Healthcare in the UK: understand how the NHS works

If you are permanently living in the UK, you will be entitled to free healthcare through the National Health Service (NHS). However, there is also the option to take out private health insurance in the UK, which can offer quicker access to specialists, better facilities, and shorter waiting times.

This helpful guide includes the following sections:

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Overview of healthcare in the UK

The UK healthcare system

The UK has a free publicly-funded healthcare system – the National Health System (NHS). The NHS is different from many healthcare systems elsewhere as it is funded through taxation rather than health insurance. There is also a smaller private healthcare sector that people can choose if they wish.

Each region of the UK has its own NHS body. This guide will focus mainly on the service in England but you can find out more information about services in other regions on the websites for NHS Scotland, NHS Wales, and NHS Northern Ireland. The differences between the regional health services are mainly structural and how some of the services are delivered.

The NHS in England is overseen by the Department of Health. NHS England is responsible for commissioning primary care services such as doctors, dentists, and pharmacists. Since 2013, Clinical Commissioning Groups (CCG) have had the responsibility of commissioning secondary care services in local areas, which are:

• planned hospital care;
• rehabilitative care;
• urgent and emergency care;
• most community health services;
• mental health and learning disability services

There have been many structural changes to the NHS over the years. Many private companies and charities have become more involved in running services in recent years. All services are publicly funded and the government is ultimately accountable, although in reality it is more of a public-private partnership in terms of delivery.

The UK was ranked 16th on the 2018 Euro Health Consumer Index.

Who can access healthcare in the UK?

The NHS is a residence-based rather than an insurance-based system. This means that all UK residents including expats can access services for free. People visiting the UK from a European Economic Area (EEA) country or Switzerland currently get free NHS care through their European Health Insurance Card (EHIC). However, this is likely to change once the UK leaves the EU.

Nationals from outside the EU/EEA/Switzerland can access the NHS for free on the same basis as a British citizen if they’ve settled in the UK and been given indefinite leave to remain. Other non-EU/EFTA nationals can access services such as emergency treatment and family planning services free of charge. However, they will need to take out health insurance to access other services.

Since 2015, those coming to the UK from outside the EU/EEA/Switzerland for more than six months have to pay a health surcharge of at least £150-200. If you are a third-country national who has paid the surcharge, you can access NHS services on the same basis as everyone else. If you haven’t paid and don’t have any medical insurance, you’ll be charged at 150% of the standard NHS tariff for any care you receive. This is unless you’re from a country that has a reciprocal healthcare agreement with the UK or qualify for an exemption.

Healthcare costs in the UK

NHS healthcare is funded mostly through direct taxation. In 2017, the UK spent £197.4 billion on healthcare. This amounts to 9.6% of annual GDP, making the UK the 10th biggest spender on healthcare in the EU/EEA/Switzerland in terms of GDP percentage.

Most services are provided free of charge to residents. However, there are some charges for certain services. These include:

• charges for dental treatment, ranging from £22.70 for emergency treatment to £269.30 for Band 3 treatment;
• prescription charges of £9 per item.

Certain groups such as low earners and those aged over 60 are entitled to exemptions or reductions on NHS charges. This applies to both dental costs and prescription costs.

How to register for healthcare in the UK as an expat

Registering for healthcare in the UK is done via registering with a general practitioner (GP). You can choose your own GP practice, although some practices may refuse patients if they do not live in the local area or if the practice is too full.

Registration is done at the surgery by completing the GMS1 form. You will usually need to provide:

• valid ID, such as a passport;
• proof of address, such as a UK utility bill

Upon registering, you should receive a medical card that can be used to document appointments. More information is available on the NHS website about how to register. This includes information about how to register as a temporary resident or homeless.

Private healthcare in the UK

A relatively low number of UK citizens (around 10.5% of the population) opt to pay for private health insurance compared to other European countries. There are several benefits of private health insurance, however, especially if you have an urgent illness or injury.

Private patients can access specialists more quickly, avoid long waiting times, and use better facilities. Private healthcare patients often enjoy private en-suite rooms rather than sharing wards with other patients.

Some of the largest health insurance companies in the UK include:

• Allianz Care
• Cigna Global

Healthcare is generally available on both a personal and family basis. Premiums depend on your level of cover, lifestyle, age, and pre-existing medical conditions.

Healthcare plans usually operate on an excess basis, meaning you’ll need to pay a proportion of the cost when you need to use your insurance. Many UK employers include subsidized or tax-only healthcare cover in their benefits packages.

It’s also possible to pay for private healthcare on a one-off basis, should you need a specific type of treatment or an operation that has a very long waiting time on the NHS. Be careful though, as this option could cost you thousands of pounds depending on the treatment you require.

Doctors and specialists in the UK

Your local general practitioner (GP) is your first point of contact for most medical queries aside from emergencies. They can provide assessments and advice for most illnesses and complaints, prescribing medication, or referring to a specialist if necessary.

Most GP surgeries operate by appointment. However, many also offer a walk-in service, usually for a couple of hours in the morning. Many surgeries offer online booking services. GPs usually open between Monday-Friday, and if you need more urgent care you can call an out of hours number, or 111 for urgent but non-emergency advice.

GP appointments in the UK are short, usually lasting between 8-10 minutes; as a result, it’s important to be concise about your problems. If you need a referral for a specialist at a hospital, your GP will provide a referral letter. Waiting times vary significantly from practice to practice.

See our guide on doctors in the UK for more detailed information.

