On February 22, 2025, Prime Minister Anthony Albanese stood in Ellenbrook and announced an $8.5 billion investment in Medicare, the largest in the program’s history, with bulk-billing rates to reach 90 per cent by 2030. “All you need is your Medicare card.”
Ellenbrook is a master-planned suburb forty minutes from Perth with a train station, a shopping centre, and enough general practices that they compete for patients. It is an excellent place to announce Medicare policy. Four hundred kilometres east, in the Shire of Narembeen, the promise did not arrive.
Narembeen has 787 residents. To keep a single GP in town, the shire pays $305,000 per year in cash and provides a house, a vehicle, and a surgery—16 per cent of its total rates revenue. The farmers and small business owners of Narembeen are not just paying for roads and rubbish. They are paying to staff a national healthcare system that does not fund itself east of the Darling Range.
In July 2023, Narembeen advertised for a medical services provider and received one tender. The bidder requested $280,000 to $300,000 annually, plus accommodation, vehicle, and premises—the cost of doing business in a town three hours from a tertiary hospital, with fewer patients than a suburban apartment block. The shire accepted because the alternative was no doctor at all, and the nearest backup in Bruce Rock only exists because another shire is paying to keep it open.
A recently published WA Local Government Association survey has found that 41 councils spent $9.5 million supporting GP services in 2024-25, up from $7.8 million three years earlier. Councils with populations under 5,000 accounted for 91 per cent of that spending. The Wheatbelt alone was 61 per cent.
The typical support package includes income guarantees of $200,000 to $300,000, free housing, vehicles and fuel, practice facilities at peppercorn rent, and administrative staff. Two-thirds of councils bundle all of these together—the baseline cost of keeping a doctor where Medicare billing cannot sustain a practice.
When the Shire of Gnowangerup went to tender in May 2024, three responses came back. One wanted $250,000 plus the standard package. One offered telehealth four days a week with no hospital cover. The third quoted $90,000 but had projected costs that made the sums impossible.
Six shires—Gnowangerup, Jerramungup, Kojonup, Lake Grace, Narembeen, and Ravensthorpe—have formed an alliance to document what this costs. Their combined population is about 8,400. Their combined spending on GP services approaches $6 million a year including housing, vehicles, surgeries, and depreciation—roughly $714 per resident, paid through council rates, on top of the Medicare levy and state taxes.
Ten practices across the six shires provide emergency care, palliative care, skin cancer clinics, psychiatry, and geriatric outreach. Hospital transfers to Perth have declined. The service works. The funding doesn’t.
The Commonwealth’s Medical Facilities Cost Adjustor sits within the Financial Assistance Grants paid to local governments. In 2024-25 it distributed $2.19 million across Western Australia, capped at $100,000 per council. Narembeen received $54,008 against $305,000 in actual spending. Lake Grace received $36,392 against $250,000. Kojonup received nothing because it partners with a not-for-profit to employ its GP, an arrangement outside the eligibility rules. Actual spending: $250,000. Across the state, the adjustor covered eighteen cents of every dollar councils spent.
The $8.5 billion announced in Ellenbrook funds bulk-billing incentives that reward patient volume, 87 Urgent Care Clinics in metropolitan areas, and 2,000 new GP training places with no requirement to work in remote areas.The policy assumes competing practices and economies of scale—conditions that exist in Ellenbrook but not in Gnowangerup, Newdegate or Lake Grace.
The Cost Adjustor already exists. Lifting the cap, adjusting the formula to match actual costs, and expanding eligibility to cover partnership arrangements would close most of the gap. The six-shire alliance has costed their proposal at $4.425 million over three years.
The Prime Minister said all you need is your Medicare card. In the Wheatbelt, the card works because local shires pay for it to work, while Canberra takes credit for a promise it hasn’t funded.