Primary care plays a vital role in preventative health and reducing strain on secondary care services. But ‘GP deserts’ are hindering people’s access to care and putting pressure on our GP workforce.
By Andrea Downey
It’s an age-old problem in health – there are not enough resources to support the growing number of patients needing care and the ensuing pressure that is putting on the healthcare system.
The importance of primary care is known. People who see their GP regularly can manage their health better and are less likely to end up in hospital.
But so-called ‘GP deserts’ are resulting in thousands of Western Australians missing out on essential check-ups, screening, medication management and other services GPs provide.
The re-elected State Government has a new focus on preventative health, designating a whole portfolio under Minister for Preventative Health Sabine Winton.
Premier Roger Cook wants to make WA the “healthiest state in Australia”, but can that be achieved, and the goal of preventative health be realised, while some still struggle to access a GP?
Geographical barriers
Research from the Grattan Institute shows around half a million Australians live in GP deserts, where they receive 40% fewer GP services than the national average.
Most GP deserts are in WA, remote Queensland and the Northern Territory.
While the term desert conjures up images of remote towns, some metropolitan areas in WA are also at the mercy of a shortage of GP services.
Peter Breadon, Program Director of Health and Aged Care at the Grattan Institute, said a number of factors were at play in WA, including our unique geography.
“There are lots of parts of rural WA that are GP deserts and WA does worse than most other states in Australia. It really is a state where urgent investment is needed,” he told Medical Forum.
“It’s partly the geography, but there’s also been rapid population growth which is hard for services to keep up with. Those things probably play a part.”
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The areas worst hit are remote regions such as the Pilbara and Kimberley, but metropolitan regions including Cottesloe and South Perth are also falling behind.
The Federal Government has confirmed nine new Distribution Priority Areas in WA, the majority of those in metropolitan regions, as the State grapples with GP shortages.
However, the new DPAs are not in areas considered a GP desert by the Grattan Institute, raising questions on whether a new approach is needed.
Mr Breadon said there needs to be a more targeted approach to addressing primary care shortages.
“One thing we’ve seen in Australian policy over the years is this focus on investing and measuring access by remoteness levels. And certainly, areas that are more remote across Australia tend to have lower levels of services, and there are more of those areas in Western Australia, however it’s not a perfect correlation.
“We’re arguing to move away from the characteristics that, on average, are associated with lower levels of care to just target those areas with lower levels of care, whether they’re in a city, a town, or a remote area.
“Targeting investment at low levels of care is the way to do it.”
The lay of the land
The Grattan Institute defines a GP desert as an area that has below 4.5 GP services per person. Those considered to be on the cusp of becoming a GP desert have below 4.9 GP services per person.
Using the latest Medicare-subsidised data, it has determined there are six GP deserts in WA and four areas on the brink of becoming one.
The Kimberley, East Pilbara, West Pilbara, Esperance, South Perth and Cottesloe were all found to have less than 4.5 GP services per person. The worst hit was West Pilbara with 2.9 services per person.
The Gascoyne, South Wheatbelt, Perth City and Manjimup were noted as almost a GP desert.
Adding to the problem are high vacancy rates and retention issues alongside dissatisfaction with incentives in rural areas.
As of 21 March, there were 78 GP vacancies in the State’s rural and remote areas, according to data provided by Rural Health West. Some of these are GPs wanting to grow their practice, but others are where a GP is absent.
Across the full health workforce there were 159 vacancies, predominantly nurses, physiotherapists and speech pathologists. The Kimberley was the worst hit region with 39 vacancies, followed by the South West with 32 and the Wheatbelt with 20.
Retention rates are further adding pressure to the system. Five-year turnover rates in some areas of WA were as high as 62%, Rural Health West data shows.
In the Kimberley the rate was 52%, the Inner Regional area was 62% and the Pilbara and Goldfields sat at 47% and 46% (see graphic for the full regional breakdown).
WA saw a 31% increase in the number of GPs training in 2025, bolstered by 67% growth in the number of registrars training as specialist GPs on a rural pathway, RACGP figures show.
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But the College’s latest Health of the Nation survey found WA has just 99 GPs per 100,000 people, lagging far behind States such as Victoria and NSW which has 116.
Nationally, Department of Health data show a shortage of 2400 fulltime equivalent GPs, forecast to grow to 8900 by 2048.
A pressure cooker
The result is an overloaded workforce at risk of burnout.
In a recent survey of GPs, Rural Health West found 44% of respondents had experienced excessive workloads in the past 12 months, 43% said recruiting more staff was a challenge and 44% said they faced problems with staff turnover.
Rural Health West Chief Executive Professor Catherine Elliott said a range of programs were being delivered to support health professionals on the ground, but funding was constrained.
“The message from rural health professionals is consistent and clear: many locations are facing critical workforce shortages that create inequity of healthcare for rural communities,” she said.