Women’s healthcare in the UK

The NHS provides a range of healthcare services for women. These can be accessed through GPs or well woman clinics. Services for women’s healthcare in the UK include:

• access to gynecology services;
• access to free sexual health services;
• free contraception;
• maternity care services;
• IVF treatment for women under 40 who meet certain criteria;
• screening programs for cervical and breast cancer

Abortion is legal in most parts of the UK if it is carried out within the first 24 weeks of pregnancy. In certain circumstances, abortions are permitted at a later stage in the pregnancy than this. However, there are stricter rules in place in Northern Ireland. Here, abortion is only permitted if there is a serious risk to the mother’s life or health.

Information on childbirth and maternity care can be found in our guide to having a baby in the UK.

Children’s healthcare in the UK

The NHS works with closely with local authority children’s services and a range of specialist agencies to provide services aimed at improving children’s health. Pediatricians are available through the NHS and pediatric services can be found online. You can register your child with your family GP. This will enable you to access specialist children’s healthcare services as needed.

Community healthcare services for families and children are available through local Children’s Centers. NHS nurses and other children’s healthcare professionals offer care and advice in areas such as nutrition, healthy weight and breastfeeding. In addition, programs around healthy eating, physical activity, and mental well-being are delivered through schools (e.g., Mytime Active).

There is a free vaccination program for children in the UK. The vaccination schedule includes:

• 6-in-1 vaccine against diphtheria, tetanus, whooping cough, polio, hepatitis B, and haemophilus influenzae type B;
• Measles, mumps, and rubella (MMR) vaccine;
• Children’s flu vaccine

Find out more in Expatica’s guides to children’s health in the UK and vaccinations in the UK.

Dentists in the UK

Dental care is available either through the NHS or privately; but in both instances, you’ll usually need to pay. Free dental care is available for those aged under 18 (or under 19 if in full-time education), pregnant women, and people who have had a baby in the last 12 months.

How much you’ll need to pay for your dental care depends on the band of care you require. In England, the structure works like this:

• First band (£22.70): Dental examinations, scale and polish if required;
• Second band (£62.10): Also covers fillings, root canal work and removal of teeth;
• Third band (£269.30): Also covers crowns, dentures, bridges and lab work;
• Emergency treatment in the UK (£22.70): Covers emergency care such as pain relief or temporary fillings

Prices for NHS dental care vary significantly in Scotland (£5.00–157.60), Wales (£14.30–199.10), and Northern Ireland (£3.44–152.98). You can find out the full details by clicking on the link for each country.

See our guide to dental care in the UK for full information.

Hospitals in the UK

Hospitals provide secondary care services in the UK and you will need a referral from your GP for most treatment other than emergency treatment.

There are two types of hospitals in the UK – NHS hospitals which are free, and independent hospitals run by private companies or charities which usually charge. NHS hospitals are run by NHS Trusts.

Most general hospitals will offer accident and emergency (A&E), maternity services, surgery, elderly care, and outpatient services. There are also a number of specialist hospitals; e.g., eye hospitals, orthopedic hospitals.

More information can be found in our guide to hospitals in the UK.

Health centers and health clinics in the UK

There are around 80 NHS walk-in centers providing healthcare in the UK open 365 days a year and outside office hours. Walk-in health centers in the UK are set up to deal with a range of minor injuries and illnesses. Some centers offer access to doctors and nurses but do not offer a full GP service and some do not treat young children.

Conditions treated in walk-in centers include infections/rashes, fractures, stitching and dressing of minor cuts, burns and bruises, and vomiting and diarrhea issues.

Pharmacies in the UK

Pharmacies in the UK are usually quite easy to find; they’ll often be in town centers or even next to your GP surgery. In addition to independent pharmacies, large retail stores and supermarkets such as Boots and Tesco sometimes have their own pharmacies.

For some types of medicine, you’ll need a prescription from your NHS doctor. You’ll usually have to pay a flat charge for your prescriptions unless you are exempt from paying. These charges apply only to England, as prescription fees have been abolished in Scotland, Wales, and Northern Ireland.

Pharmacies are usually open until around 22:00–23:00. Some in larger cities are open 24 hours a day. You can find a local pharmacy on the NHS website.

Mental healthcare in the UK

The level of mental healthcare provision available in the UK is better than in many countries. However, a recent NHS review highlighted that mental health services in England have been poor compared to hospital services for physical conditions.

Research has shown that 1 in 4 adults and 1 in 10 children in the UK experience mental illness. Mental health services can be accessed for free on the NHS. Some require a GP referral, while others allow people to refer themselves.

Services available include:

• psychological therapy and counselling services;
• drug and alcohol services;
• children’s mental health services;
• eating disorder services

You can find information out about what is available and how to access it on the NHS website. Also see our informative guide to mental healthcare in the UK.

Other forms of healthcare in the UK

You can find a range of alternative therapies in the UK. However, availability through the NHS is limited.

Therapists should belong to a regulatory body such as the Federation of Holistic Therapists. Treatments available include:

• osteopathy;
• chiropractic treatment;
• acupuncture;
• reiki;
• herbal medicine

There are also many charities involved in delivering healthcare in the UK. Some of these are commissioned by the NHS. See a list of health charities here.

You can find more information in this guide to alternative medicine in the UK.

What to do in an emergency

Emergency services are free of charge under health insurance in the UK. To report an emergency, you can call 999 and have an ambulance dispatched if necessary. If you can make it to the hospital yourself, you can visit an Accident and Emergency (A&E) department, which will be open 24-hours a day.

When you’re admitted to an NHS hospital, you’ll usually be placed on a specialist ward (an area of a hospital where people with similar illnesses are treated). There are various types of wards in UK hospitals, from maternity wards to orthopedics; you’ll usually be placed in a shared room with members of the same sex.

Useful resources

• National Health Service
• England NHS
• Scotland NHS
• Wales NHS
• Northern Ireland Direct
• Department of Health
• Citizens Advice Bureau