Entitlements to NHS care

The information provided below refers to entitlements in England. The Scottish Government has published separate guidance on overseas visitors’ liability to pay charges for NHS care and services [external link]. Further information is also available regarding health services for overseas visitors in Wales [external link].

The British Medical Association document Access to health care for asylum seekers and refused asylum seekers – guidance for doctors [external link] summarises the various entitlements and means of accessing healthcare for asylum seekers and refused asylum seekers in England and Wales, Scotland and Northern Ireland.

Services free to all

Treatment provided by a GP is free of charge, whether registering as a temporary patient [external link] (when you are in the area for more than 24 hours and less than three months) or registering as an NHS patient [external link].

There are certain types of service in the NHS that are currently free of charge irrespective of country of normal residence. These are outlined in the National Health Service (Charges to Overseas Visitors) Regulations 2011 [external link] as:

Emergency treatment at any Accident & Emergency (A&E) department, walk in centre or elsewhere (but not further emergency treatment (e.g. operations) away from these locations, or subsequent outpatient appointments)
Family planning services
Treatment for communicable diseases (see regulations for exact list)
Treatment for sexually transmitted infections (including HIV)
Diagnosis, counselling and treatment [external link] in relation to HIV
Those detained in hospital under the Mental Health Act 1983 or treatment given for mental health problems as part of a court probation order

Practitioners in Scotland can refer to the National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989 [external link].

Medical

GPs are self-employed and have contracts with the local Primary Care Trust (PCT) to provide services for the National Health Service. They have a measure of discretion in accepting applications to join their patient lists.
Anyone can approach a GP practice and apply to register on its list of NHS patients. The practice may choose to accept or decline their application.
An application may be refused if the practice has reasonable grounds for doing so, but a practice is not able to refuse an application on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.
The patient can be asked to complete a GMS1 form [external link] as part of their application to be registered with a practice.
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, such as passport, driving licence, Application Registration Card (ARC), IS96 or a Home Office letter with the patient's name and date of birth, and proof of address, such as a recent utility bill (gas, electricity, water or landline phone bill) or council tax bill. Note that not having these documents should not be a reason to refuse registration.
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 refuses to register a patient they are obliged under clause 181-184 of the Standard General Medical Services Contract [external link] and Schedule 6 Part 2.17 of The National Health Service (General Medical Services Contracts) Regulations 2004 [external link] to notify the applicant, within 14 days of its decision, in writing of the refusal and the reason for it.
Where a person has difficulty in registering for National Health Services with a primary medical services contractor they should get in touch with their local PCT (directly or via the local Patient Advice and Liaison Services [external link]) to discuss what assistance might be 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 [external link].

Dental

As with primary medical care dentists providing NHS care are self employed contractors with the local PCT. They cannot turn down an applicant for NHS treatment on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or 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 should get in touch with their local PCT (directly or via the local Patient Advice and Liaison Services [external link]) to discuss what assistance might be available locally.
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) or the patient is exempt or partially exempt from charges on age, pregnancy related, or income grounds. Further information is available from NHS choices [external link].

Hospital treatment

Entitlement to free NHS hospital treatment is based on 'ordinary residence' in the UK, not nationality, being registered with or referred by a GP, or payment of UK taxes or national insurance. Ordinary residence means, broadly, living in the UK on a lawful and properly settled basis. 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, but all other patients will be charged for treatment, except that treatment that is 'free to all', outlined above. Prescription charges may apply for out-patient or day patient treatment.
Assessments regarding eligibility for hospital treatment lie with the NHS body providing treatment and most have Overseas Visitors Managers to do this. They make their assessments in line with the Regulations and based on evidence provided by the patient.
Anyone who is taking up permanent residence in the UK is exempt from charge. The person should expect to be asked to prove that they are legally entitled to live in the UK and show that they have moved here permanently rather than just visiting.
If the person does not have an automatic right to take up permanent residence but has applied to the Home Office for leave to enter/remain on a settled basis, they will be charged for any hospital treatment up to the point their application is granted or until they accrue 12 months lawful residence in the UK or are considered ordinarily except that treatment that is ‘free to all’, outlined above resident here.
All asylum seekers in England who have not had their claim refused (including those who have an appeal outstanding) are entitled to free secondary health care. Those who have had their claim refused but are receiving section 4 or section 95 support from the UK Border Agency are also entitled to free secondary health care. See Department of Health entitlements table for asylum seekers [external link]. 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.
Please see the 2011 Regulations (above) for further details and Department of Health guidance to overseas visitors intending to take up permanent residence [external link].
Eligibility for dental secondary care is as per general eligibility for NHS medical treatment in hospitals.

