A series of well-meaning reforms designed to make primary care more affordable have instead helped push Jersey’s Health Insurance Fund towards an “unsustainable” future, according to the public spending watchdog.

Comptroller and Auditor General Lynn Pamment’s latest report concludes that while recent changes have removed cost barriers and broadened services, they have also piled pressure onto a fund now forecast to fall into annual deficit.

The HIF – which subsidises GP visits, prescriptions and other primary care services – is expected to shrink to £61 million by the end of 2029, less than a year’s expenditure. The Budget 2026–2029 warns it could be exhausted in the early 2030s without intervention.

Ms Pamment said: “The HIF is not sustainable in its present form and there is no tangible plan for primary care in the context of a sustainable, integrated health care model for the future.

“The government does not routinely assess value for money from new initiatives funded from the HIF – and the changes since 2022 have increased the risk of overpayment from error or fraud.”

There has been no clear plan of action for it since the 2021 actuarial review, despite clear indication that funds would run low, she added.

Reacting to the report, the government said that work to assess long-term funding options are “well advanced” and has been its “priority throughout 2025 and into 2026”.

It added: “Ministers have been clear, including in the 2026 Budget, that action is needed to address long‑term pressures on health funding caused by increased treatments and enhanced support with healthcare costs.”

Access expanded – but at a price

Since 2020, spending from the fund has risen sharply – from £30 million in social benefit payments in 2020 to £52 million in 2024, with forecasts of more than £67 million by 2029.

That increase reflects a wave of initiatives aimed at improving access and quality in primary care.

Over recent years, ministers have agreed to cut GP fees by £20 and then by a further £10, to introduce free GP appointments for all children and students, to subsidise home visits, to fund wound dressings and hosiery for patients with clinical need, and to expand support for nurses, allied health professionals and pharmacies.

Taken individually, many of these initiatives were framed as modest, targeted interventions designed to relieve pressure on households or strengthen community healthcare.

Collectively, they have transformed the spending profile of the fund.

The additional annual cost of routine GP appointments alone, including subsidies for adults, children, students and those eligible under the Health Access Scheme, is estimated at more than £16 million by 2026.

At the same time, between 2022 and 2026, an additional £12.3 million has been committed to support general practice and £12.4 million to pharmacies.

Good intentions, weak safeguards

The C&AG is clear that these reforms were not without merit – they have reduced financial barriers, expanded the breadth of services and placed greater emphasis on prevention and quality.

However, she found that many were introduced without full and consistent assessment of long-term impact on the fund, without sufficient consideration of system and resource implications, without robust metrics to assess value for money, without clear affordability analysis – and, in some cases, without adequate controls.

For example, when the £20 GP fee reduction was introduced, there was a recognised risk that practices might raise their own fees, offsetting the benefit to patients. No robust control was put in place to prevent that.

The review found that eight practices increased face-to-face consultation fees between May 2024 and July 2025 by between 32% and 59% – increases greater than would be explained by inflation.

At the same time, the Government has no direct control over GP pricing, despite subsidising a significant portion of the cost.

Other schemes – such as free GP appointments for children and students – were based on simple assumptions, with limited evidence to validate calculations and no detailed assessment of the risk of rising consultation volumes.

The business case behind the decision to fund free wound dressings and hosiery for patients with clinical need set out anticipated benefits for patients and the wider care sector – but made no reference to the overall affordability of the measure or its longer-term impact on the Health Insurance Fund.

Ms Pamment found that the cost of implementation was not included, nor was there detail on what additional controls would be required within the system.

The broader operational implications for government and community pharmacies were similarly left unexplored, according to the report.

What did the report recommend?

A total of 13 recommendations were contained within the C&AG’s report – as well as four areas of work which she deemed should be prioritised and one “area for consideration”.

Among the core recommendations was a suggestion that a clear “governance map” should be created, which should “seek to eliminate duplication and inefficiency”.

Several of the recommendations also suggested more thorough reviews of the various projects which require funding from the HIF, while a formal policy statement on the minimum balance to be held in the fund should also be proposed, according to the C&AG.

Another was to update the States proposition and Ministerial Decision procedures to ensure future changes are backed up by evidence and consider the implications on the fund.

It also suggested that developing a joint audit programme should be considered to monitor the HIF.

What is being done about it?

In a statement responding to the report, the government said: “Significant preparatory work has already taken place, and several of the C&AG findings and recommendations are already underway.

“This includes consideration of reform of the Health Insurance Fund as part of a whole healthcare system approach, rather than viewing the Health Insurance Fund in isolation.

“The newly established Health and Care Partnership Board, which includes a wide range of health and care organisations, will also assist in considering options.

“This work will help inform future Budgets securing effective and sustainable delivery.

“The ministers thank the Comptroller and Auditor General for their report on the Health Insurance Fund (HIF) and will review their findings and recommendations carefully.”