What this guidance is for

Many migrants will come from countries with very different health care systems to the UK. This guide 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

This guidance is about NHS entitlements in England.

There is more information about the entitlements of particular groups visiting or moving to England on the NHS website.

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

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

NHS entitlements animation

Entitlements to NHS services for migrants in England

The entitlements to NHS services for migrants in England animation consists of 6 short sections:

1. Introduction to entitlements for migrants
2. Karman’s story (case study provided by Doctors of the World UK)
3. NHS entitlements to primary care in England
4. NHS entitlements to secondary care in England
5. Dental treatment for migrants in England
6. Assessing new patients from overseas

This animation was produced with the support of Doctors of the World UK. Further resources to help healthcare professionals to support migrants’ health can be found in their Safe Surgeries Toolkit.

Visit the immunisations page of the migrant health guide, which includes an animated video about vaccinations for migrants.

See the GP services section below to learn more about GP registration for migrants.

Summary of changes after the Brexit transition period

Short-term visitors from the EU can continue to access medically necessary healthcare through the European Health Insurance Card (EHIC) scheme, or planned healthcare through the S2 funding route.

Short-term visitors from the EU who are not covered by the new UK-EU agreement on reciprocal healthcare (including former UK residents) may be charged for NHS treatment.

There are no changes to the healthcare entitlements of short-term visitors who are covered by bilateral healthcare agreements between the UK and countries outside the EU, including Norway, Iceland, Liechtenstein and Switzerland.

Citizens of the EU, Norway, Iceland, Liechtenstein and Switzerland who move to the UK from 1 January 2021 for more than 6 months will pay the immigration health surcharge as part of any visa application.

EU citizens who were living in the UK on or before 31 December 2020 must apply to the EU Settlement Scheme by 30 June 2021 to maintain their healthcare entitlements in the UK.

COVID-19 testing, treatment and vaccination

Information about COVID-19 testing, treatment and vaccination for migrants can be found on the COVID-19 guidance page.

Free services

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

For secondary care services, the UK’s healthcare system is residence-based. This means that you must be living lawfully in the UK on a properly settled basis to be entitled to free healthcare.

The measure of residence that the UK uses to determine whether someone is entitled to free NHS healthcare is known as ‘ordinary residence’. To be ordinarily resident in the UK, people from countries outside the European Economic Area (EEA) who are subject to immigration control need to also have the immigration status of ‘indefinite leave to remain’.

People who are not ordinarily resident in the UK may be required to pay for their care when they are in England. However, some services and some individuals are exempt from payment.

The National Health Service (Charges to Overseas Visitors) Regulations 2015 and government guidance on overseas visitors hospital charging regulations outline the NHS services that are currently free of charge irrespective of an overseas visitor’s country of normal residence (as long as they have not travelled to the UK for the purpose of seeking that treatment). These services are:

• accident and emergency services, such as those provided at an A&E department, walk-in centre, minor injuries unit or urgent care centre (not including emergency services provided after being admitted as an inpatient, or at a follow-up outpatient appointment, for which charges must be levied unless the overseas visitor is exempt)
• services provided for the diagnosis and treatment of some communicable diseases, including HIV, TB and Middle East Respiratory Syndrome (MERS) (see the regulations for a list of diseases for which there is no charge for treatment).
• NHS services provided for COVID-19 investigation, diagnosis and treatment
• services provided for diagnosing and treating sexually transmitted infections
• family planning services (does not include termination of pregnancy or infertility treatment)
• services for treating a physical or mental condition caused by torture, female genital mutilation, domestic violence or sexual violence
• palliative care services provided by a registered palliative care charity or a community interest company
• services that are provided as part of the NHS 111 telephone advice line

Groups that are exempt from charge include:

