If you are in the UK and need medical treatment, it is important to understand when NHS care is free and when charges may apply.
The rules can be confusing because GP services and hospital care are treated differently. Your immigration status, the type of treatment you need, and whether you are considered “ordinarily resident” in the UK can all affect whether you will be charged.
This blog explains the key points.
Registering with a GP
If you are in England, you can register with a GP even if you cannot provide ID, proof of address, an NHS number or evidence of your immigration status. GP registration is free, and your immigration status does not affect your right to register with a GP.
A GP practice should not refuse to register you simply because you cannot prove your immigration status or because you do not have documents with you.
However, a GP practice may refuse registration in limited circumstances, for example if you live outside the practice boundary, the practice list is closed, or there is another lawful and non-discriminatory reason. If a practice refuses to register you, you can ask for the refusal and the reasons to be confirmed in writing. Once you are registered, you can receive GP services without charge.
Hospital care or community health services
The rules are different for hospital care and some community health services. These are often referred to as secondary NHS services.
In England, you will usually be entitled to free secondary NHS care if you are “ordinarily resident” in the UK or if a specific exemption applies. Broadly speaking, ordinary residence means that you are living in the UK lawfully, voluntarily and for settled purposes.
If you have indefinite leave to remain, settled status or pre-settled status under the EU Settlement Scheme, this will be highly relevant to whether you can access free NHS care. However, the NHS may still consider whether you are genuinely living in the UK on a settled basis.
You may also be exempt from charges in certain circumstances, including if you have paid the Immigration Health Surcharge as part of a valid visa application, if you are an asylum seeker or refugee, if you are a victim or suspected victim of modern slavery, or if another specific exemption applies. The rules are technical and depend on your circumstances and the type of treatment needed.
Visitors and people without lawful residence
If you are visiting the UK, or if you are in the UK without lawful immigration status, you may be charged for some NHS hospital or community care.
This does not mean that treatment will always be refused. If treatment is urgent or immediately necessary, it should not be withheld or delayed because of charging issues. However, if you are not exempt from charges, the NHS may still issue an invoice after treatment has been provided.
Maternity Care
Maternity care is treated as immediately necessary treatment. This means that it must not be refused, delayed or withheld because of immigration status or inability to pay.
However, maternity care can still be chargeable unless an exemption applies. If you are chargeable, the NHS may issue an invoice after care has been provided. If you believe you have been wrongly charged for maternity care, it is worth seeking legal advice or specialist support.
Can I challenge an NHS charging decision?
Yes. NHS charging decisions are not always correct.
NHS staff dealing with charging are usually administrative or finance staff, and mistakes can happen. For example, there may be errors about your immigration status, whether you are ordinarily resident, whether an exemption applies, or whether the treatment should have been charged in the first place.
If you believe you have been wrongly charged, you may be able to challenge the decision.
If you are liable for the debt but cannot afford to pay it immediately, you may be able to ask for a payment plan, request that recovery action is paused, or ask whether the debt can be reviewed in light of your financial circumstances.
NHS Debts and Immigration Applications
Unpaid NHS debt can have serious immigration and nationality consequences.
Home Office good character guidance confirms that a person will not normally be considered of good character if they have outstanding NHS debts under the overseas visitor charging rules. NHS debt of more than £500 can also be relevant to immigration decision-making.
This is particularly important if you are planning to apply for further leave to remain, indefinite leave to remain or British citizenship.
If you have received an NHS invoice and you are unsure whether you are liable, you should take advice as early as possible.
What about the Immigration Health Surcharge?
Many people applying for UK visas are required to pay the Immigration Health Surcharge. This usually allows them to access NHS care during the period of their visa, although some exceptions and limits may still apply.
If you work in health or care and have paid the Immigration Health Surcharge, you may be eligible for a refund or reimbursement. Eligibility depends on your visa type, job role, employer and period of employment. GOV.UK confirms that some health and care workers may be able to claim refunds in 6-month periods, and dependants may also be eligible in some circumstances.
How OTB Legal can help
If you have been charged for NHS treatment and you are unsure whether the charge is correct, we can help you understand your position.
We can advise on whether you may be exempt from charges, whether the NHS has correctly applied the ordinary residence test, and whether an unpaid NHS debt could affect a future immigration or nationality application.
If you are worried about NHS charging or an outstanding NHS debt, please contact our Personal Immigration Team for advice.
