Abstract: An ageing population and increasing demands and costs for acute health care have placed health reform on the agenda. The rising burden on the health system resulting from largely preventable chronic disease is changing the focus from acute care to multidisciplinary team-based primary health care. Access to such primary health care is difficult in rural and remote areas. Much of the responsibility for the delivery of services is placed on local organisations, including state funded health facilities. These organisations are often reliant on centrally distributed funding. However, health policies created centrally in capital cities or Canberra, with uniform guidelines for allocation of funds have variable implementation and impact in different geographic regions. The North and West Queensland Primary Health Care Association is one such organisational group. A Masters by Research study being conducted at the University of Tasmania is examining the role of visionary leadership, an organisation’s culture and commitment to community and consumers in the provision of primary health care services. The study seeks to generate in-depth understanding about the drivers for a Division of General Practice, an organisation set up to support GPs, has become a major provider of allied health services in its region. Through a document review and participant interviews characteristics which have enabled this organisation to become a leader in the delivery of primary health care services have been identified. These findings will inform the development of a model for health service organisations with potential for national rollout. The case study is used to present examples of visionary leadership and organisational culture that led to major organisational development for the Division in keeping with its vision to deliver primary health care excellence. Evidence is provided of a governance structure used by the organisation that enables management by place. Place management allows for local level regional variation in the delivery of programs, a consultative and research framework that positions the community and consumer centrally and a goal to fill gaps in health services. The structure has resulted in the organisation becoming a major allied health service provider in its region. The research findings show that the organisation’s activity and function is driven through an understanding of rural and remote context and in meeting community needs. The research findings are applicable for individuals and organisations delivering primary health care services, irrespective of their particular employment characteristics. There is particular relevance for those outside metropolitan regions, where an understanding of rural and remote context as it impacts on an organisation’s ability to deliver services across its population base is essential for successful outcomes. It has implications for policy makers and funders of health services in determining allocation of funding and the implementation of health policy to provide a positive impact on health outcomes, particularly in rural and remote communities.