Health Services Amendment (Right to Primary Health Care) Bill 2026

Mr GURMESH SINGH ( Coffs Harbour ) ( 13:45 :51 ): On behalf of the Opposition, I support the Health Services Amendment (Right to Primary Health Care) Bill 2026. I acknowledge the work of the member for Wagga Wagga, Dr Joe McGirr, on this bill and commend him for being a strong advocate for regional health in this place. I also commend him for his work on the bill, particularly for adopting a very collaborative approach with members of the Opposition and for consulting various regional health stakeholders in his approach to improving regional health. The Opposition supports this bill because people in regional and rural New South Wales should not have to fight harder to access basic health care simply because of where they live. The bill will amend the Health Services Act 1997 to make it a function of rural and regional local health districts [LHDs] generally to ensure their residents have appropriate and timely access to in‑person primary health care services. In simple terms, it becomes part of the job of those health districts to make sure people can actually see a local GP, a pharmacist or an allied health professional without it being an ordeal.

The bill also defines what "appropriate and timely" means in a practical sense. It says that in assessing whether access exists, LHDs will have to consider whether a service can be reached within a two-hour drive from someone's home, and whether public transport is available to get them there and back. That two-hour measure will resonate with anyone who represents a regional electorate. It is the lived experience of our constituents. The public transport question matters because we know that not everyone has a car, not everyone can drive, and the assumption that rural residents all have reliable private transport is simply not right. Can an elderly resident who no longer drives get to an appointment? Can a young family manage the cost and time of repeated travel for a child with a chronic illness? Can someone living in a small town see a doctor before their condition deteriorates to the point at which they end up in hospital? These are the real‑world questions, which are only too familiar to those of us who live in the regions, that the bill is trying to address.

The bill also defines primary health care clearly. It covers the essential services delivered at the first point of contact with the health system—health promotion, disease prevention, early intervention, treatment of common conditions, and the ongoing management of chronic illness. It includes GPs, nurses, midwives, pharmacists, allied health professionals and Aboriginal health workers operating in community‑based settings. At its core, this legislation places a clear obligation on rural and regional local health districts to ensure people can access appropriate and timely in‑person primary healthcare services. Anyone who represents a regional electorate knows that for many communities, even basic access to a GP can be incredibly difficult. It is important to call that out because we know the consequences when primary health care is not accessible. Small problems can become serious ones. Preventative care falls away and chronic illness goes unmanaged. People delay treatment because it is too hard, too expensive, or simply unavailable, and we do not want that to happen in regional communities.

Across regional New South Wales we are seeing emergency departments under enormous pressure. Ambulance ramping is becoming more common and patients are waiting too long for care. One reason for that is the primary care system in many communities is simply not functioning as well as it could be. Emergency departments were never designed to replace local GP clinics. Hospitals were never supposed to become the front door for basic healthcare needs. But for many people in regional communities, that is exactly what is happening. It is not fair on patients, and it is certainly not fair on healthcare workers, who are already stretched to breaking point.

This bill also speaks to the broader issue of equity. Regional people contribute enormously to this State. They power our industries, grow our food and fibre, and keep regional small businesses alive. Yet too often they are expected to accept services that people in metropolitan areas would never tolerate. There are communities in regional New South Wales where people cannot get regular GP appointments, and the local hospital can go weeks without a doctor. There are communities where women have to travel hours to give birth, where access to mental health support is incredibly limited, and where people are spending entire days on the road just to attend medical appointments.

I address what the Government has said about this legislation: that primary health care is a Federal responsibility. It is, but there is no reason why rural and regional LHDs cannot have a stake in the issue as well. It is all connected—and they already have a stake. As I said earlier, when there are not enough primary healthcare services in a regional community, it inevitably puts pressure on the local hospital and the public system. The Opposition argues that it is in the interests of LHDs to be active in the primary healthcare space. The bill is worded flexibly enough for LHDs to make that work in their local contexts, and it creates a level of accountability. It means health districts can no longer simply acknowledge the primary healthcare problems and move on. They will now have a framework against which communities can ask questions and expect answers. The Opposition hopes that it will mean the system is required to actively plan for access to primary health care.

