The NHS needs a premium tier - not more taxes on the rich

The top 10 per cent of earners already supply more than 60 per cent of all income-tax receipts, while the top one per cent alone puts in almost 30 per cent. They also pay National Insurance at eight per cent on salaries up to £50,270 and two per cent thereafter – still a three-fold bigger NI bill than the median worker. Asking that same cohort to swipe a card at the surgery door is less “solidarity” than triple taxation.

Perhaps an NHS+ Pass offers a better answer. Instead of another compulsory levy, it is an opt-in annual subscription of £1-2000 for anyone earning, say, over £100,000. Payment is made through the NHS App and credited against the taxpayer’s two per cent upper-rate NIC slice, so no one is hit twice.

What does the Pass buy? Same-day digital triage, a guaranteed video consultation within 24 hours, fast-tracked results, evening or Saturday diagnostics, and personalised prevention coaching. Crucially, the core NHS offer – truly free, universal care – remains untouched. The Pass adds a premium lane; it does not erect a paywall.

This could perhaps be taken a step further to offer GP+, where private GP appointments are readily available in the evenings and weekends, and where patients can be referred for subsequent treatment within the NHS, as necessary.

The Treasury also wins. If only half of Britain’s 1.1 million £100k-plus earners enrolled, NHS+ would raise a minimum of roughly £550 million – almost the sum the service now squanders each year on missed GP appointments. The cash can be ring-fenced for frontline staff, while appointments diverted into the premium lane shorten queues for everyone else.

Because NHS+ and GP+ are voluntary and tied to tangible benefits, it sidesteps the politics of resentment. For higher earners who already carry most of the load, the Pass is a direct, visible vote of confidence rather than another raid on their pay packet.

Fiscal reality demands fresh revenue and fresh thinking. NHS+ and GP+ deliver both without ripping up the founding pledge of free care at the point of need. The way to keep that promise alive is not to squeeze the same wallets harder but to let those wallets help differently – and, in doing so, lighten the wait for us all.

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Rachel Watkyn OBE is the founder of Tiny Box Company, the UK’s leading sustainable gift‐packaging e‑commerce business.

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