Increasing demands on publicly funded healthcare systems have led to calls for reform and improved performance especially in primary healthcare, where early detection and treatment of disease along with the promotion of healthy lifestyles, should lead to improve social and economic outcomes (WHO, 1978). In New Zealand, recent primary healthcare reforms have increased funding to private not-for-profit organisations, and consequent performance monitoring requires them to be fully and openly accountable and be responsive to their communities (Minister of Health, 2001). These requirements follow the perceived wisdom that increased community input leads to more cost-effective primary healthcare delivery. However, this exploratory study illustrates that when political accountability is transferred to semi-autonomous organisations, effective processes and relationships take time to develop. Government funders should balance their expectations against those of providers and communities, in order to build and sustain healthy relationships for a more effective health system.