Guidance

NHS entitlements: migrant health guide

From:: Public Health England
Part of:: Migrant health guide
Published:: 31 July 2014
Last updated:: 27 June 2017, see all updates

Advice and guidance on the health needs of migrant patients for healthcare practitioners.

Main messages

Many migrants will come from countries with very different health care systems to the UK. It can help to:

explain to new patients how the NHS operates
explore with them how this compares to the healthcare system that they’ve been used to

Introduction

This guidance is about NHS entitlements in England.

The Scottish Government has published separate guidance on overseas visitors’ liability to pay charges for NHS care and services.

Further information is also available regarding health services for overseas visitors in Wales.

Services free to all

GP and nurse consultations in primary care and treatment provided by a GP are free of charge to all, whether registering as an NHS patient, or as a temporary patient, when the patient is in the area for more than 24 hours and less than 3 months.

The National Health Service (Charges to Overseas Visitors) Regulations 2015 and Guidance on implementing the overseas visitor hospital charging regulations 2015 outline the following services in the NHS which are currently free of charge irrespective of country of normal residence (as long as the overseas visitor hasn’t travelled to the UK for the purpose of seeking that treatment):

emergency treatment at any Accident & Emergency (A&E) department, walk in centre or elsewhere (but not further emergency treatment away from these locations eg operations, or subsequent outpatient appointments)
services provided for the diagnosis and treatment of a number of communicable diseases, including HIV, TB and Middle East Respiratory Syndrome (MERS) (see regulations for exact list)
services provided for the diagnosis and treatment of sexually transmitted infections
family planning services (does not include the termination of pregnancy or infertility treatment)
services for the treatment of a physical or mental condition caused by: torture, female genital mutilation, domestic violence, sexual violence
services provided outside an NHS hospital, unless the staff providing the services are employed by, or working under the direction of, an NHS hospital

The following groups are exempt from charge:

refugees (those granted asylum, humanitarian protection or temporary protection by the UK)
asylum seekers (those applying for asylum, humanitarian protection or temporary protection whose claims, including appeals, have not yet been determined)
individuals receiving support under section 95 of the Immigration and Asylum Act 1999 (the 1999 Act) from the Home Office
those whose application for asylum was rejected, but they are supported:
- under section 4(2) of the Immigration and Asylum Act 1999 by the Home Office
- by a local authority under section 21 of the National Assistance Act 1948
- Part 1 (care and support) of the Care Act 2014
children looked after by a local authority
victims, and suspected victims of modern slavery or human trafficking, as determined by the UK Human Trafficking Centre or the Home Office, plus their spouse or civil partner, and any children under 18 provided they are lawfully present in the UK
those receiving compulsory treatment under a court order, or who are detained in an NHS hospital or deprived of their liberty (for example, under the Mental Health Act 1983 or the Mental Capacity Act 2005) who are exempt from charge for all treatment provided, in accordance with the court order, or for the duration of their detention
prisoners and immigration detainees

There may also be exceptional humanitarian reasons where the secretary of state can determine that treatment should be provided. This exemption also applies to their child and/or companion an individual’s child who is authorised to travel with them, for whom the exemption is limited to treatment that cannot await their return home.

See NHS Choices for further exemptions and information.

Services in Scotland

Practitioners in Scotland can refer to the National Health Service (charges to overseas visitors) (Scotland) regulations 1989.

GP services

Anyone in England can register and consult with a GP without charge.

GPs are self-employed and have contracts with NHS England to provide services for the National Health Service. They have a measure of discretion in accepting applications to join their patient lists. They can choose to accept or decline an application.

An application may be refused if the practice has reasonable grounds for doing so, but a practice cannot refuse an application on the grounds of:

race
gender
social class
age
religion
sexual orientation
appearance
disability
medical condition

The practice can ask the patient to complete a GMS1 form as part of their application to register with a practice.

GP practices are not required to request any proof of identity or of immigration status from patients wishing to register. Some GP practices will however also ask to see proof of identity with the patient’s name and date of birth, such as:

passport
driving licence
application registration card (ARC)
IS96 or a Home Office letter

and proof of address, such as:

a recent utility bill (gas, electricity, water or landline phone bill)
council tax bill

NHS guidance clearly outlines that a practice cannot refuse a patient because they do not have identification or proof of address.

