Nursing and midwifery leaders say policy settings are delaying diagnoses, fracturing care and pushing rural patients into avoidable hospital admissions.
Australia’s rural health system is buckling under Medicare settings that clinicians say are now actively harming patients.
A coalition of 12 national peak nursing and midwifery bodies as well as health system experts has called for urgent federal intervention as care delays and service gaps deepen across the bush.
The group has written to the Senate Standing Committees on Rural and Regional Affairs and Transport warning that current Medicare and pharmaceutical policies were no longer merely inefficient but were driving disrupted care pathways, delayed clinical reviews and rising pressure on already fragile rural services.
The coalition said the consequences were being felt in real time across oncology, mental health, chronic disease and palliative care.
“Reform is not optional,” said Adjunct Professor Chris Helms of the Australian College of Nurse Practitioners, in the letter signed by him on behalf of the group.
“Without urgent correction, current policy settings will continue to compromise safety, sustainability and equitable access for rural, regional and remote Australians.”
There are currently roughly 3000 registered nurse practitioners working across Australia.
A particular concern raised by the coalition was the 12-month face-to-face requirement for Nurse Practitioner Medicare Benefits Schedule telehealth services.
Clinicians said this was unworkable outside metropolitan areas. For many patients in remote communities, telehealth was the only viable pathway to continuity of care, yet funding restrictions were forcing delays in reviews, investigations and follow-up.
“Where timely primary care review, prescribing and diagnostics are restricted, clinical deterioration is more likely to occur before intervention,” Professor Helms wrote.
“These impacts are particularly concerning in high-risk clinical contexts, including oncology surveillance and survivorship care, complex mental health follow-up, chronic disease management and palliative care.
“In oncology surveillance alone, nurse practitioners frequently provide longitudinal follow-up for patients with breast, prostate, bowel and lung cancers.
“They monitor for recurrence, manage treatment toxicities and coordinate care with tertiary services. Disruption to these established pathways represents a material risk to early detection of recurrence and timely intervention in high-risk populations.”
In addition, nurse practitioner- and midwife-led practices remained ineligible for MyMedicare registration, excluded from Bulk Billing Incentive Programs, locked out of key advanced diagnostic and procedural MBS items, and without appropriate rebates for after-hours and on-call services.
“It is inconsistent to promote workforce expansion through the Commonwealth’s Nurse Practitioner Workforce Plan while structurally limiting the funding mechanisms that enable that workforce to practise sustainably,” Professor Helms wrote.
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The coalition also highlighted the exclusion of nurse practitioners from the Repatriation Pharmaceutical Benefits Scheme, which forces Department of Veterans’ Affairs patients to switch prescribers purely to access subsidised medicines, disrupting established therapeutic relationships and continuity of care.
The group’s urgent reform wish list included:
- Immediate review of the 12-month telehealth requirement in rural, regional and remote contexts.
- Inclusion of nurse practitioner- and midwife-led services in MyMedicare.
- Eligibility for the Bulk Billing Incentive Program.
- Removal of outdated collaborative model requirements in Urgent Care Centres that no longer reflect contemporary regulation.
- Access to advanced diagnostic, procedural and referral MBS items consistent with scope of practice.
- Inclusion of Nurse Practitioners in the Repatriation Pharmaceutical Benefits Scheme.
- Structured MBS support for chronic disease, mental health, maternity and after-hours care delivered by nurses and midwives.
- Mandatory rural and remote impact stress-testing of all future Medicare reforms.
The coalition’s warning landed alongside broader calls for structural reform, with the Australian Association of Psychologists (AAPi) backing proposals from The Australia Institute for a remoteness loading across all Medicare items.
The policy, outlined in the Institute’s report Second-class citizens: the rural health divide, argues that Australians outside major cities face systemic underfunding that entrenches poorer access and worse outcomes.
The think tank’s report was also a submission to the Senate Rural and Regional Affairs and Transport Committee’s Inquiry into rural, regional and remote Medicare access and funding.
AAPi Executive Director Tegan Carrison said people living in rural, regional and remote areas should be afforded equitable access to mental healthcare.
“We have long been calling for incentives for rural and regional psychologists to encourage them to work in underserved areas,” she said.
“Your postcode shouldn’t determine if you can receive the essential healthcare you need, whether it’s physical or mental healthcare.”
The Australia Institute’s analysis found rural Australians faced higher rates of chronic illness, lower access to primary care and significantly greater barriers to specialist services, reinforcing what it described as a two-tiered system that left non-metropolitan patients as “second-class citizens” in healthcare access.
Read the institute’s full report here.