Special groups

For further information about the entitlements of particular groups please see the Department of Health eligibility rules [external link].

Victims of human trafficking

The 2011 NHS Regulations provide an exemption from charge category for Victims of human trafficking [external link] (Department of Health website).

Refused asylum seekers

Registration with primary care in England, Wales and Scotland as outlined above 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 that receive section 4 or section 95 support from the UKBA are entitled to free secondary health care, but all refused asylum seekers can continue, free of charge, with any course of treatment already underway before their application was refused.

Visitors from bilateral 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, if the treatment is needed promptly for a condition that arose, or acutely worsened, after their arrival in the UK.

Furthermore, people from European Economic Area member states and Switzerland are also exempt from charge for treatment for chronic conditions, including routine monitoring, but must show a valid European Health Insurance Card (EHIC) or a Provisional Replacement Certificate. In neither case is pre-planned treatment included free of charge without special, prior arrangement.

In the UK, the EHIC provides access to free medical treatment which is seen, by a medical professional in the UK, to be clinically necessary and needed before the patient’s planned return to their home country. Visitors are also covered, with an EHIC, for the treatment and routine monitoring of pre-existing conditions.

The UK has recently put infrastructure in place to allow NHS trusts to submit EHIC and treatment details to the Department for Work and Pensions. This enables the UK to claim back the cost of the treatment provided from the patient’s home member state. As this system is currently being trialled for primary care, submission of these data is not currently required by GPs. GP practices are however, still requested to ask to see the card when a patient from an EEA member state requires treatment.

The card does not provide cover for the cost of medical treatment where that is the reason for the patient being in the UK. 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.

List of the bilateral healthcare agreement countries, including the EEA member states [external link].

Data Sharing - Section 55 Data Protection Act

Note that 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 UKBA. Overseas visitors are informed as a condition of receiving treatment that information may be disclosed to the UKBA if the patient does not pay for any treatment received and that this may prevent them from being able to enter the UK at a future date.

Resources

Eliminating barriers to healthcare [external link] training video from HPA migrant health training event 12 November 2012

Department of Health Guidance for overseas visitors [external link] (eligibility rules)

HC11 Form: Help with Health Costs [external link] (available in several languages)

A claim for help with health costs can be made through the NHS low income scheme. A full help HC2 certificate (which includes free NHS prescriptions) can be applied for using the HC1 form, which is available from Jobcentre Plus offices or most NHS hospitals. HC1 forms can also be ordered by calling 0845 610 1112. This number can also be used for help or any questions about filling out the form. An interpretation service is available for patients who don’t speak English. Further information about help with health costs is provided by NHS Choices [external link]

NHS Newham has made available an example of a PCT policy on access to NHS services for migrant populations and overseas visitors: Access to the NHS by migrants and overseas visitors for primary care staff and commissioners [external link]. The document followed a consultation with the London Strategic Migration Partnership, Primary Care Commissioning, Londonwide Medical Committees and NHS Newham. It includes access policies for primary and secondary care services.

Maternity Action [external link] information on maternity rights and benefits for parents who have claimed asylum

Patient Advice and Liaison Services [external link]

Equality and Human Rights Commission [external link]

Last reviewed: 1 October 2012