• refugees (people who have been granted asylum, humanitarian protection or temporary protection under the immigration rules) and their dependentsdependants
• asylum seekers (people applying for asylum, humanitarian protection or temporary protection whose claims, including appeals, have not yet been determined) and their dependentsdependants
• people receiving support under section 95 of the Immigration and Asylum Act 1999 from the Home Office
• children looked after by a local council
• 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
• prisoners and immigration detainees

People whose application for asylum has been rejected may still be exempt from charge if they are supported:

• under section 4(2) of the Immigration and Asylum Act 1999 by the Home Office
• by a local council under section 21 of the National Assistance Act 1948
• under Part 1 (care and support) of the Care Act 2014

People receiving compulsory treatment under a court order, or who are liable to be detained in an NHS hospital or deprived of their liberty (for example, under the Mental Health Act 1983 or the Mental Capacity Act 2005) are exempt from charge for all treatment provided, in accordance with the court order, or for the duration of their detention.

There may also be exceptional humanitarian reasons where the secretary of state can determine that a person is exempt from charges for relevant services. This exemption also applies to their child or companion who is authorised to travel with them but is limited to treatment that cannot wait until their return home.

People who are covered by reciprocal healthcare agreements, who hold an EHIC or who have paid the immigration health surcharge may also be exempt from payment for certain services. For further exemptions and information, see the NHS website on accessing services if you are visiting from abroad and government guidance on overseas visitors hospital charging regulations.

Services in Scotland

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

New arrivals from Ukraine

As part of the UK’s response to the Russian invasion of Ukraine, visit the Ukraine: migrant health guide page for information about the charging exemption for NHS treatment for anyone ordinarily resident in Ukraine, but lawfully in the UK

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 NHS.

An application to join a practice can only be refused if the practice has reasonable grounds for doing so. A practice cannot refuse an application on the grounds of medical condition or any protected characteristics:

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

The practice will ask the patient to complete a GMS1 form as part of their application to register. The practice will ask people who are not ordinarily resident in the UK to complete supplementary questions. These questions ask for details of the patient’s valid non-UK EHIC or S1 form. If applicable these questions also ask if the patient considers themselves to be exempt from charge for NHS secondary care services, should these be needed.

GP practices are not required to ask for proof of identity, address or immigration status from patients wishing to register. NHS guidance on how to register with a GP surgery clearly outlines that a practice cannot refuse a patient because they do not have proof of address or immigration status.

NHS England and NHS Improvement in partnership with a number of organisations have developed and distributed physical and digital GP access cards, accompanied by posters and social media campaign resources that support access to GP registration. Voluntary, community and social enterprise organisations can get physical copies of the access card from their local Healthwatch to share with the communities they work with, or download a digital copy of the access card and associated resources from the FutureNHS platform. You may need to request access to access these resources.

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

If a practice refuses to register a patient, they must notify the applicant of the refusal and the reason for it, in writing within 14 days of the decision. The Standard General Medical Services Contract and the National Health Service (General Medical Services Contracts) regulations 2015 explain this requirement.

If a person has difficulty registering with a GP practice, they can contact:

• their local NHS England area team
• 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 while visiting the UK and is treated as a private patient, 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 NHS charging rules apply.

Immigration health surcharge

Since 6 April 2015, non-EEA nationals have had to pay the immigration health surcharge when applying for a visa to stay in the UK for over 6 months, unless they are exempt from paying the surcharge.

From 1 January 2021, the immigration health surcharge will also need to be paid by EEA and Swiss nationals coming to the UK for stays of more than 6 months.

People who have paid the surcharge (or who are exempt from having to pay it or have had the requirement waived) can use the NHS in a similar same way to an ordinarily resident person while their visa remains valid. They will still need to pay for certain NHS services, including prescriptions, dental treatment and assisted conception services.

The surcharge is £470 per year for students and those on Youth Mobility Scheme visas and £624 per year for all other visa and immigration applications. The same amount must be paid for any dependents.dependants.

Some people are exempt from paying the surcharge, including people who:

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

People 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 unless they are exempt.

