The experience of the NHS is a cautionary tale: free access paired with poorly designed wait-time targets has led to long delays, clinician burnout and a system chasing numbers instead of improving care.<\/p>\n
Healthcare systems are complex, and simple solutions rarely fix complex problems. No one disputes that affordability is a real issue. But if the goal is to build a sustainable, equitable health system, we need to ask what we\u2019re really trying to fix and whether \u201cfree\u201d gets us there.<\/p>\n
GenPro, which represents general practice owners, has welcomed Labour\u2019s focus on access but warned that design matters. As GenPro chair Dr Angus Chambers put it: \u201cWe support making access easier to general practice, but whether three free visits a year for the entire population is the most sensible way to spend the money and reduce the barriers to access with, I\u2019m not convinced of.\u201d His caution is well placed.<\/p>\n
There are at least five reasons to consider before assuming that \u201cfree\u201d automatically means \u201cbetter\u201d.<\/p>\n
1. There aren\u2019t enough GPs<\/p>\n
New Zealand is already facing a severe shortage, too few doctors, too much demand and a workforce that\u2019s ageing, burning out and leaving the profession faster than we can replace it. Making appointments free doesn\u2019t solve that; it simply floods a system already under pressure.<\/p>\n
Labour\u2019s proposal would add an estimated 4.5 million extra GP appointments every year, a huge increase in demand that can\u2019t be absorbed by a workforce this stretched. Basic economics tells us that when you remove price but don\u2019t increase supply, demand surges and something has to give. In healthcare, that \u201csomething\u201d is wait time.<\/p>\n
When every appointment is free, people naturally book more, even for issues that could be safely managed by a nurse, pharmacist or through digital triage. We also tend to see more of the \u201cworried well\u201d, people seeking reassurance rather than treatment, who understandably take advantage of a no-cost system. That\u2019s not a criticism of patients; it\u2019s human nature.<\/p>\n
That\u2019s why it\u2019s encouraging to see thinking around funded triage and digital pathways. But the real challenge lies in delivery. Without meaningful investment in new models and smarter prioritisation, clinics will remain stretched too thin to reach those who need care most. That\u2019s not equity; it\u2019s rationing by default.<\/p>\n
It\u2019s also worth remembering that one in five GP clinics aren\u2019t enrolling new patients because they\u2019re already full. If that\u2019s the reality now, what happens when every appointment becomes \u201cfree\u201d? Leave this unresolved, and we risk creating a two-tier system: those with existing GP relationships benefit, while those without are locked out altogether.<\/p>\n
Even in Sweden, one of the most equitable health systems in the world, GP visits aren\u2019t free. Co-payments exist to help manage demand and maintain sustainability.<\/p>\n
Labour leader Chris Hipkins, flanked by health spokesperson Ayesha Verrall, left, and finance and economy spokesperson Barbara Edmonds, announces a targeted capital gains tax and three free GP visits. Photo \/ Mark Mitchell<\/p>\n
2. Funding where it\u2019s needed most<\/p>\n
Universal \u201cfree for all\u201d policies sound fair, but often aren\u2019t. True fairness means targeting help where it\u2019s needed most, not subsidising those who can already afford care. Wealthy New Zealanders don\u2019t need free GP visits. But those on low incomes, M\u0101ori and Pasifika wh\u0101nau, Community Services Card holders and people aged 65 and over managing multiple health conditions do.<\/p>\n
That\u2019s where targeted investment can make the greatest impact. It should start with the basics: cervical screening and smears free when delivered by appropriately trained nurses; cardiovascular and diabetes management free when led by advanced nursing specialists (CNPs and DNPs); and immunisations and other preventive care free for all. These are the foundations of a healthier population, the right care, delivered early, by the right clinician.<\/p>\n
Broad, untargeted funding might feel equitable, but in practice it can make access less fair and widen existing inequalities. If we\u2019re going to invest billions, we should invest where the return is greatest, in the wh\u0101nau, families and communities for whom cost is still a real barrier. Every dollar spent there makes a measurable difference in lives saved, hospital admissions avoided and health outcomes improved.<\/p>\n
Blanket funding risks spreading the system too thin, forcing providers to deliver more with less and potentially worsening access for the very people the policy aims to help. A universal approach also risks repeating the mistakes of early childhood and tertiary education funding, where \u201cfree\u201d policies benefited those least in need and left providers underfunded.<\/p>\n
If affordability is the target, the solution isn\u2019t to remove cost for everyone, it\u2019s to remove it for those who need it most.<\/p>\n
3. Are we reinforcing an outdated model of care?<\/p>\n
The traditional 15-minute GP appointment was built for a different time, when most visits were short, straightforward and about treating single issues. Today\u2019s reality is very different. People are living longer, managing multiple long-term conditions and needing support that spans physical, mental and social wellbeing.<\/p>\n
A 15-minute slot can\u2019t deliver continuity, prevention or the kind of complex care that many patients now require. Yet our funding model still rewards throughput over quality, volume over value.<\/p>\n
If the goal is genuine access and better outcomes, we need to modernise how care is delivered, not just make the old model free. That means funding structures that support continuity, where patients can build trusted relationships with their primary care team, and enabling longer consultations where appropriate.<\/p>\n
