nhs charging

March 31

NHS Charging for Services


OTB Legal

Registering with a GP (primary services)

If you are in the UK, you can register with a General Practitioner (GP) without showing any ID, regardless of your immigration status. Once registered, you are entitled to receive NHS services from your GP free of charge.

A GP cannot refuse to register you because you cannot prove your immigration status or because the GP thinks you may not be ‘ordinarily resident’ in the UK. The only reason a GP can refuse to register you is if their list is full.

So, if you encounter a GP who has space on their list but refuses to register you for lack of ID or because of your immigration status, then you can probably challenge that on the grounds that it is discriminatory.    

Hospital care or community health services (secondary services)

You are only entitled to use secondary NHS services for free if you are ‘ordinarily resident’ in the UK. You will need to prove that you are in the UK lawfully, voluntarily and are ‘ordinarily resident’ in the UK.

The government has created an Ordinary residence tool to help its healthcare staff make charging decisions. You can attempt to answer these questions for yourself to find out whether you will be charged. If this tool is not flexible enough to describe your circumstances, then you should consider taking legal advice.

You won’t incur charges for secondary services if you hold ILR (indefinite leave to remain) or pre-settled or settled status under the EU Settlement Scheme. There are also possible exceptions for:

  • those who have paid the Immigration Health Surcharge as part of their limited leave to remain applications;
  • victims of trafficking;
  • refugees or asylum seekers;
  • victims of domestic violence;
  • those who come from a country with reciprocal healthcare agreement with the UK

The ordinary residence test also applies to British citizens. So, if you are British and have been living overseas for a long time, you may need to prove that you are ordinarily resident to use secondary services without cost.

If you are a visitor to the UK or are here unlawfully, you are likely to have to pay charges for secondary NHS services. If you incur any debts to the NHS over £500 that you do not or cannot repay, this is likely to count against your good character in future immigration applications.

How does NHS charging work?

If you require hospital or community treatment that is not immediately necessary or urgent, then the NHS Trust is legally required to charge you for the treatment in advance. So you will know how much you will have to pay.

You will still be provided with hospital or community health services if it is ‘immediately necessary or urgent’ (i.e.. an emergency). Even if you are not entitled to use these services for free. It is unlawful for a NHS Trust to demand payment in advance for emergency services. Although, you may still receive the bill in advance.

Can I challenge an NHS charging decision?

Maternity care is classed as ‘immediately necessary or urgent’ treatment and is often the reason that people incur NHS charges. The charity Maternity Action are experts in this field so you can contact them for advice if you think you have been unfairly or wrongly charged for maternity services.

The NHS staff who generate bills for patients are financial and administrative staff, not lawyers. They sometimes misapply or misinterpret the law around charging. If you think you have been wrongly charged, it is worth seeking legal advice on whether you can challenge a charging decision.

If you are struggling to pay an NHS charge that you are definitely liable for, you could either: negotiate a payment plan; ask for the debt to be put on hold for 6 months; or possibly even ask for the debt to be written off if you are destitute.

NHS workers

If you work for the NHS but have paid the Immigration Health Surcharge (IHS), then you will want to read our next blog. This will be a practical guide to reclaiming your IHS in instalments!

When posted, you will find this blog amongst others on our insights page...

Further Immigration Advice

For support with any other immigration related queries, get in touch at [email protected] or book a FREE initial consultation.

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