The Nationals held their first state conference since 2019 in Port Macquarie from Thursday to Saturday.

Delegates from party branches across the state approved an amended motion calling on the state government to "split the Hunter New England health district into two separate health districts".

A second clause, calling for Tenterfield to be shifted out of the local health district and moved into neighbouring Lismore, was removed for simplicity's sake.

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Chair of the Tamworth branch of NSW Nationals, Ian Coxhead, voted for the motion.

He said the argument about local control of health services won the day.

"Basically there's been a dropping-off of services," he said.

"With the Hunter New England health the services seem to be drawn back to Newcastle and of course a lot of the money is spent in Newcastle instead of in smaller regional hospitals, particularly Gunnedah and Inverell.

"They were very vocal about the lack of money to fund staff and to fund improved health services in those two towns."

Northern Tablelands MP Adam Marshall told the Leader that the motion was passed without opposition.

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The vote adds to months of pressure on the government for a rethink of the local health district.

Governing health institutions from Newcastle to the border with Queensland north of Tenterfield, the Hunter New England Local Health District (HNEH) is the state's only health body which covers a metropolitan community and a large rural area.

It was created in 2005 when the old New England and Hunter health districts were married into one, over local protest.

All eight mayors of the New England Joint Organisation of councils (NEJO) voted in March to investigate the option.

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Late that month, Northern Tablelands MP Adam Marshall issued what he called an "ultimatum", in a dramatic escalation of the campaign for reform of the "Newcastle-centric" bureaucracy. The MP said the service had cannabalised services from the bush to reinforce Newcastle.

The motion was introduced to the conference by the Nationals Central Council.

The party's next state conference will be held in Tamworth, a holdover from a decision three years ago. It was delayed as a result of COVID-19.

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