Access to public metabolic and bariatric surgery in Australia remains poor. Proposed fixes include more funding for existing medically led services, subsidised GLP-1 therapy, and centralising care through metropolitan hubs and telehealth. We argue each misses the real problem: the model of care. The Wagga Wagga MOS Clinic, NSW’s most productive public bariatric surgical unit, is built around a single purpose: getting suitable patients to surgery. A multidisciplinary team prepares them as quickly and safely as possible, through dietary and habit change and psychological preparation. Medical optimisation, including GLP-1 therapy, is used where it makes surgery safer, not as an end in itself. Two specialist bariatric surgeons operate locally on dedicated lists that are protected from cancellation by urgent non-bariatric cases, with same-day discharge where appropriate. The patient’s GP stays involved at every step, and we provide two years of postoperative care before a comprehensive handover back to primary care. Deliberately narrower entry criteria prioritise low-acuity, high-value care and keep waiting times short. This talk challenges prevailing assumptions about who should lead obesity services, how much workup is really needed, and who should go first. We propose a reproducible model for every health district.