Wagga MP Joe McGirr this week launched a petition calling on the state government to establish a department of rural health, separate to the existing NSW Health framework, in an effort to address ongoing issues in the rural healthcare sector.

Dr McGirr, who has first-hand experience in regional emergency medicine and hospital management, said his idea is about "taking part of the bureaucracy [and] putting it in the region".

The independent MP said his idea was developed following hundreds of submissions to the rural health inquiry, as well as the appointment of the state's first rural health minister.

"I think she [Bronnie Taylor] wants to make a difference," Dr McGirr said of the new minister.

"For her to get things done she needs a team ... that will focus on these issues and I don't think a team that's doing that currently exists."

The proposal for a new department has four key ideas including a focus on workforce, being an advocate so "any decisions that impact rural health ... those considerations are noticed", ensuring services stay put and expand, and improving collaboration between the state and federal governments to make sure issues are addressed.

"No one wants to own the issue; they own parts of it, they don't own the total issue - it needs to sit on someone's desk," Dr McGirr said.

In practice the new department would see existing NSW Health staff reallocated to rural areas to tackle some of the biggest issues facing rural medicine, particularly recruitment and retention.

This on-the-ground workforce would need to have significant authority in human relations, Dr McGirr said, plus be able to negotiate conditions, develop policy, and influence the government by reporting to the minister.

Corporate services operated by NSW Health out of Sydney could remain the same, he added.

"But things like recruitment, they've got a very centralised recruitment process and I think they tend to slow recruitment down," Dr McGirr said.

"They're bound by the rules that come out of Sydney and the approaches that come out of Sydney, and the workforce in Sydney is totally different."

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At this stage he hasn't conducted any costing for a new department of rural health, and said it would take "a process of some months" to establish one, but believes this is "the job of the government and the bureaucracy".

The specifics of how they would set it up is in their hands, Dr McGirr said, but his stance is that it needs to be a new focus for a new department, and a new focus for rural healthcare.

He said workforce shortages across rural NSW have been an issue for 30 years, and although he acknowledges the state government's investment in new infrastructure throughout the last decade, Dr McGirr said there are still small hospitals without medical practitioners.

"Somehow we have just slid into that situation where somehow people think that is acceptable; the bureaucrats think that's acceptable," he said, while doctor shortages are a "burning issue" in the communities where the impact is felt.

"I think the issue is they're just based in metro, they see the state through the one lens, the [local health districts] have to report into that central structure and there's no one on the ground dealing with the issues out here who has authority to implement a changed way of approaching them."

Temora doctor and vice-president of the Rural Doctors Association of NSW (RDANSW), Dr Rachel Christmas, has welcomed Dr McGirr's focus on rural health but said she worries that a new department may further fracture rural healthcare services from metropolitan ones.

Instead of creating a new department, Dr Christmas said there is a breakdown of communication on a number of levels that needs to be addressed - rural healthcare workers on the ground to city department bureaucrats, and between the state and federal governments.

"We need a way of actually being able to bring ideas to the table, solutions and have them listened to," she said.

"Engagement is really important and that engagement has to be genuine with a view to actually listening and enacting recommendations."

Dr Christmas said she is in full support of the premise of Dr McGirr's idea, that rural health is of equal importance to metropolitan health and that decisions made at the highest level need to account for those on-the-ground at the local level.

"I just have reservations and I think the [RDANSW] has reservations about fractionating rural health even further from the ministry," she said.

When asked why NSW Health itself shouldn't just be reformed to better tackle rural issues, Dr McGirr said "we don't have that time" due to it being a large organisation.

"I think if you keep doing the same things and expect a different result, you're not going to get a different result," he said.

"How do you get the bureaucracy to focus on the issue out here? ... I think we've reached a point where I'm not sure the bureaucracy can. It's not a criticism, it's just not designed to do it."

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