Where a patient applies to register with a general practice and is subsequently turned down, the GP must nevertheless provide, free of charge, any immediately necessary treatment that is requested by the applicant for a period of up to 14 days (this can vary according to circumstances).

If a GP practice refuses to register a patient the practice must notify the applicant, in writing, of the refusal and the reason for it, within 14 days of its decision.

The Standard General Medical Services Contract and the National Health Service (General Medical Services Contracts) regulations 2004 explain this requirement.

Where a person has difficulty in registering for National Health Services with a primary medical services contractor, they can contact:

their local NHS England area team directly
the local Patient Advice and Liaison Services

These services can discuss what help is available locally.

If a person goes to a GP for treatment whilst visiting the UK and is treated as a private patient then any prescription would also be private and would have to be paid for privately.

If a GP accepts a person as an NHS patient (either full or temporary) and gives the patient an NHS prescription (FP10) then normal charging rules apply.

Healthcare surcharge for non-EEA nationals

From 6 April 2015, non-European Economic Area (EEA) nationals need to pay a health surcharge when applying for a visa to stay in the UK for over 6 months, unless they are exempt.

Those who have paid the surcharge can use the NHS on the same basis as an ordinarily resident person while their visa remains valid, although they still need to pay for certain services, including prescriptions and dental treatment.

The surcharge is £150 per year for students and £200 per year for all other visa and immigration applications. Dependents will usually have to pay the same amount.

Some exemptions exist for people who do not need to pay the surcharge, including those:

seeking asylum or applying for humanitarian protection (or their dependants)
identified as a victim of human trafficking (or their dependants)
applying for indefinite leave to remain
who the Home Office’s domestic violence concession applies to (or their dependants)
where being made to leave the UK would be against their rights under Article 3 of the European Convention of Human Rights (or their dependants)

Individuals who have a visitor visa and those with a visa for under 6 months need to pay for any healthcare at the point of use.

See the Pay for UK healthcare as part of your immigration application page for a full list of exemptions and further information.

Hospital treatment

Hospital treatment is free to people classed as ordinarily resident in the UK. This is not dependent on nationality, payment of UK taxes, National Insurance contributions, being registered with a GP, having an NHS Number, or owning property in the UK. To be considered ordinarily resident, you must be living in the UK on a lawful and properly settled basis for the time being – you may be asked to prove this.

Since 6 April 2015, non-EEA nationals who are subject to immigration control must have the immigration status of indefinite leave to remain (ILR) at the time of treatment and be properly settled, to be considered ‘ordinarily resident’.

However, if you are a family member of an EEA national who is resident in the UK, you may not be subject to immigration control, even though you yourself are from outside the EEA. For more information about applying to join family living permanently in the UK, visit GOV.UK.

Some people who are not considered ordinarily resident in the UK (‘overseas visitors’) are exempt from charges for NHS hospital treatment under the current regulations.

All other patients are charged for treatment, except that treatment that is free to all.

Prescription charges can apply for out-patient or day patient treatment.

The legal duty to assess patients on their eligibility for hospital treatment lies with the NHS body providing treatment. Most hospitals have Overseas Visitors Managers or their equivalents to do this assessment. They make their assessments in line with the Charging Regulations, and based on evidence provided by the patient.

Patients should expect to be asked to prove that they are entitled to free NHS Hospital Treatment.

From 6 April 2015, individuals living outside the EEA who do not have personal health insurance will be charged 150% of the cost of NHS treatment for any care they receive, unless they are exempt.

For more information see:

Dental treatment

As with primary medical care, dentists providing NHS care are self-employed contractors with NHS England.

They cannot turn down an applicant for NHS treatment on the grounds of:

race
gender
social class
age
religion
sexual orientation
appearance
disability
dental condition

In applying to become a NHS patient of a particular dental practice, there is no formal requirement to prove identity or immigration status.

