Negotiating the future. The development of family health nurses and family nurse practitioners in remote and rural Australia.

BACKGROUND The World Health Organisation HEALTH21 strategy has firmly placed families and family oriented services at the core of health care delivery. OBJECTIVE In this article we argue that a fundamental reorganisation of primary health care practices in remote and rural Australia needs to be undertaken. DISCUSSION Nurses have been shown to be equally effective and less costly than general practitioners. Family nurse practitioners should be a first point of contact, and family health nurses should be responsible for responding to problems of multiple deprivation and social exclusion in remote and rural areas. These practitioners would, in their respective areas of responsibility, identify, diagnose, refer or treat individuals, families and communities. In effect they would act as gatekeepers to health and social care services. Family health nurses would also aim to support the community in developing and sustaining the capacity to take responsibility for its own health and social care. The main obstacles to these initiatives are concerns of general practitioners and nurses, the inertia of large organisations when faced with the need to undertake radical change and the highly unionised and rule bound nature of Australian nursing.