Every Australian deserves access to high-quality, affordable primary health care – no matter where they live. I do not subscribe to the view of some that if one chooses to live rurally, they should accept poorer access to primary care. Not only does primary care inequity offend my personal values, I just also think it’s dumb wearing my health economics hat, as it leads to higher treatment and transportation costs and lower economic productivity. It’s this economic productivity that pays for public services.

 Yet across rural and remote Australia, access to primary care is diminishing. Over the past five years, we’ve seen the closure of private general practices in towns as large as Longreach. These “failed primary care markets” have left too many communities without local access to specialist primary care.

At Larter Consulting, we’ve been proud to work with organisations as diverse as the Royal Flying Doctors Service, rural workforce agencies, Primary Health Networks, Aboriginal Community Controlled Health Services, and Community Health Services that have received government funding to enhance care access. These grants bring together local stakeholders – health professionals, councils, community leaders, and consumers – to design new service models for towns that have lost access to primary care altogether. As you would expect, where it works well is where it’s community-led problem-solving, not one-size-fits-all programmatic solutions.

Perspective 1: Balancing Public and Community-Controlled Care

In many rural communities, large public health services vitally provide the majority of community and primary care services. However, our work has shown that such arrangements can sometimes crowd out the efforts and priorities of smaller, locally embedded organisations – including Aboriginal Community Controlled Health Organisations (ACCHOs) and small private general practices.

Larter has proudly supported partnerships that recognise the strength of community control, cultural safety, and shared responsibility. We have helped broker referral and treatment pathways grounded in the principle of “no wrong door”—where every service acts as an entry point to care. Joint, community-based health promotion and social marketing have amplified these efforts, helping people understand how and where to seek care.

Perspective 2: Rethinking Scope of Practice in Rural Health

Rural communities have long been experts at “making do” with the resources they have. But as the Scope of Practice Review, led by Professor Mark Cormack, makes clear, structural barriers are holding them back. The review identifies that maldistribution of the health workforce and restrictive regulations are major contributors to rural health inequities. Importantly, Recommendation 18 calls for reforms to be implemented first in rural and remote communities – a recognition that reform here is not optional but urgent.

Key recommendations that Larter supports include:

• Empowering nurses and nurse practitioners to manage chronic conditions, prescribe medications, and order diagnostic tests, working alongside other providers and with appropriate MBS remuneration, including through telehealth.

• Expanding pharmacists’ roles in managing chronic conditions and treating simple, acute illnesses – improving access while freeing up GP appointments.

• Growing the rural generalist medical workforce, enabling GPs to work to their full scope of practice.

• Allowing allied health professionals – such as physiotherapists, podiatrists, and psychologists – to accept referrals from a wider range of practitioners, and in some cases, initiate rebateable care directly.

These reforms recognise that rural health care requires flexibility, collaboration, and trust in multidisciplinary expertise.

Perspective 3: Funding Reform – From Piecemeal to Universal

None of this will work without funding reform. Medicare’s fee-for-service model, while effective in urban settings, fails to sustain primary care in rural areas. Patient volumes are lower, travel times are longer, and the complexity of care is greater. Over the years, models like Multi-Purpose Services, Section 19(2) exemptions, and rural loadings have helped—but the situation has now reached a tipping point.

Larter supports blended or block funding approaches that enable stable, team-based care. This would allow rural clinics to employ diverse health professionals – nurses, diabetes educators, mental health workers – and focus on community health priorities, not just billable appointments. Predictable funding means clinics can stay open, teams can stay together, and communities can thrive.

This would of course bring new challenges. How can we train (or attract) the workforce needed to work rurally? How can we avoid cherry-picking patients or the creation of significant wait lists, since there is less incentive for throughput? How can we measure and reward “outcomes” when some patients’ care needs are incredibly complex and sometimes rooted in deep trauma?

While the Commonwealth’s focus on bulk-billing incentives is welcome, it must not delay deeper reform. We must create a funding environment that rewards prevention, teamwork, and long-term outcomes – not just activity.

Conclusion

Rural and remote Australians are resilient, resourceful, and innovative. They deserve a health system that matches their ingenuity. By combining community-led planning, expanded professional scopes, and modernised funding, we can finally close the access gap and ensure that every Australian – wherever they live – has the opportunity to stay well and out of hospital.

At Larter, we remain committed to partnering with governments, PHNs, and communities to make that happen. If you’re keen for a discussion or collaboration, contact us.