and community health teams, the report said.

The report also recommended that Cohealth account to North Western Melbourne PHN for how it spent the allocation including number of clients seen and outcomes achieved. It also needed to be accountable to NWMPHN for the nature of its community engagement.

The report recommended there should be a clear, independent evaluation strategy as part of the pilot of multidisciplinary teams at Cohealth.

“Cohealth should establish robust client and community engagement processes at the municipal level (Maribyrnong, Melbourne and Yarra), and proposals to NWMPHN for use of the multidisciplinary grant should be co-designed using these processes,” the recommendation stated.

The next recommendation was that the Cohealth Health Program Grant incorporate in addition a multidisciplinary team payment based on the number of Cohealth clients registered with MyMedicare.

“The basis of the payment (per patient) should have two components:

• 85% of what might have been able to be billed by allied health, psychologists or other health professionals under chronic condition and Better Access psychology items. This discount of the allied health and psychology items is to recognise that these items are rarely used to 100% of their value and that some patients may choose or require services outside Cohealth.
• An amount equivalent to the Workforce Incentive Program – Practice Stream that might otherwise have been paid to Cohealth.”

It also recommended the Department of Health, Disability and Ageing add community health services (and other not-for-profit practices) serving high need communities to the list of area of need settings that must be included in GP training.

“This recommendation could (and should) be implemented quickly,” they wrote.

Government and Cohealth responses

Cohealth welcomed today’s release of the Review and accepted all recommendations.

A spokesperson said it provided a clear pathway towards transformational reform and was an important win for the communities of Collingwood, Fitzroy and Kensington.

“The recommendations, supported as a full package, will provide a more sustainable approach to multidisciplinary healthcare for communities with high and complex needs and greater long-term certainty for the people who rely on these services every day,” the organisation’s statement said.

Cohealth was working with the Commonwealth and Victorian governments to implement the recommendations which would include a more sustainable model of care.

“Other work that is already underway includes the recruitment for a Chief Medical Advisor, redevelopment planning for the Hoddle Street Collingwood site with Government, a review of infrastructure and overhead efficiencies and strengthening community and staff engagement.”

Cohealth acknowledged the review identified areas where governance, leadership, communication and community engagement needed to be strengthened. It confirmed significant reform work was already underway, including strengthened governance arrangements, significant leadership renewal and additional oversight measures.

It also recognised that the process had been traumatic for some people, and that the changes have taken their toll on many clients, community and staff.

“We reaffirm our commitment to rebuilding trust, strengthening services and working towards a more stable and sustainable future for the communities who rely on these services,” it said.

An Australian government spokesperson told HSD:

“Since receiving the review, the Commonwealth agreed to provide up to $1.5 million to Victoria’s Cohealth community health organisation, ensuring services remain open at the Collingwood, Fitzroy and Kensington sites while Cohealth undertakes improvements to its operations.

“This means patients, families and communities currently served by Cohealth, will continue to get the care and support they need.

“The Commonwealth will consider all recommendations in the review, which identified the need for changes to Cohealth’s governance, management and service delivery models to support long-term sustainability of the general practices.

“The $1.5 million funding is time-limited and conditional for up to 12 months while Cohealth, supported by North Western Melbourne Primary Health Network, makes the necessary changes in response to the independent review.

“Changes are expected to include a strengthening of senior management and board governance, and a new integrated general practice model of care that is sustainable.”

The Victorian government did not respond to HSDs request for comment prior to deadline. Download the full Cohealth Review and Recommendations.