“Beyond workforce”: a systemic solution for health service provision in small rural and remote communities

• Successful, “innovative” primary health care (PHC) models exist that have adapted to the specific circumstances of their rural and remote context.
• A typology of discrete, integrated, comprehensive and outreach rural and remote services exists rather than a “one coat fits all” PHC health service model.
• Successful models are characterised by macro-scale environmental enablers (supportive health policy, federal– state relations, and community readiness) and five essential service requirements (workforce organisation and supply; funding; governance, management and leadership; linkages; and infrastructure).
• Service sustainability depends on ensuring that key systemic service requirements are met at the local level in ways that accord with, and are supported by, the broader macro-scale environmental enablers.
• Based on these principles, these model types are amenable to generalisation and evaluation in other regions.