Twelve national organisations are calling for immediate reform to Medicare and pharmaceutical policy settings that are delaying diagnosis, fragmenting care and driving avoidable hospital admissions in the bush. The peak bodies representing nurses, nurse practitioners, endorsed midwives, and midwives, together with health system experts, have written jointly to the Senate Standing Committees on Rural and Regional Affairs and Transport, warning that current settings are materially compromising timely access to essential health care across rural, regional and remote Australia. The group is warning the consequences of recent policy changes are “no longer theoretical,” with services reporting disrupted care pathways, delayed clinical reviews and increasing strain on already fragile models of care. “Reform is not optional,” said Adjunct Professor Chris Helms of the Australian College of Nurse Practitioners. “Without urgent correction, current policy settings will continue to compromise safety, sustainability and equitable access for rural, regional and remote Australians.” “These settings are no longer administrative inefficiencies – they are contributing to delayed diagnosis, fragmented care, avoidable hospital escalation and inequitable outcomes for high-risk populations,” said Adjunct Professor Helms, who signed the letter on behalf of the group. The signatories highlight the 12-month face-to-face requirement for Nurse Practitioner Medicare Benefits Schedule telehealth services as a particular concern, noting that for many rural, regional and remote Australians, telehealth is not a convenience but the only clinically viable pathway to continuity of care. Patients are experiencing delayed reviews, postponed investigations and fragmented follow-up solely due to funding restrictions. The group warns these impacts are especially serious in oncology surveillance and survivorship care, complex mental health follow-up, chronic disease management and palliative care. In addition, nurse practitioner- and midwife-led practices remain ineligible for My Medicare 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,” the letter states. The group also calls out the exclusion of Nurse Practitioners from the Repatriation Pharmaceutical Benefits Scheme (RPBS), which forces Department of Veterans’ Affairs patients to transfer to alternative prescribers solely to access subsidised medications – disrupting established therapeutic relationships for administrative reasons alone.