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 of charge for people who are ordinarily resident in the UK. This does not depend 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.

Since 6 April 2015, non-EEA nationals who are subject to immigration control must have the immigration status of indefinite leave to remain at the time of treatment and be properly settled, to be considered ordinarily resident. This requirement will also apply to EEA and Swiss nationals who move to the UK on or after 1 January 2021.

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 if you are from outside the EEA. There is more information about applying to join family living permanently in the UK, at Family visas: apply, extend or switch.

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

All other patients are charged for NHS treatment, except for treatment that is free to all. Payment is required in full and in advance of treatment where clinicians consider the need for treatment to be non-urgent (meaning it can wait until the patient can reasonably be expected to return to their country of residence). Where clinicians consider treatment to be immediately necessary or urgent, it will be provided even if the patient has not paid in advance and the patient will be asked for payment afterwards.

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

The legal duty to assess patients’ 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. Since 23 October 2017, all NHS trusts and NHS foundation trusts must record when a person is an overseas visitor.

All overseas visitors will be charged 150% of the cost of NHS treatment for any care they receive, unless they are exempt from charges for NHS hospital treatment.

For more information see:

• guidance on overseas visitors hospital charging regulations
• National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2015, as amended

Dental treatment

Information about dental entitlements and oral health can be found on the dental health page of the migrant health guide.

Visitors from the EU, Norway, Iceland, Liechtenstein and Switzerland

Visitors from reciprocal healthcare agreement countries and the EEA on or before 31 December 2020

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

There is more information about visitors who do not need to pay for NHS treatment on the NHS website.

There will be no changes to healthcare access for residents from the EU, Iceland, Liechtenstein, Norway and Switzerland whose visit to the UK began on or before 31 December 2020 and continues uninterrupted after that date.

They are exempt from charge for treatment that becomes medically necessary during their stay, including treatment for chronic conditions, such as routine monitoring. They must show a valid EHIC or a provisional replacement certificate to receive free 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.

Visitors from the EU from 1 January 2021

People from the EU will continue to be able to use a valid EHIC or a provisional replacement certificate to access healthcare if they fall ill or have a medical emergency during a temporary stay in England from 1 January 2021.

Students who began their course at an accredited higher education institute in the UK on or before 31 December 2020 will be able to use their EHIC for medically necessary healthcare until the end of their course. They must apply to the EU Settlement Scheme if their course extends beyond 30 June 2021.

If their course begins on or after the 1 January 2021 and lasts for longer than 6 months, they will need to pay the immigration health surcharge as a part of their visa application.

Pre-planned treatment is not included free of charge without special, prior arrangement using an S2 form. EU residents should speak to the authorities in their home country if they want to come to the UK specifically to receive treatment.

There is more information for visitors from EU countries on the NHS website.

Visitors from Iceland, Norway, Liechtenstein or Switzerland from 1 January 2021

UK nationals who moved to Iceland, Norway, Liechtenstein or Switzerland on or before 31 December 2020 can continue to access healthcare in the UK using their member state’s EHIC, or a UK S1 form.

From 1 January 2021, Norwegian citizens residing in Norway can access medically necessary healthcare when visiting the UK, using a valid Norwegian passport.

Other visitors from Iceland, Liechtenstein or Switzerland may have to pay for NHS healthcare. Any treatment that has to be paid for will be charged at 150% of the national NHS rate.

There is more information for visitors from Iceland, Norway, Liechtenstein or Switzerland on the NHS website.

Vulnerable migrants

Information about migrant children, vulnerable migrants and human trafficking can be found in the migrant health guide.

