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The National Health Service (NHS) provides healthcare in the UK. The guidelines as to who is eligible to be treated for free within the NHS are governed by The National Health Service (General Medical Services) Regulations 1992 and by the National Health Service (charges to Overseas Visitors) Regulations 1989 (amended). The first section covers treatment with a General Practitioner (GP). The rest of the page covers the right to receive hospital treatment.

Access to treatment with a General Practitioner (GP)

Changes to the regulations governing this area are currently being considered. The Department of Health has proposed new criteria for determining who is eligible to receive free NHS primary medical services. The proposals include an option to allow GP’s to charge visitors as private patients. GP’s can currently decide to register overseas visitors as NHS patients. The consultation, ‘Proposals to Exclude Overseas Visitors from Eligibility to Free NHS Primary Medical Services: a Consultation’, aims to bring primary care services in line with amended hospital regulations, which came into force May 2004. The newly amended hospital regulations are detailed later in this page.

What is the current situation?

The section below discusses who can visit a GP for free and is taken from the website of the Department of Health. Free GP treatment is based on residence in the UK, not on nationality, the payment of UK taxes or National Insurance contributions. A person who is regarded as ordinarily resident in the UK is eligible for free treatment by a GP. A person is 'ordinarily resident' for this purpose if lawfully living in the UK for a settled purpose as part of the regular order of his or her life for the time being. Anyone coming to live in this country would qualify as ordinarily resident.

Overseas visitors to the UK are not regarded as ordinarily resident if they do not meet this description. For example, a person who emigrated from the UK, but returns sometimes for visits is not seen as ordinarily resident, regardless of any previous UK taxes or contributions they have paid or receive. He or she would not normally be entitled to free NHS treatment from a GP. Any person who leaves this country to live abroad should be removed from his or her GP list after 3 months.

There are however some circumstances which entitle overseas visitors to free treatment:

• Asylum seekers and refugees given leave to remain in the UK, or awaiting the results of an application to remain, are regarded as ordinarily resident and entitled to full NHS GP treatment.
• EEA nationals carrying form E128 (short-term posted workers or students and their accompanying dependants) are entitled to free NHS GP treatment. EEA member states include Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Netherlands, Norway, Portugal, Spain and Sweden.
• EEA nationals carrying form E112 (specified medical conditions) are entitled to free NHS GP treatment for that condition.
• Any person, whether ordinarily resident or not, requiring treatment that a GP regards as emergency or immediately necessary shall receive that treatment free of charge, whether registered with a GP or not.

GPs have the choice of accepting patients either as fully registered patients or as temporary residents if they are in the area for more than 24 hours but less than three months. They may offer to accept non-qualifying patients as private patients, liable to pay fees for treatment.

Access to hospital treatment

This rest of this page deals with the right to receive hospital treatment. Hospitals have a right, and a duty, to charge for services provided to those who are nor eligible for free treatment in the UK. This might include those who do not normally live here, including those British Citizens who do not live permanently in the UK. The hospital treating you will make the decision as to whether you are eligible to free treatment. They may ask you to provide evidence to support this. The regulations do not require hospitals to refuse to treat someone in urgent clinical need solely because they are, or are believed to be, liable to charges and unable to pay. These regulations were amended in 2003 and the new amended regulations, as stated on this page, came into force in May 2004.

Who is entitled to free NHS hospital treatment?

These exemptions extend to the spouse and school-age children of an exempt person if they are living in the UK with the exempt person on a permanent basis.

• anyone engaging in employment where the employer's principle place of business is in the UK or is registered in the UK as a branch of an overseas company; or engaging in self employment where the principle place of the employment is in the UK;
• anyone who is an unpaid worker with a voluntary organisation providing services similar to health or social services;
• anyone who is pursuing a full time course of study of not less than 6 months in duration or pursuing a course of study of any duration that is substantially funded by HM Government;
• anyone who has come to the UK to take up permanent residence (people who have made an application to the Home Office for leave to remain will be chargeable until leave to remain has been granted);
• anyone who has been living lawfully in the UK for 12 months immediately before requiring treatment;
• refugees and formal asylum seekers whose applications have not yet been determined;
• anyone working on ships registered in the UK;
• anyone who is in receipt of a UK war pension;
• anyone who is working as a diplomat in a UK based embassy;
• anyone who is a member of HM armed forces;
• anyone working abroad for the UK civil service who was recruited in the UK;
• anyone working abroad for the British Council or the Commonwealth War Graves Commission who was recruited in the UK;
• anyone working abroad whose post is financed in part by the UK Government in agreement with another government or public body;
• anyone who has lived lawfully in the UK for 10 continuous years at some point but who is now working abroad and has not been away for more than 5 years;
• anyone who works abroad in another EEA country (or Switzerland) who pays compulsory (not voluntary) National Insurance in the UK;
• nationals of other EEA member states (or Switzerland) who have been referred to the UK for specific treatment. They must have a form E112 or E123 issued by the state health authority in their "home" country that covers (or insures) them for healthcare;
• prisoners and those detained under immigration laws;
• nationals of countries with which we hold bilateral healthcare agreements and who are in the UK to receive specific treatment with the agreement of their "home" country;
• UK state pensioners living not less than 6 months in the UK and not more than 6 months in another EEA Member State and who are not registered as resident in another EEA Member State;
• anyone who is serving with the armed forces of a country which is part of NATO but only where treatment cannot be readily provided by either his or her own medical service or the UK armed forces medical service.

