How to tackle ‘GP deserts’

People living in GP deserts get about 40 per cent less care than the national average, despite being sicker and dying younger.

But as every Canberran knows, it’s not just a problem for the bush. The ACT has the lowest bulk-billing rate in the country, fewer GPs per person than some remote communities, and several Canberra suburbs are GP deserts.

Back in 2010, the territory government was forced to set up nurse-led clinics. Last year, the federal government stepped in with a bespoke $24 million package to establish new bulk-billing clinics.

The ACT’s experience reflects what the data show nationally. The way the federal government pays GP clinics simply doesn’t work in GP deserts, even after a multibillion-dollar boost.

The bulk-billing incentive, which clinics get when they don’t charge a patient, was tripled in 2023, then expanded to all patients in 2025. Annual spending on the incentive has surged to about $2.8 billion a year, or almost a third of total Medicare spending on general practice.

The subsidy helped lift bulk-billing across most of the country, but it’s poorly targeted and arbitrary.

The incentive rises with remoteness. A clinic in a regional centre gets one rate. A clinic in a small town gets more. Those jumps have no relationship to local rates of bulk-billing, patient fees, or whether there are enough GPs.

Some regional centres sit in the top quarter of the country for GP services per person. Some are in the bottom 5 per cent. The subsidy treats them the same.

It’s like handing out drought relief without checking which farms had too little rain, or how much money they’re losing. That’s why the multibillion-dollar increase in bulk-billing incentives hasn’t helped GP deserts.

A year after the incentive was tripled in 2023, care in GP deserts actually fell, despite rising almost everywhere else. Early data suggest services in GP deserts may have fallen again after the incentive was broadened last year. And after both changes, bulk-billing rates in GP deserts barely shifted.

Bulk-billing incentive boosts were never designed to fix thin markets. It’s an affordability measure, and in most of the country bulk-billing has increased significantly. But with the government spending an extra $1.5 billion a year on general practice, and leaving communities with the least care behind, the case for action on GP deserts is stronger than ever.

So what should governments do?

They know a new approach is needed, and they have already taken the first step.

Most of the debate on the new national health funding deal was about how to split the ever-growing public hospital bill. But the fine print of the agreement, released this month, also lays the groundwork for a systematic approach to thin markets for primary care.

It commits governments to measuring and publishing local levels of unmet need. It says structures will be developed for Primary Health Networks, state health departments, and Aboriginal Community Controlled Health Organisations to jointly plan and fund care where the market has failed.

But architecture alone isn’t enough. An independent review of the last five-year national health agreement found that many commitments were never delivered. It found that reforms with dedicated funding were much more likely to actually happen.

The new agreement makes real progress in outlining a model, but it’s silent on money. If governments are serious, they need to commit real, long-term funding – at least five years – when health ministers meet later this year, or at the latest in next year’s budgets.

And the money must go where it’s needed most. The agreement commits to measuring unmet need, and it commits to filling gaps in care. But it doesn’t explicitly link the two. There is no requirement that investment be directed to the areas with the greatest need first.

The agreement suggests the approach is “particularly” for remote and very remote areas, but the trigger for intervention should be unmet need, not a line on a map.

Governments should commit to a GP Guarantee: a minimum level of care every community can expect. If an area stays below it, that should automatically trigger funding for Primary Health Networks to step in.

Canberra’s struggles with GP access show that when the standard model fails, governments must intervene directly. The new health agreement provides the framework to do that consistently and fairly.

The Senate inquiry should push governments to back that approach with funding, and a commitment to target the worst first, turning a promising framework into fair access to healthcare.