UK: A guide for migrants on how to access the National Health Service (NHS)

Access to the NHS for migrants

The National Health Service (NHS) is the government-funded medical and healthcare service in the UK. Understanding which NHS services are freely available for people born outside of the UK can be confusing. Some NHS services are always free and some people (because of their experiences, residency or type of visa) always receive free health care. It is important to know which NHS services could be free to you and what documents you may need to show to receive them.

People who always receive free treatment

There are groups of people who are always entitled to free NHS health care. You should not be charged for most NHS care if you are considered to be ‘ordinarily resident’. You have ordinarily resident status if you are living lawfully in the UK “on a properly settled basis for the time being”. This may include:

• British citizens. However, British citizens who are no longer living and settled in the UK are not ordinarily resident.
• People who have ‘settled’ or ‘pre-settled’ status from the EU Settlement Scheme.
• People who have indefinite leave to enter or remain in the UK.

Other groups who are entitled to free NHS care include:

• A refugee: a person who has been forced to leave their country (in order to escape war, persecution, or natural disaster) who has been given permission to remain in the UK by the government.
• An asylum seeker: a person who has been forced to leave their country (in order to escape war, persecution, or natural disaster) who has applied for permission to remain in the UK and whose case is still being assessed.
• A refused asylum seeker (Northern Ireland, Scotland, Wales only).
• A refused asylum seeker receiving support from the Home Office or a local authority (under the Care Act).
• A victim (or suspected victim) of trafficking or modern slavery. To confirm this, during your appointments, you may be asked if you have experienced violence or abuse (now or in the past).
• A child under the care of a local authority.
• A detainee in immigration detention, prison or young offenders institution.
• A full-time student (Scotland only).
• A person who has paid the Immigration Health Surcharge (also known as NHS Surcharge).

There are some differences depending on whether you live in England, Northern Ireland, Scotland, or Wales.

If you are entitled to free health care, you can get it immediately. It does not matter how long you have been in the UK.

If you are seeking primary care (e.g. GP practices, NHS walk-in centres, dentists, pharmacists and opticians) you should not be asked about your immigration status, as this is not relevant. It is clearly explained on the NHS website (under the heading If you have no proof of address or identification) that you do not need to show proof of address or ID.

But in reality, people trying to register at primary care services are often asked for immigration status and official documents – and may be turned away if they do not have them. If a GP practice refuses your registration you can get support and advice from Doctors of the World Clinic advice line: 0808 1647 686 (freephone) or email clinic@doctorsoftheworld.org.uk

Treatment that is always free

Certain health treatment is always free, meaning your immigration status does not matter. These services include:

• Primary care at GP practices and NHS walk-in centres.
• Accident and Emergency services.
• Diagnosis and treatment of communicable diseases (diseases that can be passed from person to person). These include HIV, coronavirus (COVID-19), tuberculosis (TB) and malaria.
• Diagnosis and treatment of sexually transmitted infections (STIs).
• Contraception and advice (not including pregnancy terminations or maternity care).
• Treatment for conditions that have been caused from torture, female genital mutilation (FGM), domestic violence, or sexual violence. To confirm this, during your appointments, you may be asked if you have experienced violence or abuse (now or in the past).
• Compulsory psychiatric treatment – if you have a mental disorder that puts you, or others, at risk (under the Mental Health Act or Mental Capacity Act).
• Services provided through NHS 111 (a telephone advice line).
• Services provided by health visitors and school nurses.

HIV prevention, testing and treatment is free across the UK, regardless of your immigration status. This includes pre-exposure prophylaxis (PrEP) and antiretroviral therapy. This is because HIV is a communicable and sexually transmitted infection.

It is important to know your HIV status to stay healthy. If you do take an HIV test and the result is positive, HIV medication will help to keep you well and healthy. If you take a test and it is negative, you may wish to consider taking PrEP (a drug that is highly effective in preventing HIV being passed on during sex). PEP is available to people who may have been exposed to HIV sexually. All of these services are free.

Most people need to pay for NHS prescriptions, eye tests and dental treatment. The charges are the same regardless of immigration status. As explained later on this page, the charges can be waived for people on low incomes.

Secondary care

Secondary care refers to services provided by health professionals who generally do not have first contact with a patient. Treatment for conditions such as heart disease, diabetes and cancer are examples of secondary care.  People tend to be referred to secondary care by another healthcare professional. If you do not have ‘ordinarily resident’ status or are not part of the groups of people who always receive free care, you may be charged for secondary care.

Even if you are receiving free treatment for HIV, you may be charged for other secondary care services. For example, if you are living with HIV and need hospital treatment for heart disease or maternity care, you may be issued a bill.

Nonetheless, some secondary NHS care is considered immediately necessary or urgent, so will not be refused to you (even if you cannot pay).

Health treatment is considered immediately necessary when it:

• is lifesaving
• prevents a condition from becoming immediately life-threatening
• prevents permanent serious damage from occurring.

