Local councils call for ‘GP guarantee’

A coalition of rural councils has banded together to call for a $200 million ‘GP guarantee’ in a bid to ensure all residents have access to healthcare.
 
Local Government NSW (LGNSW) launched its six-point action plan on Thursday, as communities in rural, regional and remote regions face a ‘crisis in the provision of essential healthcare services’.
 
Its plan for a GP guarantee calls for support for recruitment in ‘hard-to-fill locations’, and for consistent access to primary care in under-serviced communities.

‘In a country as wealthy as ours, it is unacceptable that in parts of rural, regional and remote NSW accessing a GP is nearly impossible,’ the plan says.
 
The report also highlights the extent to which rural councils are redirecting ratepayers’ money into healthcare amid a significant shortfall in government spending.
 
In response, LGNSW is calling for a $20 million program to alleviate the financial pressure health services place on councils.
 
LGNSW President Darcy Byrne said ‘for too long, councils have been bridging the gaps in access to appropriate healthcare for their communities’.
 
In NSW this has resulted in more than 20% of regional and rural councils having to dip into their finances to fund health services, ‘where state and federal governments are neglecting their obligation’.
 
This includes subsidising running costs of medical facilities, providing health infrastructure and supporting workforce housing.
 
RACGP Rural Chair Associate Professor Michael Clements said the growing role of councils in this space is indicative of the ‘systemic failure of Medicare alone to be able to fund and operate many rural and remote health services’.
 
‘Medicare is a very blunt tool to try and cover everywhere from Brisbane to Bourke. In and of itself, it’s not able to do that, and to be fair to the Federal Government, they recognise that,’ he told newsGP.
 
‘What’s universal is that they all recognise there needs to be access to other funds, other than Medicare alone, to be able to make general practice viable.’
 
In one NSW example, the Bogan Shire Council took on the responsibility of funding and operating the area’s only medical centre nine years ago, after facing the risk of losing local primary care services.
 
The practice has 3400 active patients – well above the local population of about 2400.
 
But despite being well managed and operational costs kept low, ‘annual expenditure increasingly outweighs income from patient fees, meaning the practice is considerably subsidised by over $600,000 per year from council’s other revenue including property rates’.
 
The largest expense is securing locum doctors, including housing, vehicles and travel.

‘While councils are not responsible for funding health services, they have little choice if they want to ensure their communities can access critical care,’ LGNSW said.
 
‘Often, these are the smallest and most remote councils, least able to afford these additional costs. Yet without council intervention, communities would go without basic health services.’
 
Without adequate reimbursement, NSW councils warned, funds ‘desperately needed’ for libraries, roads, playgrounds and sports fields will continue to be diverted to medical services that are the responsibility of the State and Federal Governments.
 
Associate Professor Clements encourages councils to consider becoming involved in supporting practices, as ‘local councils are the best people to help guide local services’, and there are some examples around the country where it was working very well.
 
‘The idea that all medical services can be funded and controlled from Canberra isn’t fair, or right, and so it doesn’t surprise me at all that local councils do need to step in,’ he said.
 
The WA experience
At a recent Senate Committee hearing into rural, regional and remote Medicare access and funding held in Kununurra, WA, Ms Kerida Hodge from health workforce agency Rural Health West said more councils are stepping in to support GP services for their communities.
 
‘Back in 2021–22, around 48 local governments contributed around $7.8 million towards GP services. That had grown in 2024–25 to $9.5 million,’ said Ms Hodge, who is General Manager of Communications and Business Analytics.
 
‘And 90% of that funding is coming from local governments with quite small populations of under 5000 people, in those inland regions like the wheatbelt region of WA.’
 
She explained that local government support is delivered in a wide range of ways.
 
‘Sometimes it’s housing and premises, but a significant chunk of that is also in direct financial incentives and income guarantees, and the local governments are doing this because they understand how critical a GP is to the liveability of their community,’ Ms Hodge said.
 
‘And while this is really noble, the local government intervention distorts the market signals and masks the unsuitability of Medicare in these communities. GP services continue to operate, but only because they’re being subsidised outside of the Medicare system.’
 
The underlying problem is that the Medicare model isn’t necessarily fit for rural practice, Ms Hodge told the committee, as it was designed around patient volume and economies of scale, ‘and those conditions just often don’t appear or exist in rural communities’.
 
‘In smaller towns, patient numbers are lower, consultations are often longer and more complex, and through a lot of communities, particularly in the inland regions, communities are served by a solo GP who’s responsible for covering the full cost of running a practice,’ she said.
 
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