Abstract: Shortages of GP services have a big impact. When people can’t see a GP, they get sick with conditions that could be prevented. This is costly for the health system and for individuals. Many parts of Australia have too few GP services. The number of services per person in the lowest-access rural areas is less than half that of the major cities. These gaps affect a significant proportion of the population. More than a million people, one in 20 Australians, live in the seven under-served rural areas discussed in this report–in places such as Tamworth, Goulburn and Mt Isa, as well as the Northern Territory and most of Western Australia. The problem has been around for generations. Successive policies have tried to fix it, but they have only solved the easiest problems by bringing GPs to inner regional centres, not to the areas with the greatest need. Many of the worst shortages have remained stubbornly high for decades, when the worst problems should be fixed first. At current rates of improvement, it would take more than 65 years for very remote areas of Australia to catch up to the levels of GP services that the big cities have today. Current responses –such as training more doctors, or paying them bonuses to move to rural areas –haven’t done enough. More of the same won’t fix the problem. We need new solutions that do more than tinker with the system. This report outlines a plan for the parts of rural Australia with the lowest access to GP services We don’t aim to bring these areas up to the national average, just to end the most extreme shortages. To achieve this, we have to make the most of scarce resources, while keeping GPs at the centre of the system. The first step is to make much better use of pharmacists’ skills. Pharmacists are highly trained, have deep expertise in medicines, and are located in communities throughout Australia. But their role is far more limited in Australia than in many other countries. With the agreement of GPs and patients, pharmacists should be able to provide repeat prescriptions to people with simple, stable conditions. They should also be able to provide vaccinations and to work with GPs to help patients manage chronic conditions. We also need to increase access to other services, including diagnosis, which currently only GPs can provide. Australia should introduce physician assistants, health workers who practise medicine under the supervision of a doctor. There is good evidence that physician assistants could expand the care available in under-served areas, without compromising quality or safety, and at an affordable cost. The proposals in this report only apply to the seven rural areas with the worst shortages of GP services. They can be in place within five years. In 2011-12, they would have resolved the worst shortages for just $30million.The costs would mostly have been offset by fewer, or less costly, hospitalisations as a result of better population health. Too many people have waited too long to get primary care. But the solution is surprisingly achievable, if we’re willing to adopt new responses to an old problem.