Access to healthcare

Registering with a local GP surgery is the most direct way to access a whole range of NHS services and treatment. According to NHS Guidance, everyone in England is entitled to register and consult with a GP without charge.

A GP is there to listen to your health concerns and to provide advice. Your GP will let you know if you need other NHS services and will help you to get an appointment. Find your local GP via the NHS choices website.

You do not need to show proof of address, identity or immigration status to register with a practice. The receptionist may ask you to provide proof of address and photo ID when you register, but these documents are not necessary, and you should not be refused registration if you are unable to provide them.

Your registration may be refused if the practice list is closed to new patients or you live outside the practice boundary. If your registration is not successful, the practice should explain this in writing.

Your immigration status does not affect your right to register with a GP. It is not considered a reasonable ground to refuse registration.

To help you assert your rights, NHS England has developed “My right to register” cards, which you can show to the receptionist when you register.

For more information on registering with a GP, see the NHS guidance. You can also find information about registering with a GP and accessing preventative healthcare in this Healthy London Partnership leaflet, including translated resources.

If you have problems registering with a GP surgery, you can:

• call the NHS England Customer Contact Centre on 0300 311 22 33 or [email protected]; or
• contact the Doctors of the World clinic advice line: 0808 1647 686 (freephone) or email [email protected]

You should be treated with respect and dignity when you attend your GP practice. You should not be discriminated against on the basis of any of the following protected characteristics:

• age
• disability
• gender reassignment
• marriage and civil partnership
• pregnancy and maternity
• race
• religion or belief
• sex
• sexual orientation.

You must be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality.

You have the right to be cared for in a clean, safe, secure and suitable environment. You have the right of access to your own health records; and the right to privacy and confidentiality. However, the NHS is legally obliged to inform the Home Office of a relevant unpaid debt for NHS care.

If you are not happy with the service received from your GP, you should tell the practice manager about your concerns. If they cannot deal with your concerns straight away, you can go through the practice’s formal complaints process. By law, every GP practice must have an efficient process for handling complaints.

If your complaint is about NHS treatment and you are not happy with the way your GP practice handles your complaint, you can contact the Parliamentary and Health Service Ombudsman on 0345 015 4033. You can find more information about your rights in the NHS Constitution.

All women in the UK are entitled to NHS maternity care, regardless of immigration status or ability to pay. For more information on accessing maternity care, please see Maternity Action's website.

Maternity care is always deemed immediately necessary, see our section on What happens if I need immediate or urgent care? for more information.

Maternity Action’s legal team provides free advice to women about accessing maternity care, including your rights and entitlements and what to do if you have been charged. They can take on cases of migrants, refugees and people seeking asylum who have been wrongly charged and also deliver advice to healthcare professionals.

For more information, see Maternity Action’s website or call them on 0808 800 0041 Wednesday and Thursday 10 am–12 noon.

Some services can be accessed by anyone, regardless of their immigration status. However, they will need to be paid for if the person is not exempt from charges, or if they do not qualify for help with health costs under the low-income scheme.

These services are:

• prescriptions
• dental treatment
• eye care
• healthcare travel costs
• wigs and fabric supports.

A person will be exempt if they are:

• 60 or over;
• under 16;
• between 16 and 18, and in full-time education
• pregnant; or if they have had a baby in the previous 12 months, and have a valid maternity exemption certificate
• holding a medical exemption certificate because they have a certain medical condition – see the NHS list of applicable medical conditions.

If you are not exempt, and you have a low income, you may be eligible for an HC2 certificate through the NHS Low Income Scheme. This would entitle you to full or partial help. You can apply for a HC2 certificate regardless of your immigration status. To apply for the HC2 certificate, an HC1 form must be completed.

See the NHS information on help with health costs, or if you are seeking asylum you can contact Migrant Help on 0808 8010 503 or via their webchat.

Your GP will support you to access the secondary care services you need by making a referral.

People who are not “ordinarily resident” in the UK may have to pay for some NHS services received in hospital or in the community, due to the NHS charging regulations.

Since 1 July 2021, this regulation has included European citizens and their family members who arrived in the UK before 1 January 2021, and who do not have either settled or pre-settled status. This also includes those who have not made an application to the EU Settlement Scheme; and those who arrived after 1 January 2021 and have not paid the Immigration Health Surcharge. More information on healthcare entitlement for EU citizens is available via Doctors of the World.

Some services are exempt from this regulation. As such, they are available free of charge for everyone, regardless of immigration status. These exempt services are:

• accident and emergency (A&E)
• family planning (excluding termination of pregnancy)
• treatment for communicable disease.

The immigration health surcharge (IHS) applies to everyone coming to the UK for longer than six months. The IHS is payable during the visa application process.