Importantly, the bill sends a message to regional communities that this Parliament recognises their concerns as legitimate. One of the most frustrating things for regional communities is that they often feel they have to justify that they deserve basic services. When it comes to health care, our communities are not asking for special treatment. We are asking for the ability to see a doctor without travelling half a day. We are asking to access preventative health care before conditions deteriorate. We are asking for a healthcare system that works for us as well as it works for people in major cities. That is not unreasonable. People in regional New South Wales deserve timely access to primary health care and they deserve a health system that works for them, no matter where they live. For those reasons, we support the bill and commend it to the House.

Mr DAVID MEHAN ( The Entrance ) ( 13:52 :03 ): I contribute to debate on the Health Services Amendment (Right to Primary Health Care) Bill 2026. As the Parliamentary Secretary for Health has already indicated, the Government does not support the bill. Notwithstanding the passion, dedication and advocacy for health care exhibited by the member for Wagga Wagga, which all members appreciate and is highly regarded by the House—and I am sure highly regarded in his community—this bill contemplates a huge and remarkable change to the established funding arrangements for health in this country, not just in this State or in the electorate of Wagga Wagga.

Primary health care is within the purview of the Commonwealth. There are Commonwealth-State relationships already in place to deal with exchange, cooperation and the demarcation of what is within the purview of the Commonwealth and what is within the purview of the State Government through the State hospital system. There is already a good mechanism and architecture in place to allow for cooperation and to deal with many of the things that the member for Wagga Wagga seeks to have dealt with under this bill.

The bill seeks to set up a new regime. Without commenting on the funding implications of that regime, a new health regime for all of the State except for the six local health districts enumerated in the bill. The regime that the member for Wagga Wagga seeks to introduce would apply to the Central Coast Local Health District, which covers my electorate, so the matter is of concern to me. As the Parliamentary Secretary to the Treasurer, I must have regard to budgetary implications. As I indicated, the bill has huge budgetary implications that were not looked at in any way before it was brought to the House. As I said, notwithstanding the good, pure and humane intentions behind the bill, we cannot contemplate introducing it without detailed work on the budgetary implications that flow from it for the Commonwealth and the State.

In that regard, I am surprised that the member for Coffs Harbour, and Deputy Leader of the Opposition, is so keen to support it. That might play out okay in Facebook land, in the branches and maybe in the media, but I ask the people who have responded positively to the Opposition's irresponsible support for the bill to have regard to its huge budgetary implications. Is it the Opposition's policy for the State to take over all health care—primary health care as well as public hospital health care—for most of New South Wales and to let the Commonwealth off the hook without any study into budgetary implications? Is that the policy it will take to the next election? That is an important question for those opposite to confirm with the community between now and the election on 13 March next year.

With those introductory remarks, I turn to a couple of things that the House and the community should be aware of. The Minister for Health asked me to relay to the House the existence of the NSW Regional Health Strategic Plan. The plan focuses on six priorities: strengthening the regional health workforce; enabling better access to safe, high-quality and timely health services; keeping people healthy and well through prevention, early intervention and education; keeping communities informed, building engagement and seeking feedback; expanding integration of primary, community and hospital care; and harnessing and evaluating innovation to support a sustainable health system. We know there has to be coordination between primary health and the health services delivered through the public hospital system administered by the State.

I see that happening in my electorate all the time. My Commonwealth colleagues have funded two bulk‑billing urgent care clinics on the Central Coast. The State Government has funded an urgent care service at the Long Jetty hospital, which was in decline under the former Government. Services were being withdrawn and people were asking, "What are we going to do with that facility there at Long Jetty?" The former State Government took beds and services that were being delivered to the community out of that hospital. We agitated locally and convinced the Central Coast Local Health District to survey the community about what they wanted to see in the area. That survey showed that people wanted a place where they could access health care locally. As a result, the Long Jetty Urgent Care Service was established in 2023. Since then, 28,000 people have been seen by that service. People who otherwise would have had to turn up at the Wyong Public Hospital emergency department or the Gosford Hospital emergency department have been dealt with in a more orderly fashion at the Long Jetty Urgent Care Service, including me.

