The fund that provides financial benefits for medical services, such as subsidised GP visits, is not sustainable, the government's auditor has warned.
The Comptroller and Auditor General has reviewed the health of the HIF.
Lynn Pamment found has that changes to the services that are covered by the fund, rising treatment and medicine costs and the pressures of an ageing population mean that it will be running at a loss every year.
She warns that by 2029, there will be less than a year's worth of spending left in the pot - with an estimated balance of £61 million.
The C&AG says this deficit has been indicated since 2021, but there is still 'no clear plan of action' to tackle the problem.
Though recent initiatives, such as bigger payments to GP surgeries aimed at making appointments cheaper for patients, have helped to reduce cost barriers in primary care, Ms Pamment says they were introduced without a full assessment of the long-term impact on the HIF.
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The report says:
"There is no control to prevent general practices from increasing fees to neutralise the impact of increased benefits approved by the Minister for Social Security. The C&AG identified instances of fees being increased in excess of inflation in the period from February 2024 to July 2025."
The audit also uncovered an 'increased risk of overpayment from error or fraud' from the changes to the benefits paid from the HIF.
Ms Pamment concludes:
"...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 has responded, saying:
"Work to assess long‑term funding options for health and care costs is already well advanced and has been a key Government priority throughout 2025 and into 2026."
It says several of the C&AG's recommendations are already underway.
"This includes consideration of reform of the Health Insurance Fund as part of a whole health care system approach, rather than viewing the Health Insurance Fund in isolation."
MInisters say they will carefully review the report's findings.
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