Country towns are losing GPs, maternity services and access to basic healthcare, while cash-strapped councils are being forced to plug the gaps. Doctors say the inequity is ‘astonishing’.
Rural NSW councils are being forced to bankroll essential health services abandoned or inadequately funded by higher levels of government, prompting demands for urgent action ahead of the March 2027 state election.
Local Government NSW (LGNSW) has launched a six-point rural health rescue plan, warning that country communities are being left without GPs, maternity care and reliable patient transport while councils divert funding from core services to keep healthcare afloat.
“Your postcode should not determine the services you can access”, said LGNSW president and Inner West Council mayor Darcy Byrne.
“It is completely unacceptable that someone’s postcode will determine their access to essential healthcare services.”
The local government’s Caring for our Regions six-point rural and regional healthcare plan has called for $440 million in workforce investment, $150 million for patient transport, and a $20 million program to reimburse councils for filling gaps in health services over four years.
“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 LGNSW’s plan read.
For GPs alone, it called for a $200 million investment over four years to expand regional training, recruitment in hard-to-fill locations and retention initiatives.
It pointed to training numbers, which, despite having grown 17% nationally, had increased by just 4% in NSW in 2025.
A 2025 NSW parliamentary inquiry also found that more than 40 towns were expected to lose their GPs by the end of the decade.
While the Isolated Patients Travel and Accommodation Assistance Scheme (IPTAAS) processed 99,600 travel assistance claims in 2023-24 – up 21% from the previous year – LGNSW said that for residents without access to a vehicle or driver, partial travel reimbursement was “effectively inaccessible”.
Instead, LGNSW said the state government must recognise transport as core health infrastructure in regional and remote NSW.
It pointed to Narrandera Shire Council, which provided 15,171 trips to more than 700 clients, relying on the goodwill of 29 volunteer drivers who contributed 7,500 hours over the reporting period.
The peak local government representative called for the implementation of all 44 recommendations from the NSW Parliamentary Inquiry into rural and regional healthcare’s 2022 report – “our communities need and deserve real action to address this crisis,” Councillor Byrne said.
Regional and remote councils were also often required to step in to fill gaps in health services, at the expense of core community services and infrastructure, he said.
For instance, over the previous nine years, Bogan Shire Council had taken on full responsibility for Nyngan’s only medical centre, with annual expenditure exceeding patient fees by $600,000, funded by the council’s other revenue, most of which was attributed to securing locum doctors.
Another priority was restoring access to safe, local maternity care in NSW, with at least $120 million invested over four years, following the nation’s loss of 41% of maternity units between 1992 and 2011.
Parkes Shire has been without a birthing unit since 2019. In January 2025, its only obstetrician resigned, leaving the town without obstetric services.
“Mayor Neil Westcott reports the community is constantly reassured that Parkes maternity reinstatement is high on the agenda of NSW Health, but a solution does not appear to be any closer,” the LGNSW’s report read.
Finally, to allow people age in place, LGNSW urged the state government to work with the Commonwealth on a $250 million, four-year Rural and Regional Aged Care Transition Fund to remunerate council-delivered aged care and reduce preventable hospitalisations.
LGNSW Rural and Regional vice-president, and Queanbeyan-Palerang Regional Council, mayor Kenrick Winchester said that despite two to three million people living outside Sydney, Newcastle and Wollongong, they were all too often neglected by politicians.
“We need to make sure our state government develops policies and provides funding that benefits our communities,” he said.
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Rural Doctors Association of NSW president Dr Rachel Christmas said the LGNSW’s advocacy was very similar to independent member for Wagga Wagga, Dr Joe McGirr’s Rural Health Action Plan, and told The Medical Republic it was “really unfair” that local governments were expected to foot the bill.
“Rural communities have always had to think outside the box and depend on a lot of community members volunteering or providing some extraneous services, which don’t have to happen in the cities,” she said.
“The inequity is astonishing.
“We’re needing place-based solutions, and not every country town is the same. The councils know their communities and know their towns, so they’re in a very good position for understanding what their town needs.”
However, she said the responsibility for maintaining health services did not rest with councils – “this is not their remit”.
“If [councils] are going to keep picking up the pieces and working collaboratively, they need to be funded to do so because otherwise they must take money from other services that they provide.
“And then that means the community misses out again. It means closing the swimming pool, reducing library services, or being unable to provide a recycling service because it’s too expensive, which reduces community engagement and satisfaction.”
Dr Christmas said there needed to be more systems in which hospital-based doctors provided primary care in underserved towns – “if we don’t have primary care, everything falls apart”.
While she said the state government would be more likely to engage meaningfully with the LGNSW’s campaign because of its responsibility for managing the fallout, the federal government appeared uninterested.
“[The federal government] funds general practice, but they don’t really take responsibility for the downturn in primary care, because the flow-on effects of that are really into the state system,” she said.
Read the full LGNSW campaign here.
