Fixing the NHS means embracing private providers
As a German health economist who lived in Britain, I learned a lot about the NHS and people’s admiration for it. But there is one aspect of the system that continues to baffle me: the sheer length of time it takes to be seen, treated, or referred. In Germany, such delays are practically unheard of. Here in the UK, they are a daily reality.
Across the board - from GP appointments to specialist consultations to elective surgery - wait times in Britain are unacceptably long. And they are worsening. Over 7.5 million people in England are now on NHS waiting lists for elective treatment, with many patients forced to wait more than a year. In Germany, such backlogs are so rare that waiting times aren’t even routinely measured. Why? Because they simply aren’t a problem.
Let me offer a comparison drawn from both experience and data. To see a GP in Germany typically takes four days, often less, especially for those with private insurance. In the UK, the average wait is around 10 days, and over 17 million patients last year waited more than four weeks. To see a specialist in Germany, patients with statutory insurance wait about 30 days on average; those with private insurance, just over a week. In the UK, the median wait is 3.3 weeks, but many patients - especially in under-resourced areas - endure delays of five months or more.
And then there is elective surgery. The NHS aims to treat patients within 18 weeks of referral, yet millions wait far longer. Many live in pain, their conditions deteriorating, with no clarity on when - or even if - their operation will come. In Germany, while detailed nationwide statistics on elective surgery waits are scarce, that is mainly because there’s no pressing need to collect them. The system works well enough that delays are not a major policy concern, and patients are generally treated within weeks, not months.
What explains this difference? A large part of the answer lies in how healthcare is structured. Unlike the UK’s predominantly state-run NHS, Germany delivers universal healthcare through a system in which most services - from GPs to hospitals - are provided by private doctors, clinics, and hospitals operating within a publicly funded framework. This model blends universal coverage with the efficiency and responsiveness of independent providers. Patients can choose among a wide network of competing practices, which creates incentives to offer timely, high-quality care. The result is a system that remains accessible to all, yet agile enough to avoid the long bottlenecks and delays that have become commonplace in the NHS.
Germany’s system does demonstrate that long waits are not a universal feature of public healthcare - they are a symptom of policy choices and systemic design.
British patients deserve better than this. They should not be left in limbo for months on end, navigating pain and uncertainty while they wait for a basic consultation or procedure. The Health Secretary, Wes Streeting, must make it his urgent mission to tackle this crisis head-on. That means learning from systems that are delivering care in a timely and equitable way — and that means looking to places like Germany.
This is not just a policy issue. It is a moral one. No one should wait over a year for surgery. No one should have to chase down GP appointments or specialist referrals like lottery tickets. A civilised society does not tolerate that, and a modern healthcare system should not require it.
If Britain is serious about restoring the NHS to the pride of place it once held, it must move beyond slogans and begin emulating systems that work. Germany is one of them. And the lessons are there, if only someone is willing to listen.
Fred Cyrus Roeder is a German Health Economist and Managing Director of the Consumer Choice Center.
