Only a quarter of patients' deaths are due to cancer, but the vast majority of the patients of specialist palliative care services have cancer as a primary diagnosis. Almost two-thirds of patients dying of an expected illness do not receive specialist palliative care at all, and this proportion is likely to increase as the population ages. Australian health system care for dying people needs systematic change so that people who may require palliative care in the foreseeable future are systematically identified, and have proactive care plans developed to meet their complex needs. This can be done in general practice and aged care, as shown by a model for such care in the United Kingdom. We explain the need for system change, and propose steps by which this might be achieved.