The federal government plan to treat diabetes patients could widen the gap between city and country health services, a source of anxiety for rural doctors.

The $436 million proposal would give doctors a fixed annual payment to treat diabetics as well as incentives if the patient's health improves.

Dr Nola Maxfield from the Rural Doctors Association however says the plan does not seem to take into consideration some of the dilemmas in treating people who live outside major cities.

People who live in rural areas tend to be older and they tend to be sicker and have poorer health outcomes already, she said.

They also have less access to doctors and to diabetes educators and allied health people.

The plan was also criticized by the Australian Medical Association, saying they were not consulted and that it is policy on the run.

But, Nicola Rixon, the Federal Health Minister, rejected the claims.

She said, This was recommended by our health reform commission whose report was released in July last year.

The chair of the AMA's division of general practice was on that committed and recommended voluntary enrolment for chronic disease.