Evidence shows that continuity of care delivered by a consistent, connected team reduces hospitalisations and improves outcomes, particularly for people with chronic conditions. Free appointments risk embedding a short-term, transactional model at the very moment we need to evolve towards long-term, team-based continuity of care.<\/p>\n
4. Are we supporting the whole healthcare team?<\/p>\n
Even the best-designed model fails without the right people behind it. Healthcare doesn\u2019t begin and end with GPs, it\u2019s delivered by nurse practitioners and nurse prescribers, pharmacists, mental health clinicians, kai\u0101whina, social workers and health coaches who keep communities well every day.<\/p>\n
When GP appointments are free but nurse or mental health clinicians aren\u2019t, people naturally choose what costs nothing, even when another clinician might have been the best option. That distorts demand, undermines efficiency and increases costs by sending more people to the highest-cost clinician.<\/p>\n
For this policy to succeed, Labour will need to make clear that funding extends across the entire primary care workforce. Every clinician, not just GPs, must be properly resourced to work at the top of their scope.<\/p>\n
This is where Labour\u2019s proposal for an Independent Pricing Authority (IPA) is a genuinely good idea, a rational, evidence-based way to align funding with real costs and ensure sustainable, multidisciplinary care. A sustainable health system doesn\u2019t revolve around one profession; it thrives on collaboration. The goal isn\u2019t to spend less, it\u2019s to spend wisely, building a connected front line that values every contributor and keeps people healthy in their communities.<\/p>\n
Once a service is \u201cfree\u201d, it becomes politically untouchable. Photo \/ 123RF<\/p>\n
5. Have we learned from previous \u2018free\u2019 policies?<\/p>\n
We\u2019ve seen this pattern before. \u201c20 Hours Free ECE\u201d was a well-intentioned policy that made early learning more affordable, but funding never matched the real cost of delivery. Centres were forced to absorb shortfalls, \u201coptional charges\u201d emerged and quality slipped. The \u201cFees-Free\u201d tertiary policy followed a similar path: intended to help students in hardship, it ended up benefiting wealthier groups the most.<\/p>\n
Healthcare risks the same fate. \u201cFree\u201d is politically powerful but operationally fragile. Unless funding matches real costs, year after year, the promise will buckle under pressure.<\/p>\n
Healthcare costs rise annually through wages, consumables, technology and rent. General practice has been underfunded for decades, forced to absorb those increases while doing more with less. Without structural reform, \u201cfree\u201d could quickly become unsustainable.<\/p>\n
And once a service is \u201cfree\u201d, it becomes politically untouchable. If funding fails to keep up, quality inevitably suffers. Practices can\u2019t adjust fees to survive, so they reduce services, freeze hiring or limit enrolments. The result is a system more dependent and less resilient.<\/p>\n
Sweden\u2019s health system shows that low-cost care can work, but only when underpinned by deep resourcing, strong planning and a robust workforce strategy. New Zealand doesn\u2019t yet have that foundation.<\/p>\n
A stronger, fairer way forward<\/p>\n
The answer isn\u2019t to make more appointments free; it\u2019s to make every interaction count. That means funding models that lighten the clinical load through AI-assisted workflows and digital triage, encourage team-based care so patients see the right clinician at the right time, reward prevention and outcomes rather than volume, and direct funding to where it\u2019s needed most, supporting people and communities for whom cost remains a genuine barrier.<\/p>\n
That starts with getting the basics right: free cervical screening by trained nurses, free cardiovascular and diabetes care led by advanced nursing specialists, and free immunisations and preventative care. These are the foundations of a healthier population \u2013 the right care, delivered early, by the right clinician.<\/p>\n
Technology is already transforming what\u2019s possible in healthcare. Smarter tools, better data and AI-driven insights can make care more accessible, efficient and human. Labour\u2019s inclusion of AI and digital triage in its policy platform is a step in the right direction, but implementation is the hard part.<\/p>\n
At Tend, we\u2019ve seen both the potential and the challenge first-hand. We\u2019re New Zealand\u2019s largest implementer of AI in primary care, not by outsourcing it, but by building it ourselves. Our AI scribing tool, designed specifically for the New Zealand clinical environment, has already supported more than 125,000 consultations, both in person and online.<\/p>\n
The value of AI isn\u2019t in quick efficiency gains; it\u2019s in creating sustainable workloads, improving documentation accuracy and freeing up clinicians to focus on care. AI doesn\u2019t replace care; it rebalances it. But it\u2019s not a magic switch. Implementing AI safely takes careful design, strong governance and true integration into clinical workflows. Technology should empower clinicians, not replace them.<\/p>\n
If we want a sustainable future for healthcare, this is what it looks like: not \u201cfree\u201d, but fair, thoughtful and enduring. The real measure of success shouldn\u2019t be how many people see a GP, but how many stay well because they could access the right care early.<\/p>\n
With the right investment and vision, New Zealand can build a fairer, more resilient health system, one that empowers clinicians, embraces technology and puts people at the centre. It\u2019s encouraging to see both the current Government and the opposition continuing to prioritise and invest in primary care, recognising its critical role in improving health outcomes and equity.<\/p>\n
The future of healthcare isn\u2019t about doing more for free; it\u2019s about designing smarter, more equitable care that delivers better outcomes for all New Zealanders.<\/p>\n