Family Medicine is making great strides in Gauteng Province as new district-based Departments of Family Medicine/Primary Health Care are being set up to provide clinical leadership in the District Health Services (DHS) in this urban powerhouse in South Africa. The author has been centrally involved in this and tries to reconcile what appears a contradiction: that the dynamics in the DHS (and the future direction of the DFMs) appear to detract from community-orientation. This article explores the challenges of developing a COPC approach by Family Physicians in Gauteng District Health System (DHS). The Karks offer some practical approaches.