As of 1 January 2021, this includes European citizens moving to the UK for the first time.

The fee is currently:

• £776 per year for a student or Youth Mobility Scheme visa
• £776 per year for visa and immigration applicants aged under 18 at the time of application
• £1,035 per year for all other visa and immigration applications.

You must pay the IHS for the duration of your proposed stay. For example, if you are applying for a visa on the basis of your relationship with your partner, this is usually granted for 30 months (two-and-a-half years). Therefore, you would have to pay £2,587.50 (£1,035 times two-and-a-half years).

The following people are exempt from paying the IHS (though this is not an exhaustive list):

• those applying for indefinite leave to enter or remain
• health and care workers who are eligible for a Health and Care Worker visa, and their dependants
• those applying to the EU Settlement Scheme
• people seeking asylum and their dependants
• domestic workers who have been identified as a victim of slavery or human trafficking
• those applying for discretionary leave to remain in the UK, having been identified as a victim of slavery or human trafficking
• those to whom the Home Office’s domestic violence concession applies
• S2 Healthcare Visitors
• those eligible for a Frontier Worker permit, and who have an S1 certificate.

More information on the Immigration Health Surcharge can be found on the government's website.

People who are not “ordinarily resident” in the UK may have to pay for some NHS services received in hospital or in the community, due to the NHS charging regulations. However, some groups are exempt from NHS charges.

The following people are exempt from NHS charges:

• Visa holders who have paid the health surcharge as part of their visa application to enter or remain in the UK
• refugees (those granted asylum, humanitarian protection or temporary protection under the immigration rules) and their dependants
• asylum-seekers (those who have applied for asylum and those who have not applied, but intend to apply, for asylum, humanitarian protection or temporary protection; and those whose claims, including appeals, have not yet been determined), and their dependants
• individuals receiving section 95 asylum support
• refused asylum seekers, and their dependants, receiving section 4 support or local authority support under Part 1 (Care and Support) of the Care Act 2014
• children being looked after by a local authority
• survivors and suspected survivors of modern slavery
• people receiving treatment under the Mental Health Act
• prisoners and those held in immigration detention
• refused asylum seekers living in Scotland and Wales.

Survivors of torture, female genital mutilation, or domestic or sexual violence should not be charged for treatment needed as a result of their experience of violence (including mental health treatment). See the government guidance (page 14) for more information.

For information on COVID-19, please see our COVID-19 page.

From 24 February 2022, Ukrainian nationals who have permission to enter or remain in the UK are exempt from the NHS charging regulations and can access the NHS on the same basis as someone who is ordinarily resident in the UK. Further information about support available to Ukrainian Londoners is available on our dedicated page and on the government website.

Thrive London have produced information and resources to support the mental wellbeing of Ukrainian arrivals and other displaced populations.

You can find more information about the NHS charging regulations on the government website, and on the No Recourse to Public Funds Network website.

If your treatment is immediately necessary or if it is urgent, it should not be withheld, even if you are unable to pay – although you may receive a bill afterwards.

• Immediately necessary treatment includes treatment that is required to save a patient's life, to prevent a condition from becoming life-threatening or to prevent serious damage
• Urgent treatment includes treatment that a clinician determines should not wait until a patient can be reasonably expected to leave the United Kingdom.

Maternity care is always deemed immediately necessary. Maternity Action has produced guides to help you understand the NHS charging programme. For more information on maternity care, see Can I access maternity care?.

Only clinicians can make an assessment as to whether a patient’s need for treatment is immediately necessary; urgent; or non-urgent. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998.

If your treatment is withheld, you can contact Doctors of the World for advice on 0808 1647 686 (freephone), or email [email protected].

More information about Urgent and Immediately necessary treatment, and implementing the overseas visitors charging regulations, is available on gov.uk.

The NHS may inform the Home Office if you have an outstanding healthcare charge of over £500. More details about this, and other information relevant to data-sharing, can be found on the Maternity Action website.

One of the general grounds for refusal in immigration applications (not applicable to people seeking asylum) is an outstanding NHS debt of over £500. Therefore, your immigration application may be affected if you cannot pay for your healthcare. However, this is not a mandatory ground for refusal, and it is possible your application will not be refused; therefore, it is not a reason for you not to make an immigration application.

Whilst being charged for NHS treatment can be concerning, it is important that patients receive the healthcare they need. Support is available for patients who are worried about a bill. In some cases, the NHS Trust may allow a patient to pay in instalments.

The Mary Ward Legal Centre may be able to help with arranging a repayment plan with the NHS Trust.

Doctors of the World may be able to help patients who believe they have been incorrectly billed.