In its ideal state, primary care strengthens population health, enhances quality of life and extends life expectancy. Despite broad consensus on its importance, it gets barely a mention in the budget. That New Zealand is not alone is little solace. Common global themes include wait times, access to care and healthcare workforce shortages, according to the McKinsey Health Institute.
Historically, a primary care practitioner has been the first point of contact for preventive care — administering vaccines or ordering colonoscopies — as well as for diagnosing and managing illnesses and conditions from ear infections to obesity.
When providers are not providing continuous care throughout a patient’s life, they are referring patients to specialists for what they suspect could be a mental disorder, a type of cancer or an orthopaedic problem.
However, despite broad consensus on its importance, access to primary care remains a global challenge, no better example than New Zealand. While there are wide variations in populations and funding, common themes include wait times, access to care, and healthcare workforce shortages.
This ranges from almost 60 percent of UK adults in a survey saying they have the most difficulty accessing general practitioner (GP) services; 54 percent of participants with unmet needs in a Canadian study citing long wait times as the main reason; to around half of public primary care positions in Sierra Leone being filled by unsalaried volunteer workers and five percent of Haiti’s rural population having access to good quality primary care.
The cost of inaction is clear: widening inequities, avoidable disease burden, and escalating system strain. The opportunity, however, is equally compelling—a more resilient, equitable health system anchored in strong, accessible primary care.
Yet what distinguishes the United States (and arguably New Zealand) is not only uneven access to primary care but also underinvestment in the very system intended to keep people healthy.
While other OECD countries allocate roughly 13 percent of their health spending to primary care, the United States and New Zealand spend only 5-6 percent—a structural imbalance that undermines both health outcomes and economic productivity. Patients can wait weeks for appointments especially in some rural and underserved areas.
The future of primary care includes empowering patients, reimaging both the workforce itself and how care is delivered.
Recruitment is one concern: 32 percent of all physicians in the US practice primary care specialties (including internists, pediatrics, gerontology, and family medicine), but the field has struggled to recruit medical students.
In New Zealand, general practitioners make up less than 24 percent of the active medical workforce, down from nearly 40 percent in the year 2000. Recent polls indicate only 14 percent of medical students are considering careers in general practice. [1, 2, 3, 4]
As discussed in the 2025 McKinsey Health Institute (MHI) report, “Heartbeat of health: Closing the healthcare workforce gap,” across specialties, the gap between population needs and system capacity in any country threatens its health and its economic vitality.
In the United States, McKinsey says, without bold investment in primary care—expanding the workforce, reducing burnout, modernizing delivery models, and aligning incentives—the United States risks declining productivity, rising preventable disease, and deepening inequities. The same can be said for New Zealand.
In an ideal state, patients can prioritise primary and preventive care as part of their daily lives, have access to the care they need beyond traditional referral pathways, and ultimately support primary care clinicians’ efforts to address patient needs.
The case for action:
Strengthening primary care to protect health and economic resilience.
When people cannot receive timely, continuous primary care, the consequences cascade across the health system—worsening outcomes, increasing provider burden and driving avoidable healthcare spending.
Conditions such as uncontrolled diabetes, respiratory illness, and cardiovascular disease often progress to crisis when early primary care access could have prevented the need for higher acuity care.
Access to affordable, effective primary care can interrupt this cycle. By managing chronic conditions, offering preventive care, and addressing emerging health needs before they escalate, primary care clinicians could reduce reliance on expensive emergency and inpatient services, improving patient lives while easing system-wide pressure.
Innovating in primary care to address access and capacity challenges will require investments not just in traditional clinical infrastructure but also in enabling technologies and new care models that connect patients and clinicians seamlessly across settings.
There is a critical window of opportunity for action: As more groundbreaking studies and research activities in diseases and conditions indicate, primary care is well equipped to be the first point of care delivery.
Beyond primary care capacity, there is an important question of primary care quality, and what more could be done to elevate best-in-class care models.
To narrow the gap between the needs and access of patients, stakeholders across the healthcare ecosystem — policymakers, payers, providers, and innovators — can consider how to increase investment into primary care.
Additionally, action requires committing to redesigning care models to better meet patients where they are and building a workforce equipped for the future.
The report from which this article relies on to parallel the issues faced in the US with those in New Zealand is a collaborative effort by Carina Serreze, Kana Enomoto, Kevin Collins, and Matt Wilson, with Jon Zifferblatt, Shelley Lyford, Timothy A. Lash, and Zia Agha, representing views from the McKinsey Health Institute and West Health.