Across the the world healthcare systems are struggling with rising costs and variation in quality. At its core is a realization that it is time for a fundamentally new approach to organization of healthcare work. At present, healthcare systems continue to be hospital centric. The emerging view that dependency on hospitals to provide care to ever increasing numbers of older people and those living with chronic illness is no longer feasible. Traditional role boundaries in the future will be more fluid so care can be optimized for service users. This presents the need to develop evidence-based and innovative ways to deliver healthcare at the lowest point of acuity.