Refused asylum seekers

Refused asylum seekers can be registered with a GP and receive free primary care services in England, Wales and Scotland, as can 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, refused asylum seekers are only entitled to free secondary health care if they receive:

• section 4(2) support from the Home Office
• section 21 support from a local authority
• support under Part 1 (care and support) of the Care Act 2014

All refused asylum seekers can continue, free of charge, with any course of treatment already underway before their application was refused. For new courses of treatment, any treatment that clinicians consider is needed immediately or urgently (before the patient is able to leave the UK) will be provided even if payment is not made in advance of treatment, and arrangements for payment can be discussed with the hospital. Maternity care will always be provided, even when charges apply.

Refused asylum seekers can receive free NHS hospital treatment (secondary care) for:

• accident and emergency services
• the diagnosis of infectious diseases (even if there is a negative result)
• treatment of infectious diseases if they test positive

Victims of certain types of violence (such as sexual violence) are also treated free of charge. For more information see:

• the Refugee Council set up the Health Access for Refugees Programme (HARP) to support asylum seekers and refugees to understand and access the UK health system
• the Royal College of General Practitioners’ position statement on access to primary care for failed asylum seekers and vulnerable migrants

Migrant and/or undocumented children

The Royal College of Paediatrics and Child Health has developed resources to support access to healthcare for migrant and/or undocumented children. This includes a flowchart to help health professionals support vulnerable migrant children and families to understand charging regulations and exemptions.

Data sharing

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Personal data, such as someone’s name, address or medical details, will only be shared with other bodies when consent is given or under circumstances of legal necessity. These circumstances are strictly controlled by data protection law, which includes a legal duty to communicate what data is being shared, and when.

However, Under these strictly controlled conditions, personal data, not including medical data, can currently be shared for the following reasons:

• The NHS can seek information from the Home Office about a person’s immigration status to inform an assessment of their eligibility for free NHS treatment. They must also share with the Home Office non-clinical information about overseas visitors who have NHS debtdebt. (forFor services provided on or after 6 April 2016)2016, data is shared if the debt is £500 or more and has been unpaid for 2 months or more.

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Resources

Patients can apply to the NHS low income scheme for help with health costs. There is more information about how to do this on the NHS Business Services Authority website. This includes information on help with health costs in several languages.

A full help HC2 certificate (which includes free NHS prescriptions) can be applied for using the HC1 form. You can order a HC1 form on the NHS website. It is also available from Jobcentre Plus offices and most NHS hospitals.

HC1 forms are also available to order by phone on 0300 123 0849.

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

Help with health costs advice is available on the NHS website.

The immunisation information leaflet is for anyone who has moved to the UK. It advises migrants on the need to register with a GP to get up to date with their routine vaccinations.

Maternity Action has information on maternity rights and benefits for migrants, asylum seekers and refugees.

The Equality and Human Rights Commission has produced guidance on asylum seekers’ entitlements to healthcare and case studies of good practice.

The British Medical Association has produced an asylum seeker and refugee health resource for medical practitioners to help them understand asylum seekers’ and refugees’ health needs and how to overcome common barriers.

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

BHA has produced videos about how to use the NHS in England. These are available on YouTube in:

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

The Department of Health and Social Care’s Questions to ask: getting the most out of your appointment leaflet is available from the UK government web archive in:

• English
• Arabic
• Bengali
• French
• Gujarati
• Polish
• Portuguese
• Punjabi
• Somali
• Spanish
• Urdu

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

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

Healthy London Partnership in partnership with Healthwatch London and Groundswell has produced ‘My right to access healthcare’ cards to help adults who are homeless or have no fixed address register and receive treatment at GP practices.

Doctors of the World UK and the University of Sheffield have created migrant.health, a user-centred, practical online resource and community that can be used to help adapt primary care services to meet the needs of new migrants.

Doctors of the World UK has also launched a Safe Surgeries Initiative to help GP practice staff provide safe and accessible services to everyone in their community without increasing workload. Becoming a safe surgery equips surgeries with access to training, resources and a supportive national network.

The Home Office has produced guidance for asylum seekers staying in temporary accommodation while their claim for asylum is assessed, which is available in a range of languages.