I used the system. I rang the Healthdirect phone number—1800 022 222—and spoke to a nurse. I had something called mallet finger, which means that I could not straighten my finger. She said, "You need to go to the urgent care service." I went to the urgent care service. They hooked me up with a local radiology service for an X-ray. It then sent me back to the urgent care service, which bound my finger. I have a public hospital appointment for further treatment. That integration is now happening. If local health districts work well with the primary health networks administered and funded by the Commonwealth, there are better health outcomes for the whole community. But the Commonwealth has to be part of it.

Since the time of the Chifley Government back in 1945, Labor has fought Opposition members every step of the way for Medicare and affordable, accessible primary health care in our communities. It was challenged in the High Court by doctors from the British Medical Association, introduced by the Whitlam Government after years of being ignored by members opposite, thrown out by the Fraser Government, then reintroduced by the Hawke Labor Government. We did not spend all that time convincing the community that Medicare should be the foundation of primary health in this country just to see the Opposition back a plan that says, "We're going to take over that now. You can trust us with it." Members opposite cannot be trusted with primary health care—not one iota.

For those reasons, as I said, whilst I commend the member for Wagga Wagga and his advocacy for his electorate, my view is that the health professionals in the Commonwealth—and the health professionals in the local health districts of our State, who work with Commonwealth-funded primary health care networks—are doing a good job delivering primary health care, supported by the State public hospital system. Under this Labor Government, things are getting better for the people of the State, and that should be defended. We instead need to worry about the plan endorsed by members opposite today.

Mr JUSTIN CLANCY ( Albury ) ( 14:02 :13 ): I welcome the opportunity to contribute to debate on the Health Services Amendment (Right to Primary Health Care) Bill 2026, which I support. I begin by acknowledging the member for Wagga Wagga, who is in the Chamber with me. At the end of the day, the member sets out to address an issue through the bill. Despite the reflections by the member for The Entrance, at the very end of which he said that primary health care is generally in a good state and the Labor Government is doing a good job, the member for Wagga Wagga seeks to address an issue that has clearly been felt in regional communities and has been clearly identified by members on both sides of the House on a number of occasions.

In fact, work began through an inquiry during the previous term of government, and was followed up by the Select Committee on Remote, Rural and Regional Health, of which the member for Wagga Wagga was chair. I had the privilege of working alongside him in the latter stages of that committee. I thank him for introducing the bill and for his work as chair of that committee. I also thank my fellow committee members. Notwithstanding the comments made by the member for The Entrance, I am sure that all other members of this House would agree that we need to do better when it comes to access to primary health care in regional communities. I note that the Minister for Health, and Minister for Regional Health, is in the Chamber. I know that he would also acknowledge that we need to do better when it comes to primary health care.

We all recognise the challenge at the interface between the provision of health care covered by the Commonwealth and acute health care mainly funded by the State. It is not a new problem; it is a problem that has confronted communities for a number of years, and there have been several attempts to try to address the issue at different levels. One example that came up during the inquiry into remote, rural and regional health was the Mareeba project of the National Rural Health Alliance, which was a rural, integrated, multidisciplinary primary health care service. Another example was the HealthOne NSW model introduced under the former Government, which I know the member for Wagga Wagga would be quite aware of. In our Federal electorate, a HealthOne model was rolled out in Corowa. For the benefit of the House, the HealthOne model website states:

HealthOne NSW aims to create a stronger and more efficient primary health care system by bringing Commonwealth-funded general practice and state-funded primary and community health care services together.

That goes to the heart of it. Even under this New South Wales Government, there have been previous attempts to drive improvements in primary health care within our communities. The former Government demonstrated that it was willing and prepared to work on such a model. That is not to say that it has always been successful, and I know that there have been limitations. But the bill introduced by the member for Wagga Wagga simply seeks to ensure that State governments remain committed to working to address the problem. The member does that by calling on local health districts to consider primary health care. Schedule 1 [1] to the bill is the nub of it. Item [1] amends section 10, "Functions of local health districts", to insert:

… generally to ensure residents of the areas of rural and regional local health districts have appropriate and timely access to in‑person primary health care services.