This includes maternity care. In order to protect lives, all maternity services (from pregnancy to after birth) must be treated as ‘immediately necessary’. NHS maternity care is only free to those who are listed above as always receiving free treatment. If you do not fall within any of these groups you may be asked to pay for your care, but you cannot be refused maternity care if you cannot pay because it is ‘immediately necessary’.

‘Urgent’ care is something that doctors do not think is immediately necessary but which cannot wait until the person can be reasonably expected to leave the UK. If your doctors consider your care to be urgent, you can still receive treatment even if you cannot pay straight away. They will take into account a range of factors, including:

• the pain or disability the condition is causing
• the risk that delaying treatment might lead to a more expensive medical treatment being needed
• the likelihood of the condition becoming life-threatening because treatment was delayed.

Non-urgent treatment will not be given until a full payment is made.

If you are ordinarily resident or otherwise eligible for free secondary healthcare, you may be asked to prove this. This is something likely to disproportionately affect ethnic minorities, non-British/non-EEA nationals, or those with non-British accents or names.

If you cannot afford to pay

It is very important not to ignore hospital bills. You should contact the hospital even if you cannot pay. The hospital should be able to offer you a repayment plan in which you pay a little bit of the bill each month. Citizens Advice or a local debt advice service can advise you on this.

Concerning prescriptions, dental care and eye tests, you may be able to pay a lower fee or receive exemptions via the NHS Low Income Scheme. You will not be asked about your immigration status on the forms. You will be asked for your name, address, who you live with, your income and savings. Fill out the HC1 form or the HC5 form to claim back charges you have already paid. It is important to keep receipts of any payments you have made. For advice, contact the NHS Low Income Scheme helpline on 0300 330 1343.

Information sharing and charges

There are concerns about what information is shared between the NHS and the Home Office.

In 2018, the UK government agreed to stop the NHS sharing personal information (information that can be used to identify someone – such as a name, address etc.) with the Home Office for immigration enforcement purposes. The Home Office cannot ask the NHS for your address to investigate immigration offences. Nonetheless, the Home Office can still ask the NHS for your address if they are investigating a ‘serious crime’ such as murder or rape.

There are still two circumstances in which NHS staff may share information about you with the Home Office. Firstly, if they have not been able to establish your immigration status (and healthcare entitlement) they may make an enquiry to the Home Office. NHS charges vary according to a person’s immigration status. There are six different payment groupings based on a person’s experiences, residency and/or type of visa. Secondly, if you have a hospital bill that is over £500 and has not been paid for over two months, they will pass on details to the Home Office. This information could be used to update Home Office records and possibly for immigration enforcement. Your application for leave to remain or enter can be refused if you are in debt to the NHS.

The information shared might include your name, any aliases, date of birth, gender, nationality, National Insurance number, Home Office reference number, and any other reference numbers (for example passport number or Immigration Health Surcharge Number).

The NHS does not need your permission to share non-medical information with the Home Office. Medical information – such as your HIV status and details of your treatment – cannot be shared unless you have given permission.

If you are worried about giving personal details to your GP or another healthcare provider, you have the right to register using someone else’s home address (called a ‘care of’ address). You can also say you have ‘no fixed’ address.

If you have a problem with the service you receive, there are steps you can take to address this. This should not impact your immigration status.

Paying before you arrive in the UK

If you apply for a UK visa from outside of the EEA or Switzerland, you will likely have to pay the Immigration Health Surcharge (also known as the NHS Surcharge). This gives you access to NHS hospital treatment on the same basis as people who are ordinarily resident.

The Immigration Health Surcharge is included in the UK visa fee (if you are planning to stay for over six months but are not applying to remain in the UK permanently). The annual fee is £624 for adults and £470 for children, students and those on the Youth Mobility Scheme. Some applicants are exempt from paying this fee.

When you have paid the surcharge, you will receive a reference number. It is important to make a note of that reference number as it proves you have paid the fee and may be requested when registering for primary care (and possibly when accessing other health care). This number is different from the NHS number that everyone who is registered for NHS health care has. When your Immigration Health Surcharge reference number is linked to you NHS number, NHS computer systems will show that you are eligible for free health care. This means you may not need to show your surcharge number after you are registered at a GP.

Additional support

Understanding the NHS system can be confusing. You can contact the organisations listed below if you need general or specific advice about:

• filling in paperwork (for free prescription, dental care and eye tests)
• requesting an interpreter during your appointments
• what to do if a GP practice refuses to register you
• paying hospital bills or debt
• getting support if you think you have been charged unfairly.

Doctors of the World (clinics in Bethnal Green and Hackney, London). Clinic advice line: 0808 1647 686 (freephone) or email clinic@doctorsoftheworld.org.uk

Freedom from Torture (for survivors of torture). Clinics in: London, Manchester, Newcastle, Birmingham and Scotland.

Maternity Action (information and a telephone advice)

Citizens Advice