British people love to complain about the NHS and to defend it in the same breath. For a newcomer, the surprise is that the gap between the headlines and daily life is wide: most people register with a doctor in an afternoon and are seen when they need to be. The slower parts are routine specialist appointments and dentistry.
What matters first is how you gain access. Healthcare in the UK for expats depends on how you arrived, and it is the reason the surcharge exists.
How does healthcare in the UK work for newcomers?
The NHS is the public health service, funded from general taxation. Each nation runs its own service: NHS England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland. At the front door is the GP, the family doctor, who refers you to specialists and hospitals.
If you come with a visa lasting more than six months, you normally pay the Immigration Health Surcharge with the application and then have access from the start of your visa as if you were resident. If you hold settled or pre-settled status from the EU Settlement Scheme, you use the NHS without paying a surcharge; see the EU Settlement Scheme guide. Irish citizens have access under the Common Travel Area and pay no surcharge; see Irish citizens moving to the UK.
Without a right to NHS care, hospital treatment can be charged at 150% of the NHS national tariff in England. Emergency treatment in A&E and consultations with a GP stay free for everyone.
What is the Immigration Health Surcharge and how much is it?
GOV.UK sets it at £1,035 per adult per year, and £776 per year for students, their dependants, Youth Mobility Scheme holders and anyone under 18 at the time of applying. You pay the full amount up front for the length of your visa. The exact total depends on how long your visa lasts, and GOV.UK's page on how much you pay sets out the rule for each length.
Some people are exempt, including holders of the Health and Care Worker visa and their family, people applying to the EU Settlement Scheme, visitors, and those applying for settlement. If you apply for a visa of six months or less from outside the UK, you do not pay it.
The surcharge is not refunded if you leave early, or if your visa is granted and you do not come. Having a private insurance policy does not remove the requirement either. Two refund routes exist. An S1 form, for example for a pensioner whose pension is paid by an EU country, lets you register with the NHS Business Services Authority and claim the surcharge back. And certain full-time higher-education students with a European Health Insurance Card, who do not work and whose visa began on or after 1 January 2021, can also ask for a refund.
Trying to work out what your visa means for your care, or how the surcharge applies to the whole family? Moovy can walk through it for your household, explain the NHS terms in plain English and list the steps for registering. Moovy cannot book appointments for you, and for medical decisions the NHS or your doctor decides.
How do you register with a GP?
Do it in your first days, even if you feel well. In England, GOV.UK and the NHS say you do not need ID, proof of address or proof of immigration status to register with a GP, and many surgeries let you do it online in about 15 minutes per person. In Scotland, you register with the form from the practice, and you may be asked for ID or proof of address.
Choose a surgery near your home, ask for its catchment area and check the opening times. You will get a letter with your NHS number. Keep your share code to hand because a hospital may ask you to prove your status through your eVisa.
For emergencies, call 999, or use A&E. If you are not sure whether it is serious, NHS 111 gives advice, and in Scotland NHS 24 answers at 111 when the practice and pharmacy are closed. The 112 number also reaches emergency services.
What do you still pay for in healthcare in the UK?
The NHS is not entirely free at the point of use. In England, prescriptions are charged per item unless you qualify for an exemption. Dental care and eye tests are charged, and so are some fertility treatments. Wales, Scotland and Northern Ireland handle prescriptions differently. In Scotland, prescriptions written by your GP are free and eye tests are free for everyone, according to the Scottish government.
Because dentists have limited NHS places in some areas, many people pay privately. A dental plan or an insurance policy is a personal decision, not a legal one. Private healthcare is also available, and some employers include a policy in a benefits package. It can reduce waiting times for specialist consultations, but it does not replace the surcharge.
How does a typical visit to the NHS work in practice?
Your GP is the gatekeeper. For a routine problem you book an appointment, by phone, online or through an app, depending on the surgery, and you may see a nurse or a pharmacist-led service first. Pharmacies are worth knowing: a pharmacist can advise on minor illnesses without an appointment, and they dispense the prescriptions your GP writes.
For a hospital specialist you usually need a GP referral, and for non-urgent care you then join a waiting list. Emergencies are different: A&E treats everyone, whatever their status, and you will not be asked for a visa at the door. Cultural tip: British patients say "I don't want to waste your time" even when something is serious. Describe your symptoms clearly and say when something is getting worse; the system rewards clarity.
If you take regular medication, bring a list of the active substances rather than brand names, since names differ between countries, and ask your doctor at home for a short summary in English. A GP in the UK can then decide what to prescribe locally. Do not assume that your home prescription will be honoured: a UK prescription is needed.
Should you buy private health insurance as well?
It is optional. The NHS covers you once your access is in place, and a private policy does not replace the surcharge. People buy private cover to shorten the wait for specialist consultations, to have a choice of hospital or to cover dental care. Some employers provide a policy as a benefit, so read your contract before buying one.
If you arrive on a stay of under six months, the NHS recommends personal medical insurance even if you have lived in the UK before. For a long stay, compare the policy wording carefully: exclusions for pre-existing conditions are the usual disappointment. For mental health, many surgeries now offer a route to talking therapy that you can sometimes self-refer to, and your GP can explain what is available locally.
Which mistakes should you avoid with the NHS?
- Relying on your home European Health Insurance Card. It is for temporary stays and medically necessary care. When you move on a visa for over six months, the surcharge is what opens the NHS.
- Arriving uninsured for a short stay. For stays under six months, the NHS recommends personal medical insurance.
- Assuming a GP registration gives full hospital rights. It does not on its own.
- Forgetting the S1 registration. The form does nothing until it is registered with the NHS Business Services Authority.
- Confusing the UK GHIC with an entry ticket to the NHS. The Global Health Insurance Card is issued to UK residents for temporary trips abroad.
What changes by nation and by profile?
Scotland: GP prescriptions and eye tests are free, and NHS Scotland does not share patient data with the Home Office for immigration enforcement, as the Scottish government's welcome pack says. See living in Scotland vs England.
Students: some full-time students can claim back the surcharge with a European Health Insurance Card, as above. Pensioners with an S1: your home country pays your care. Swiss citizens follow the same logic, with different refund dates for Swiss periods.
Your first weeks usually go: register with a GP, get your NHS number, find a pharmacist and a dentist and keep your share code handy. For the general checklist, see moving to the UK.