The Division was established in September 1994 and was incorporated under the NSW Associations Incorporation Act in August 1995.

The Division was formed as a breakaway from the South East New South Wales Division because, whilst the area is rural and the GPs practice 'rural medicine' by providing hospital services etc, the relationship for referral and support services is all to the north, to Liverpool and Campbelltown. There are no relations to the south.

At the time of establishing the Division, consideration was given to joining Macarthur Division based at Campbelltown, some 66 Km to the north. However, it was recognised that the Campbelltown medical community; the health services; and the community in general were entirely different at the two locations. The Southern Highlands is distinctly rural whereas Campbelltown is urban in all of the above three respects.