Can The French Offer The NHS Some Lessons on Funding Effective Healthcare?

How Healthcare funding differs across the channel

What does it mean to be British? It’s a question that has got everyone in a twist in recent years. But if we know Britain as a set of cultural norms, values and memories, then we can think of some answers, whether it be Del Boy selling something ‘knocked’ off down the Nag's Head, apologising after absolutely everything, a football obsession that we proudly proclaim is our game and finally, an NHS that has become part of the national psyche.

The NHS has become so ingrained in our identity that even a discussion to change its funding model could spell the end of a politician’s career in high office. But with funding issues now dominating headlines, is it time for the British to ask: How do the French do it?

Should we be more French?

One thing we can say about the UK healthcare system is that it is fairly easy to explain (GP partners aside). We fund roughly 80% of the NHS’s budget through general taxation, with national insurance contributions covering most of the rest. A small amount of cash is generated from patient charges, such as prescription costs, but this is negligible relative to the overall budget. The government then allocates these funds to NHS organisations to pay salaries and deliver services, amongst other things. Simple.

Make a short trip across the Channel, and you’ll find France runs its healthcare system very differently, particularly in how it is funded. It operates a state-regulated social insurance model, in which most healthcare costs are covered by Assurance Maladie, financed through a combination of payroll contributions and taxation (a bit like our general taxation and national insurance contributions).

But this does not cover all costs, though. The remaining share is usually paid through complementary “top-up” insurance (“mutuelles”), which French citizens need to ensure that they have. For most employees, this supplementary cover is mandatory and partly funded by employers. Lower-income groups, pregnant women, and some patients with chronic conditions can receive full coverage through schemes such as Complémentaire santé solidaire.

So if you visited your local Parisian GP and were charged, let’s say, 30 euros for your visit, you would pay the practice and only weeks later be reimbursed by your insurance company.

Now, introducing the conversation of money in health divides opinion. For some, the mere mention of money in healthcare leaves them uncomfortable; for others, the introduction of the topic creates a psychological cost that influences behaviour. It creates a clearer sense in society that healthcare has a finite cost and could perhaps reduce unnecessary abuse of the healthcare system.

What’s the Verdict?

The reality is that the two systems are incredibly different. France converts its funding into access differently. Long waiting lists, where one waits weeks to speak to a clinician or even book a GP appointment, have become characteristic of the NHS and are simply not seen anywhere near the same degree in France.

Now, the Commonwealth Fund report in 2020 showed that France spends 20% more per person on health than the UK ($5,154 compared with $4,290), and some argue that if we simply increased NHS funding, we would see comparable outcomes. Is it as simple as this? Spending more is likely to help, but some believe that without structural changes in how care is delivered and funded, the long-term future of the NHS remains in doubt.

Longevity Clinics: More Data, More Problems

Everywhere you turn in 2026, you are met with ‘Longevity Medicine’ clinics and doctors. The appeal is understandable: a more sustainable vision of healthcare has to involve people staying healthy, rather than managing the crises when they arrive. Enter longevity medicine, promising deeper conversations that last longer than 10 minutes, an abundance of tests and biomarkers and often, a hefty bill at the end.

These clinics operate on a simple premise that has become the norm in 2026. More data points can only be a good thing. People today track their sleep, their exercise, their meals and so on. Being data-driven is, of course, noble, but when it comes to health, do we need hundreds of tests to know that eating well, maintaining a healthy weight and sleeping enough are the strongest determinants of good health? 

There has to be a point where we ask a serious question about when the harms of additional tests, such as incidental results, false positives, cascade testing and unnecessary NHS referrals from these companies begin to weigh the NHS down.

Where Have All The Secretaries Gone In The NHS?

Is low administrative spending holding back our doctor workforce?

Admin… it can be the bane or saviour of many doctors’ lives. But is slow administration simply a product of our lack of investment in making it more efficient? Most NHS consultants rely heavily on their medical secretaries to keep the ship sailing, yet recent “efficiency savings” have seen huge cuts to this sector.

As a total share of health spending, the UK actually spends far less on administration than comparable countries.

The Cost of “Saving”

What this has now created is a system where NHS doctors spend far too much of their precious time doing admin tasks and typing away without end. So hang on, should the numbers above surprise us? Of course, it is in the private sector where you will find huge numbers of medical secretaries, medical scribes and personal assistants to help their senior doctors out. In the NHS, however, many of these administrative tasks fall on doctors, and specifically senior consultants.

The taxpayer will also have good reasons to be aggrieved by this. When a consultant sits down for an hour to do tedious referral forms and paperwork, the taxpayer is effectively paying a consultant’s hourly rate for a task that could be performed much more cheaply, while also freeing up their time for more “meaningful activities” such as treating patients or teaching juniors.

Many of us have rotated through departments that demonstrate both extremes of this issue. For those lucky enough to have worked in departments with efficient administrative teams, they know how streamlined clinic referrals and paperwork can be.

Perhaps we should be starting a new discussion: whether the NHS should be diverting funds towards better-qualified administrators to support our consultant and resident doctor workforce to do the patient-facing work they came into this profession for.

“It was the first time we saw real involvement from our prime minister in the pay dispute. He offered a warning to the BMA that ongoing strike action would threaten the additional training places offered in this year’s application, and it seems from Streeting this week that this was not an empty threat as many predicted.”

"We need to end the scrub top and jeans combinations. I am not even one to die on the hill of dressing smart, but come on… we used to be a serious profession.”

“Interesting one from Starmer this week: The NHS should fit around your life, not the other way around. Surely he isn’t addressing doctors here? After uprooting my life to move deaneries three times, frequently arriving home after my kids are in bed and spending my non-working hours building my CV, I can assure you that my life does revolve around the NHS Prime Minister.”

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Some things to review when you’re off the ward…

Around one in five deaths in 2023 were considered preventable or treatable in England (21.6%), with the leading cause of avoidable mortality remaining cancer. This puts the NHS as the second worst in the developed world for avoidable deaths. This all comes despite record funding for the NHS, which currently sits at £242 billion. Where is it all going wrong?

Check out this post in the BBC this week about how two health trusts are set to cut 600 roles by 2028, reducing the people they employ by 3.75%. North and South Tees NHS Foundation trusts said the staff reductions were necessary to ensure their workforce models reflected the needs of the region. No comment has been made about where specifically these cuts were coming from.

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The “Seniority Jump”: Amending Consultant Pay Scales

Nodal point reform in the resident doctor pay dispute has got many thinking about how Consultant pay should evolve to ensure fairness. While resident doctors have dominated the headlines, a new proposal for Consultant pay has been gaining traction on online forums regarding speciality-specific entry points.

The core of the argument surrounds mandatory training duration. For example, to become a cardiology consultant requires a minimum of 8 years additional training after F2; three years more than the mandatory five years needed to become a Radiology Consultant. Yet, on "Day 1" as a Consultant, both are paid the same. The proposal is to bump the said day 1 cardiology consultant to year 3 seniority pay.

What do you think about such a reform? The logic of three more years sacrificed for the cardiologist certainly makes sense, but many would argue that our pay scales are designed to reward output and responsibility of the current role, not the length of the journey it took to get there. There can be no doubt about the huge gulf in the roles and responsibilities of a senior registrar and a consultant.

Is this a correct way of structuring pay? Well, we will leave that to our On-Call audience. Perhaps a “training completion bonus” would be more appropriate for certain specialities with longer training routes rather than a nodal-pay jump.