Where a person has difficulty in finding a dentist willing to provide them with NHS dental care, they can contact:

their local NHS England area team
the local Patient Advice and Liaison Services

NHS dental charges are levied on all those who are taken on as NHS patients, unless:

the treatment is free (certain NHS dental treatments are free)
the patient is exempt or partially exempt from charges on the grounds of age, pregnancy, or income

Eligibility for dental secondary care is as per general eligibility for NHS medical treatment in hospitals (see hospital treatment).

Further information about dental care is available from NHS Choices.

Special groups

For further information about the entitlements of particular groups, see Information for those visiting or moving to England.

Refused asylum seekers

Registration with primary care in England, Wales and Scotland applies to refused asylum seekers as for any other patient regardless of immigration status.

In Scotland and Wales, asylum seekers and refused asylum seekers are entitled to free secondary health care on the same terms as any other ordinary resident.

In England, only those refused asylum seekers who receive section 4(2) from the Home Office or section 21 support from a local authority are entitled to free secondary health care.

However, all refused asylum seekers can continue, free of charge, with any course of treatment already underway before their application was refused.

For more information see:

Refugee Council leaflet on access to healthcare for asylum seekers in several languages
The Royal College of General Practitioners position statement on access to primary care for failed asylum seekers and vulnerable migrants

Visitors from reciprocal healthcare agreement countries and the European Economic Area (EEA)

People who are visiting the UK from a country which has a bilateral healthcare agreement with the UK are exempt from charges for NHS hospital treatment in England.

To see what level of cover is provided see NHS choices.

People from EEA member states and Switzerland are also exempt from charge for treatment for chronic conditions, including routine monitoring. They must show a valid European Health Insurance Card (EHIC) or a Provisional Replacement Certificate to receive care.

Pre-planned treatment is not included free of charge without special, prior arrangement. Residents of EEA member states should speak to the authorities in their home country if they wish to come to the UK specifically to receive treatment.

See: information for EEA visitors

Health professionals are under no obligation to share personal medical data on patients, even if requested by other government agencies. In some circumstances, doing so could be a violation of a health professional’s obligations under the Data Protection Act and duty of confidentiality.

The NHS can however share information about overseas debtors with the Home Office. Overseas visitors are informed, as a condition of receiving treatment:

that information may be disclosed to the Home Office if the patient does not pay for any treatment received
that this debt may prevent them from being able to enter the UK at a future date

Resources

Patients can apply to the NHS low income scheme for help with health costs.

See ‘HC11: help with health costs’ information available in several languages.

A full help HC2 certificate (which includes free NHS prescriptions) can be applied for using the HC1 form, which is available to order online, from Jobcentre Plus offices or most NHS hospitals.

HC1 forms are available to order by phone: 0300 330 134.

Use this number for help or any questions about filling out the form. An interpretation service is available for patients who don’t speak English.

See ‘Get help with health costs’ on NHS Choices.

Maternity Action has information on maternity rights and benefits for parents who have claimed asylum.

Equality and Human Rights Commission provide information about equality and rights for healthcare.

Fact cards in several languages are available from The Forum, about accessing NHS.

NHS Inform factsheets include information about access to NHS services in Scotland for asylum seekers, refugees and those coming to Scotland to work and study. The factsheets are available in a number of languages.

Videos about how to use the NHS in England produced by the BHA, are available on Youtube in:

English
Arabic
Cantonese
Farsi/Dari
French
Kurdish
Mandarin
Polish
Somali
Sylheti
Urdu

The Department of Health Questions to ask: getting the most out of your appointment leaflet is available from the National Archive in:

English
Arabic
Bengali
French
Gujarati
Polish
Portuguese
Punjabi
Somali
Spanish
Urdu

The Patient Advice and Liaison Service (PALS) offers confidential advice, support and information on health-related matters, and provides a point of contact for patients, their families and their carers.

NHS Choices provides advice and information about health issues to members of the public.

Contents

Document information

Published: 31 July 2014

Updated: 27 June 2017

+ full page history

27 June 2017 Updated and made editorial changes to meet GOV.UK style.
31 July 2014 First published.