Targeted primary care investment will make ‘biggest difference’ to the NHS, think tank says

The Government should prioritise moving resources to primary care services to fix the NHS, rather than considering moving to an insurance-based healthcare system, a leading think tank has argued.

The Institute for Public Policy Research (IPPR) found that there is ‘no evidence’ that insurance-based healthcare systems out-perform tax-funded systems, and argued that the NHS’s poor performance against comparator countries is ‘partly driven by chronic underinvestment’. 

Their analysis – spanning 22 high-income countries – concluded that switching the NHS to a European-style insurance system would not improve performance across measures of capacity, access, quality, efficiency and equity. 

The report also found that on GP access, the UK is a ‘relatively high performer’, performing better than France and Germany on access to general practice.

The authors also pointed out the risks of transitioning from one system to another, saying any such move could ‘cost billions and potentially take decades’. 

They said that evidence points to areas (see box) where additional spend and policy attention ‘will make the biggest difference’, including primary care.

However, they warned against more structural changes, pointing out that reorganising institutional boundaries and contracting models ‘often absorbs management capacity without directly improving care’.

The report said: ‘International evidence consistently shows that systems with stronger primary care services achieve better outcomes at lower cost.

‘The Government’s neighbourhood-first approach is well-aligned with this evidence. Its implementation must be a strategic priority in this parliament.

‘Strengthening primary and community care must begin with improving the delivery offer: better access, more personalised support, and more effective management of long-term conditions before they escalate.

‘Structural reform may aid these efforts, but recent NHS history suggests that reorganising institutional boundaries and contracting models often absorbs management capacity without directly improving care.

‘Structural change should be tightly sequenced and explicitly justified in terms of clear delivery improvements.’

In a foreword to the report, Lord Ara Darzi said: ‘This report does not merely diagnose. It sets out where targeted investment and reform will make the greatest difference: sustained capital investment to address the NHS’s long-standing infrastructure deficit; a genuine shift towards primary and community care, where the evidence shows consistently better outcomes at lower cost; serious resourcing of long-term and social care, where the gap between England and comparable countries is striking; and a more ambitious approach to public health.

‘These are the priorities that will determine whether the NHS is able to serve the next generations as it has those before.’

In 2024, Lord Darzi’s own review of the state of the NHS had recommended increased GP funding should be a ‘fundamental strategic shift’.

The IPPR report concluded that sustained capital investment will be required to put the NHS back on its feet before progress can be made on long-term transformation.

And it said that while attempts to bring additional capital into the service through public-private co-investment models are ‘welcome’, given the scale of the NHS’s capital deficit, the Government should consider revisiting the capital settlement agreed in the 2025 spending review.

Head of health at IPPR Sebastian Rees said: ‘There is no structural silver bullet for the NHS. The idea that simply switching to a European-style insurance model would fix its problems is a pointless distraction and not supported by the evidence.

‘The NHS’s challenges are real – but they are the result of a decade of chronic underinvestment and choices on how money is spent, not the funding model itself.

‘Policymakers should focus on what actually works: investing in infrastructure, strengthening primary care, and tackling the drivers of poor health.’

In a speech at the report’s launch this morning, health secretary Wes Streeting said: ‘Our approach is to invest in the NHS, to modernise it, and transform the way it delivers healthcare. We are doing all of that while protecting its founding principles.

‘Healthcare with Labour will always be free at the point of need, owned by us, funded by us, there for all of us.

‘As the IPPR report finds, the NHS’s problems would not be solved by moving to a different funding system. It blows out of the water the assumption on the Right that an insurance model would be more efficient.

‘The NHS model is the fairest way of funding healthcare. I believe that as a matter of principle, but IPPR underlines the pragmatic case, too.

‘And when you look at what’s coming down the track, it is the model that gives us the best chance of seizing the opportunities of the future.’

The IPPR had previously suggested that GP practices should operate as ‘spokes’ to a central ‘neighbourhood health hub’.