From Fragmented to Connected: Northern Sydney Wellbeing Collaborative Model to Improve Care and Support Health Professionals
Sydney North Health Network
A recent Royal Australian College of General Practitioners (RACGP) survey reveals that GPs are managing increasingly complex patient cases due to longer specialist and hospital clinic waitlists, and increasing financial barriers which prevent patients from accessing private allied health or specialist care.1
An ambitious new initiative, the Northern Sydney Wellbeing Collaborative (developed by Sydney North Health Network), is set to establish a more connected, responsive, and person-centred primary care model that works for local patients and health professionals.
Dr. Margaret Byrce is a General Practitioner in Gladesville, she says, “When I started 30 years ago, chronic disease and community service needs were minimal. Today, patients live longer with more complex conditions and their expectations have shifted dramatically—they want faster, more accessible, and equitable care. Yet, the fee-for-service model limits us, paying only for time spent face-to-face, while the workload continues to grow. Collaborative care aligns perfectly with our training in preventive and patient-centred care. To meet today’s challenges, we need a cross-service, community-led health system —and GPs must be at the centre of this transformation.”
By addressing connectivity issues and the transition between local healthcare, social care, and community services, patient outcomes can be improved and a more holistic approach to healthcare realised. Through a focus on prevention and early intervention the demand on acute health services will also be reduced, which in turn will alleviate the pressure on general practices, emergency departments, and residential aged care and social services in the area.
“With the fourth highest number of residential aged care facilities in Australia by aged care planning region, and a higher percentage of people with a CALD background (29% compared to 23% in NSW), northern Sydney has its own unique demographic and specific health needs. The Northern Sydney Wellbeing Collaborative is partnering with primary care including local GPs and mental health professionals, aged care services, and social support services to develop hubs that will address local needs. Hubs will help reduce the need for patients to navigate multiple disconnected services on their own and ease the pressure on the local health system.” Says Kevin Barrow, CEO of Sydney North Health Network.
Local General Practitioners, Practice Nurses, and Allied Health professionals were invited to a webinar to find out more about this progressive long-term co-design project that brings together more than 200 contributors from health, aged and social care, as well as local businesses, community members, government, philanthropists, and academics.Through multidisciplinary and community collaboration, the Collaborative aims to establish wellbeing ‘Hubs’ in Ryde, Hornsby, and the Northern Beaches, which will inform cross-sector collaboration on important health and social challenges in key areas.
"This initiative is about building a model of healthcare that is tailored for local people and their families and concentrates on bringing care providers together with community members to create a system that is seamless, coordinated, and built around the patient’s needs, rather than bureaucracy." Continues Kevin.
The Wellbeing Collaborative will now begin co-designing local Wellbeing Hubs with local health professionals and community members, with the goal to see services rolling out across Northern Sydney in July 2026.
If you are interested in finding out more about, or joining the Northern Sydney Wellbeing Collaborative, please visit https://sydneynorthhealthnetwork.org.au/northern-sydney-wellbeing-collaborative/
1 RACGP, General Practice Health of the Nation 2024, https://www.racgp.org.au/health-of-the-nation/chapter-1-patient-interactions-and-health-trends/reasons-people-are-seeing-their-gp
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ABOUT: Sydney North Health Network www.snhn.org.au
The Northern Sydney Primary Health Network, operated by the Sydney North Health Network – a not-for-profit organisation – is one of 31 Primary Health Networks (PHNs) established by the Australian Government to increase the efficiency and effectiveness of medical services for the community. Our focus is on patients who are at risk of poor health outcomes. We work to improve the coordination of their care, so they receive the right care, in the right place, at the right time.
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