The National Health Service (NHS) is the Government-funded medical and health care services for all the UK: England, Scotland, Wales and Northern Ireland.
The NHS has the same values and basic operational principles throughout all the UK. But with the decentralisation of the NHS in 1999, the 4 countries started to adopt different rules and policies regarding their healthcare system. There are therefore some differences in how the NHS works in each country of the UK.
Accessing the NHS
Everyone can get medical care through the NHS.
If you are a resident in the UK, the NHS is free, whatever your situation. If you are European and are in the UK for a temporary stay or for tourism, you can access the NHS using your European health insurance card (it only gives access to emergencies and unforeseen care). If you are a temporary resident or a tourist coming from a country outside the European Economic Area, you must pay a tax in order to access the NHS.
Registering with the NHS
This is not automatic. You first need to register with a GP at an NHS surgery located near where you live or work providing them with your national insurance number and a proof of address. Some NHS surgeries may ask for an ID.
If you are already a resident in the UK and stay temporarily in another part of the country, you can go to a different NHS surgery than the one where you are registered, but you must register as a temporary patient at a different NHS surgery. This is possible for up to three months.
Seeing an NHS general practitioner (GP)
The NHS GP is the patient’s first point of contact with the health care system: everyone must first see a GP before seeing a specialist/consultant, including a gynaecologist or a paediatrician. The aim of this system is to make sure that NHS patients see specialists only if medically necessary.
The average consultation time with an NHS GP in the UK is 10 minutes. Some NHS surgeries can ask their patients not to raise more than one issue per consultation. In the case you need to discuss various issues with your GP, it is advised to make this clear when you book your appointment, as you may be able to get a double appointment.
Seeing a specialist
As explained above, you must first see your GP who, if they deem it necessary, will refer you to a specialist. You will then be placed on a waiting list. Depending on the seriousness of your condition you may be given priority over other patients. The waiting time can depend on the area where you are seeking treatment and the type of treatment you require. If after seeing the specialist you need to be operated on, you will likely be put onto a new waiting list.
NHS patients are generally hospitalised in shared wards, except for quarantine patients who are isolated in a separate side room. Some private amenity rooms are available in certain maternity wards for postnatal care; these rooms generally cost around £100 per night (but can go as high as £450), which is much less than a room in a private hospital. However if a patient is admitted to the hospital who has a greater medical need for the room you would return to the general maternity ward.
The NHS private wings
Most NHS hospitals also have a private patient unit (also known as NHS private wings). They are often located in a separate building or hospital wing. They offer a level of comfort similar to the service provided in private hospitals. Patients pay for their care out of pocket or through their insurance company, like in a private hospital, safe in the knowledge that their money will be reinvested in this same NHS hospital.
Many NHS hospitals are better equipped than private hospitals for serious conditions and unforeseen illnesses. For example, NHS hospitals have intensive care units which are often lacking from small private hospitals.
Accident and emergencies (A&E)
It is important to note that private hospitals do not treat emergencies. For A&E services you will need to go to an NHS hospital as only the NHS is equipped to deal with serious injuries and trauma The service is generally very good, and the care excellent.
As many NHS hospitals have a private wing, if you are admitted to hospital following your A&E treatment your insurer may be able to cover the cost of the subsequent treatment. You would need to get an authorisation from your insurer, which means that you will have to wait for the approval of your insurer before asking the NHS to transfer you to the private wing. Please note that this is generally not possible with a UK PMI which only covers planned treatment, and not medical emergencies.
The NHS services of the four UK countries has targets regarding upper limits on how long patients should expect to wait for medical care. The targets differ from country to country.
Here are the targets for England and Scotland (outside emergencies):
- 6 weeks maximum waiting time for key diagnostic tests and investigations, from the moment they have been ordered by the GP or the specialist doctor.
- 12 weeks maximum waiting time for a new outpatient appointment with a specialist doctor, from the moment the patient has been referred by their GP.
- 18 weeks maximum waiting time from referral from the GP to starting the treatment prescribed by the specialist doctor.
In Wales, 95% of inpatient and outpatient treatment should start within 26 weeks while 100% of treatment should start within 36 weeks.
In Northern Ireland the targets are: 50% of patients must be seen within 9 weeks, and all patients must have been seen within 21 weeks. For hospital care, 50% of patients should receive treatment within 13 weeks and all patients must have been treated within 36 weeks.
Due to understaffing as well as financial pressure on the NHS, the waiting times can sometimes be exceeded. They tend to be longer in Wales than in the rest of the UK.
It’s important to stress that these waiting times don’t apply to A&E services, for which another target applies for all the UK: at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours.
However, NHS hospitals struggle to meet this target. In the past years, the performance of hospitals in regard to A&E targets have gradually declined. In England, for example, 11.6% of patients waited for more than 4 hours in 2017/2018. The wait in A&E is generally longer during winter months.
Prescription medicine is free in all of the UK, except in England where a fixed charge is applied: £9 per medication. The prescription charge is subject to yearly increases. Some prescribed medications are exempt from the prescription charge such as the contraceptive pill. Certain categories of people are exempt from prescription charges: pregnant women, children, people over 60 years old and those suffering from certain medical conditions. For more information please see the Prescription costs page on the NHS England website.
Dental and optical care
Dental and optical care are a paid medical service in all four UK countries but each country applies different rules. The categories of people exempt from paying for these services also differ from country to country. For example, dental and optical examinations are free for all in Scotland whereas they are charged for in the rest of the UK (except for some categories of the population).
Some categories of the population can receive free eye care or receive vouchers to buy glasses or contact lenses prescribed by an NHS optician. The value of the vouchers and categories of people who are eligible varies from country to country. More information on the NHS optical vouchers in each UK country: NHS England, NHS Scotland, NHS Wales and NHS Northern Ireland.
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