“It’s not just about workforce numbers – it’s about burnout, barriers to training, and the pressure of delivering quality care with limited support.
“If we’re serious about equity for rural communities, we must keep listening to the workforce and backing them with the resources they need.”
Albany-based GP and AMA(WA) Chair Rural Doctors Practice Group Dr Paddy Glackin said general practitioners in regional areas often take on more responsibility than their urban counterparts, such as running local emergency departments.
“There is a relatively small number of doctors forced to carry out an awful lot of responsibility, and that’s very pressurising,” he told Medical Forum.
Then there is difficulty finding the balance between the need for GP services and patient demand.
“You need a certain population to be able to support a GP, but you also need a certain number of GPs to be able to run a truly sustainable service,” Dr Glackin said.
“As a result, there are country GP practices struggling to get enough work to maintain a sustainable practice compared to their metro counterparts.
“Then word gets around of ‘don’t go and work there because they’re burnt out’. So, consequently, people go somewhere they won’t get burnt out or where they are in a more collegiate, supportive and well-structured environment.
“Look at the impact on small towns like Norseman, which had a GP for close to 20 years who provided general practice services and also worked in the hospital and did a huge amount of work in that community.
“Then when it was time for him to move on, they found it next to impossible to find anybody who can replace the huge amount of work that doctor did.
“There’s quite high turnover in country practice. It’s really tough.”
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Mr Breadon added that GPs and other healthcare workers could experience “moral injury” when they felt they were not meeting the needs of their patients because they are too stressed.
“That can be a downward spiral where people leave those areas, or stop working, or work less, further diminishing the amount of care that’s available,” he said.
“There are big economic and health system consequences from these gaps in access to care.”
Bidding wars
As regional and rural towns struggle to fill GP vacancies, local governments have stepped in to offer huge incentives and salary packages.
The Wheatbelt Shire of Quairading made headlines in 2023 after offering a $1 million salary package for a new GP, including housing.
It is not the only regional area to offer such large sums. Last year Livingston Medical advertised a GP role in Bremer Bay for up to $450,000 plus a house and car.
Similar situations are being seen elsewhere in Australia where GP shortages persist, including Queensland.
Dr Glackin said these bidding wars can be “very problematic”, adding that he is aware of some local governments spending large portions of their budget on GP incentives, which then limits their capacity to provide other essential services.
Dr Michael Livingston, founder of Livingston Medical which has provided medical services in country WA since 2013, said the secret to attracting and retaining GPs is to treat them like human beings.
As part of his work setting up clinics in rural areas, Dr Livingston often negotiates housing and car packages with local governments to make the transition to country work easier.
“Whatever site we get, I don’t ask people to do something I wouldn’t do myself,” he said.
“So, for every single one of these locations I always go in first so that when the next person comes in it’s streamlined.”
Mr Breadon argues that the situation needs cross-government intervention, calling for a minimum care threshold to be put into the National Health Reform Agreement to “draw a line in the sand on what we consider to be insufficient”.
“In areas that persistently fall below that threshold of acceptable levels of care, we argue that Commonwealth and State Governments should work together to fill those gaps with what’s sometimes called co-commissioning,” he said.
“Funding should be unlocked on a population health needs basis to identify the gap in care and give an investment to fill those gaps.”
That funding, he said, should be based on a salaried model as many of the traditional subsidies do not work to attract and retain clinicians.
Patient impact
Of course, at the heart of this issue, is patients – often the most vulnerable – who are missing out on care.
Most GP deserts are located in areas where patients are typically sicker and poorer. Some are missing out on care altogether.
Data from the Grattan Institute shows last year 8% of people aged 65 and over in these areas didn’t see a GP at all, compared to less than 1% of the rest of the country.
People living in these areas are almost twice as likely to go to hospital for a condition that might have been avoided with good primary care, or to die from an avoidable cause.
“If you’re adding GP services anywhere in Australia, these are the most important places to start,” Mr Breadon said.
“On average they need care more than other parts of Australia because people there tend to be sicker, more disadvantaged, and in many cases they have lower bulk billing rates. We really wanted to shine a light on those places with the very lowest level of care to start investing there.”
Dr Glackin said a lack of access to GPs creates a vicious cycle where patients get sicker, eventually needing further care.
“When you become unwell, you’ve got less access to diagnostic modalities, you’ve got less access to specialist care than what would be delivered in the city to support your GP and to help advise on your treatment. You lose out at every level.”
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But despite its challenges, Dr Glackin wouldn’t work anywhere else.
“I really enjoy my work, it’s endlessly fascinating, I love the variety. Tomorrow I’ll be working in a local emergency department.
“It’s challenging, it’s exciting, you work much closer to the top of your scope of practice.
“I think that’s very rewarding, and the level of care and support you can provide to patients, families and communities is great.”
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