Primary health care thus becomes a function of local health districts. The member for Wagga Wagga seeks to say that, consistent with previous attempts, there needs to be a strong drive by local health districts to be part of the conversation. They are called to be part of the solution. I share that view with the member, given that our electorates share the Murrumbidgee Local Health District, a local health district that seeks to do and has done that in several different ways, including the single-employer model, which has helped to break down the barriers between GPs and visiting medical officers when it comes to their funding and employment model. I thank and acknowledge the Government for its support and rollout of that model across the State.

In the Murrumbidgee Local Health District, we also see it through the innovation of the Murrumbidgee Health and Knowledge Precinct. That is, again, to the credit of the member for Wagga Wagga and the former Premier, who I understand funded that particular model. That is another endeavour to integrate primary health care and acute health care. It is, in my view, a model that we should see more of across our State. All members would have a clear understanding of the benefits of driving improvement in primary health care, and even in preventative health care, in our communities. Just earlier this morning I was at the George Institute for Global Health, where staff spoke about how we could all work together to drive down hypertension as a significant killer and cause of premature death. A few weeks ago Dr James Muecke gave a talk to members—and I recall that the Parliamentary Secretary for Health was in the room—about type 2 diabetes. Members across the Chamber have a strong desire to do better—and an understanding that we need to do better—when it comes to preventative health and primary health care.

The bill seeks, firstly, to acknowledge that there is an issue. Notwithstanding the contribution of the member for The Entrance, we all recognise that we need to do better when it comes to primary health care. Secondly, we also recognise the benefit of better health care for individuals, families and our community. As the Minister for Health would be in accordance with, it helps reduce the pressures on our acute healthcare system. We recognise that there have been endeavours to do that previously, whether it be the HealthOne model in New South Wales or the model at Mareeba with the National Rural Health Alliance. There are endeavours that look to collaborate between levels of government to get better integration between primary health care and acute health care. The member for Wagga Wagga simply seeks to enshrine that and place a responsibility on our health district and health department to attend to that. We cannot continue by operating in silos. We need to come together. We need to collaborate. We need to have a more cohesive model. That is what the bill sets out to do, and that is why I support it.

Mr RYAN PARK ( Keira—Minister for Health, Minister for Regional Health, and Minister for the Illawarra and the South Coast) (14:10:58): I contribute to debate on the Health Services Amendment (Right to Primary Health Care) Bill 2026. I acknowledge the member for Wagga Wagga. I have acknowledged, both publicly in this place and privately to him, his commitment to improving health services in regional, rural and remote New South Wales. I share that commitment. Regardless of our political allegiances in this Chamber, I hope those living in regional, rural and remote New South Wales see that it is a personal passion and commitment of mine, not just because I am from a larger regional centre. Having spent a long time in the health space, as shadow Minister and then as Minister for three years, I see the realities that people in rural and remote communities need to deal with in this area. I acknowledge the deep commitment of the member for Wagga Wagga and of many other members in this Chamber.

There are challenges, though. I want to be clear from the outset: New South Wales has a big responsibility in running our State's hospital system. I do not ask Minister Butler or Minister Rae to run our emergency departments. That is my responsibility. I do not ask them to manage the elective surgery lists. That is up to me and the system. We do the acute care. We do a lot of the outpatient work. We have very defined roles. The Commonwealth has its responsibilities too, given the way in which the health agreement has been written up and put in place. I acknowledge that leaders of our nation, including former Prime Minister Rudd, have attempted to try a single funder model. No-one would like a single funder model for health care more than me.

Ms Janelle Saffin: I was part of it.

Mr RYAN PARK: As the Minister for Small Business says, she no doubt was a part of it. But we do not have that. We are in a jointly funded system with the Commonwealth, and we are asking it to do its component. That component is primarily around aged care, primary care and, in large part, disability care. When the Commonwealth fails to adequately deliver on its responsibilities, the State feels that impact. I understand what the member for Wagga Wagga is talking about. I wholeheartedly acknowledge the burden raised by the member, by reports and by the special commission of inquiry. At the moment—right now, today, at this hour—people are presenting to our emergency departments because they cannot access a GP. A GP appointment is perhaps delayed or would result in out-of-pocket expenses. Around one in 10 people presenting to our emergency departments say they only did so because they could not access a GP. If 8,000 people come into our emergency departments each day, roughly 10 per cent of them—a substantial number of people—are there simply because they could not access a GP.

