The statistics are damning. In 2023, 43% of patients in England could not get a GP appointment when they needed one, according to the British Medical Association's own data. The average wait time for a routine appointment has stretched to over two weeks, with some practices booking three weeks in advance. Meanwhile, A&E departments report that 30% of attendances could have been handled by a GP — if patients could actually see one.
This is not a story about underfunding. NHS England's budget for primary care has increased by 15% in real terms since 2019. The problem is structural, and it stems from a system that has insulated general practice from the basic market forces that drive efficiency and patient service everywhere else in the economy.
The GP Partnership Monopoly
At the heart of the crisis lies the GP partnership model — a relic of the NHS's 1948 founding that grants family doctors exclusive territorial rights over patient lists. Unlike hospital consultants who are salaried employees, GPs operate as independent contractors with guaranteed income streams regardless of patient satisfaction or accessibility.
This creates perverse incentives. A GP partnership that limits appointments to reduce workload faces no meaningful competition. Patients cannot easily switch practices, particularly in areas where all local surgeries maintain waiting lists. The result is a cartelised market where supply is artificially constrained and consumer choice is virtually non-existent.
The contrast with other healthcare systems is stark. In France, patients can see any GP without referral and appointments are typically available within 24-48 hours. In Germany, practice opening hours are regulated to ensure evening and weekend availability. Both systems achieve better primary care access while spending comparable amounts per capita.
The Workforce Flexibility Problem
The current GP contract structure also stifles workforce innovation. Nurse practitioners, physician associates, and other healthcare professionals could handle routine consultations, minor ailments, and chronic disease monitoring — tasks that consume 60-70% of GP time. Yet the partnership model creates financial disincentives to employ these alternatives, as partners must share profits with additional staff while bearing the costs of training and supervision.
Private healthcare providers have demonstrated what's possible. Companies like Babylon Health and Push Doctor offered same-day video consultations before regulatory barriers restricted their NHS contracts. Private GP services routinely provide appointments within hours, not weeks, because they compete directly for patients.
The Political Cowardice of 'More Money'
Labour's response to the GP crisis follows a predictable pattern: promise more funding without addressing fundamental reform. Shadow Health Secretary Wes Streeting has pledged an additional £1.6 billion for primary care, but this misses the point entirely. The NHS already employs more GPs per capita than most European countries — the problem is how they work, not how many there are.
This approach represents political cowardice dressed as compassion. It's easier to promise taxpayer money than to confront the vested interests that benefit from the current system. GP partnerships earn average profits of £150,000 per partner while maintaining appointment scarcity that would bankrupt any private business.
The Conservative Case for Reform
True conservative healthcare policy should embrace three principles: patient choice, provider competition, and taxpayer value. This means breaking the GP partnership monopoly and introducing genuine market mechanisms into primary care.
First, patients should have the right to register with any practice within a reasonable travel distance, creating competition for the most accessible and responsive services. Second, alternative providers — from private companies to social enterprises — should be able to bid for NHS primary care contracts on equal terms with traditional partnerships. Third, payment structures should reward practices that provide timely access, not those that manage demand through rationing.
The objection from the medical establishment is predictable: market reforms will create a 'two-tier' system that undermines universal healthcare. This argument collapses under scrutiny. We already have a two-tier system — one where the wealthy pay privately for prompt access while ordinary families wait weeks for basic care. The difference is that market reform would extend choice and competition to benefit everyone, not just those who can afford to opt out entirely.
International Evidence
The Netherlands provides a compelling model. Dutch primary care operates through regulated competition, where patients can switch practices easily and providers compete on quality and access. The result: 85% of Dutch patients can see their GP within one day when needed, compared to 57% in the UK. Healthcare outcomes are superior, and per-capita costs are lower than the NHS.
Photo: The Netherlands, via thetrustedtraveller.com
Similarly, Australia's mixed public-private primary care system ensures that bulk-billed (free at point of use) appointments are available alongside fee-paying options. This creates competitive pressure that benefits all patients, regardless of their ability to pay.
The Broader Implications
The GP appointment crisis is a microcosm of Britain's broader economic malaise — a combination of monopolistic structures, regulatory capture, and political unwillingness to confront entrenched interests. A country that cannot provide timely access to basic healthcare will struggle to attract investment, retain talent, or maintain social cohesion.
Conservatives should recognise that defending the NHS's current structure is not conservative at all — it's defending a socialised monopoly that fails patients while enriching providers. True conservative healthcare policy would harness market forces to deliver what the current system cannot: accessible, responsive primary care that serves patients rather than professionals.
The choice is clear: embrace reform that puts patients first, or watch Britain's primary care system continue its managed decline while politicians promise more money for the same failed model.