Is every NHS hospital service liable for charging?

• services provided in an Accident and Emergency department, unless and until the patient is admitted as an in-patient (this will include emergency operations and admittance to a High Dependency Unit) or registered at an out-patient clinic;
• services provided at a walk-in centre providing services similar to those of an Accident and Emergency department of a hospital;
• treatment of certain specified illnesses on public health grounds;
• treatment provided at, or resulting from a referral from, a sexually transmitted disease clinic, but in the case of HIV only in relation to diagnostic testing and associated counselling;
• family planning services;
• compulsory psychiatric treatment.

Is anyone exempt from paying for some NHS hospital treatments?

This is limited to treatment required for a condition that arises during a visit to the UK, not routine treatment of a pre-existing condition.

• anyone who is a national, or refugee, or stateless person or a member of their family resident in EEA member states and Switzerland;
• anyone, or the spouse or school-age children, of a person in receipt of a UK state pension who has lived lawfully in the UK for 10 continuous years at some point or has been employed by the UK government for 10 continuous years at some point;
• anyone from non-EEA countries with which we hold reciprocal health care agreements;
• anyone who is without sufficient resources to pay the charge and who are nationals of a country (currently Turkey and Cyprus - from 1 May 2004 Cyprus will join EU) which is a contracting party to the European Convention on Social and Medical Assistance 1954;
• anyone who has lived lawfully for 10 continuous years in the UK at some point but who is now living in an EEA member state or Switzerland, or a non-EEA country (other than Israel) with which we have a reciprocal health care agreement, and their spouse and school-age children.

Countries with reciprocal healthcare agreements with the UK

Nationals of the member states of the European Economic Area (EEA), or their dependants, and refugee and stateless persons living within the EEA, have the right to NHS treatment without charge where the need arises during their stay. EEA national who wish to enter the UK for treatment should obtain authorization from their national social security association which will bear the cost of the treatment. EEA member states include Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Netherlands, Norway, Portugal, Spain and Sweden.

Other categories of people are exempt from charges for treatment if the need for treatment arose whilst in the UK and if their country has a reciprocal healthcare agreement with the UK. This provision excludes travel to the UK for treatment of a pre-existing condition. The group consists mainly of European Union citizens and their dependants, and nationals of the countries below.

Bulgaria, Czech and Slovak Republics, Gibraltar, Hungary, Malta, New Zealand, Russian Federation, Former Soviet Union States (except Estonia, Latvia and Lithuania), Yugoslavia ie Serbia and Montenegro, together with successor states Croatia, Bosnia, Slovenia and Macedonia.

Residents irrespective of nationality of the following countries

Anguilla, Australia, Barbados, British Virgin Islands, Channel Islands, Falkland Islands, Iceland, Isle of Man, Montserrat, Poland, Romania, St Helena, Sweden, Turks and Caicos Islands.

Why were the regulations covering hospital treatment for overseas visitors amended?

The government intended the new regulations to prevent certain abuses of the NHS by people they saw as not being entitled to free treatment and care. Some of these abuses included people visiting the UK just to obtain treatment, free hospital care for failed asylum seekers and free treatment for people in the UK on business and their families.

New categories were created to cover overseas students studying in the UK and pensioners living in the UK and another European Economic Area (EEA) country. There has not previously been a category to cover students, and the new exemption allows students on full time courses longer than 6 months to access free treatment. Another category allows UK pensioners to live in the UK and another EEA country for part of the year and still receive free treatment, as long as they are not registered as resident in the other country.

For more on the access to GP’s proposals, and on the current legislation, visit the Department of Health's website for overseas visitors at www.publications.doh.gov.uk/overseasvisitors

For information on the regulations themselves, we suggest you consult the following documents;

‘Implementing the Overseas Visitors Hospital Charging Regulations: Guidance for NHS Trust Hospitals in England’, Department of Health

'Proposals to Exclude Overseas Visitors from Eligibility to Free NHS Primary Medical Services: a Consultation’, Department of Health

Last updated December 22, 2004