There are fewer GPs in 2025 than there were in 2021. It is important for members to let that sink in. As has been acknowledged in the special commission of inquiry and in the regional healthcare inquiry of the committee chaired by the member for Wagga Wagga, the New South Wales Government is already stepping into aspects of primary care, including through our significant investments in virtual and urgent care. But it is not sustainable for the State to effectively subsidise the Commonwealth in the provision of primary care. In a perfect world, we would have the funding to do that under a single funder model. Unfortunately, primary care sits with the Commonwealth under the National Health Reform Agreement [NHRA].

It is not the case that I do not think the best thing would be to allow States to run primary care. I think we probably could do a much better job at it, but we do not have the funding allocation. I think we could do a better job because we are closer to the system on the ground. The member for Wagga Wagga acknowledged that, but it comes at a price. That money would need to flow and, at the moment, that does not happen. Our State and our system cannot let the Commonwealth off the hook more than we are already doing. We would be setting a precedent. If we bail out the Commonwealth on the failure to provide adequate primary care, we open the floodgates to bailing it out in other areas, including aged care—where we have the challenge of around 1,300 patients stuck in our hospitals—the NDIS and tobacco enforcement. The list would go on.

If we offer to do the Commonwealth's job for it, it would place huge pressures on the State's budget. We must all acknowledge that reality. These things come at enormous cost. If funding is allocated to one level of government to do its role and another part of government takes it on, that money would need to flow. At the moment, that does not happen. The NHRA now extends to 2031. It makes clear that the Commonwealth is responsible for system management, support, planning and policy for general practice and primary health care and, importantly, that it has a stewardship role for primary care. We will work collaboratively to meet service demands and address market sustainability.

Activity-based funding is provided to the States for health care under the NHRA, as the member for Wagga Wagga knows. That is based on State delivery of hospital services. New South Wales is unlikely to be funded under that model to deliver primary healthcare services. The challenge is that money does not automatically follow the moment we enter into that space. Despite that, the State Government has had to fund services like urgent care, virtual care, virtualKIDS, virtualADULTS and other primary healthcare services to take pressure off our health system. That means the bill will have, from our perspective, an unquantified financial impact. The Government has invested $685.6 million from 2023-24 to 2027-28 to attract and retain staff in rural and regional New South Wales to deliver better health care. The budget for the seven regional local health districts is $8.6 billion, an increase of about 4.1 per cent from 2024-25. An additional $200 million was committed to increase key worker accommodation across rural and regional areas in New South Wales.

As I said, some of the services currently delivered by NSW Health fall within the scope of the bill. However, that work has been undertaken due to historic funding and service gaps in the primary care network that is under the responsibility of the Commonwealth Government. Transferring more of the primary care services under NSW Health would carry additional resourcing and financial liability to those not responsible for primary health care. There are unquantified costs associated with the implementation of the bill and the responsibility for those are located with other entities than New South Wales. The bill does not indicate what portion the State or the State budget should shoulder, with the exception of limiting its application to a number of local health districts. I inform members that in 2023-24, $89.1 billion was spent on primary and community health care in Australia, mostly by the Australian Government and non-government entities, with State and Territory governments comprising a smaller portion of this sum, principally in relation to public health expenditure.

Again, I acknowledge the work that the member for Wagga Wagga has done ever since he stepped into this place. All Government members have an enormous amount of respect for him and his engagement with regional and remote health services. I know that he has engaged with the Opposition on this topic. The Government is not being difficult about our ability to provide primary care. It is because primary health care is too broadly defined. Under the agreements that are in place, it is largely the responsibility of the Commonwealth. The Commonwealth is responsible for system management, support, planning and policy for general practice and primary health care. The NSW Health secretary has the power to determine the role, functions and activities of local health districts. Also, the costs associated with the bill are unquantified. As a Minister and someone who has responsibility for the money of taxpayers, that is something I have to take into consideration. I thank the member for his ongoing advocacy, particularly for regional, rural and remote health care. But at this stage the Government cannot support the bill.