Escalating health care costs worldwide, due in part to a domination of the health industry by large institutions and powerful medical and pharmaceutical interests, have forced a reappraisal of health care delivery methods. Shifts in political ideology and health policy affect not only citizens but those who are responsible for the delivery of health care. This chapter centres on reforms to community health and the impact of growing medicalisation on the preventive focus of primary health care. It reviews shifts in community health generally and draws on a case study of experienced generalist community nurses, who provide a wide range of services throughout metropolitan, regional and rural Victoria. The chapter then examines the effect of economic rationalist ideology and managerialist strategies on the ability of the community health sector and nurses in particular, to deliver services that are appropriate to the needs of the community and that incorporate the principles of primary health care health promotion and illness prevention.