NHS guide for expats: how to navigate UK healthcare

The NHS — the National Health Service — is one of the most iconic things about life in the UK. Free healthcare at the point of use, funded by taxes and National Insurance contributions, covering everything from a sore throat to open-heart surgery. In theory, it sounds wonderful. In practice, when you arrive in the UK as an expat with no medical history, no GP, and no idea what "111" means, it can feel like deciphering a system in a foreign language.

This guide walks you through everything you need to know to actually use the NHS: how to register with a GP, how prescriptions work, what dental and optical care costs, and critically — which number to call in an emergency.

What Is the NHS and Who Can Use It?

The National Health Service was founded in 1948 on the principle that good healthcare should be available to all, regardless of wealth. It is funded primarily through taxation and National Insurance contributions (NIC), which is one of the reasons you'll see NIC deducted from your payslip each month as a working expat.

The Immigration Health Surcharge (IHS)

If you arrived in the UK on a work visa — such as a Skilled Worker Visa or Global Talent Visa — you almost certainly paid the Immigration Health Surcharge (IHS) as part of your visa application. As of 2026, this is currently £1,035 per year (pro-rated for shorter visas), charged upfront for every year of your leave.

This surcharge grants you full access to NHS services on the same basis as a UK resident. You are not an NHS tourist — you have already paid for your access. If your employer is sponsoring your visa, some companies cover the IHS on your behalf (or reimburse it), so it is worth checking your employment contract or asking HR.

If you are on a short-stay or visitor visa, you are not eligible for free NHS treatment beyond emergency care. Planned, non-urgent treatment is chargeable at 150% of the NHS tariff rate.

Step 1: Register with a GP

A GP (General Practitioner) is a family doctor, and they are your primary gateway into the NHS. You cannot simply walk into a hospital for routine care — the system is designed so that your GP assesses you first and refers you onward to specialists if needed.

How to Find and Register with a GP

1. Find surgeries near you: Use the NHS GP finder at nhs.uk and search by your postcode. The tool shows distance, patient ratings, and whether the surgery is currently accepting new patients.
2. Check if they are accepting new patients: Many inner-city London surgeries have closed lists. If your nearest surgery is not accepting patients, try the next closest — you are not restricted to your immediate street. Surgeries can refuse patients who live outside their defined catchment area, but there is no rigid national boundary.
3. Register online or in person: Most surgeries now allow online registration via their own website or through the NHS app. You will be asked to fill in a registration form including your name, date of birth, NHS number (if you have one), address, and a brief medical history.
4. No NHS number? That is fine: You do not need an NHS number to register. A new NHS number will be created and allocated to you automatically once your registration is processed.

What documents might you need?

Surgeries are not permitted to refuse registration solely on the basis that you lack documents, but in practice most will ask for proof of address (a utility bill or tenancy agreement works well) and photo ID. Bring what you have.

How long until you can see a doctor?

The post-pandemic NHS was under significant pressure up until around 2025. In my own experience living in Zone 6, calling the surgery at 8 am almost always secured me a same-day appointment — but I know that is not everyone's story, and wait times varied a lot depending on the area and the surgery.

More recently, things do seem to have improved noticeably. Whether that is down to government investment, policy changes, or just a welcome coincidence, routine GP appointments have become easier to get. Phone and online consultations have also become far more common, which helps enormously for non-urgent issues — you no longer always need to travel in person just to get a prescription renewed.

Step 2: The NHS App — Your Digital Health Record

Once registered, download the NHS App (available on iOS and Android). This is your digital front door to the NHS and allows you to:

• Book and manage GP appointments
• Order repeat prescriptions
• View your test results and health record
• Access your vaccination history (important if your employer asks for proof)
• Generate a healthcare record summary for travel

Setting it up requires verifying your identity via the app itself — it will match your details against NHS records, so ensure your GP registration is fully processed first.

Step 3: How NHS Prescriptions Work

When your GP prescribes medication, you will receive a prescription — most commonly sent electronically to a pharmacy of your choice (called the Electronic Prescription Service or EPS). You can nominate your preferred pharmacy through the NHS App.

The Flat-Rate Prescription Charge

In England, there is a flat charge per prescription item, regardless of the actual cost of the medication. As of 2026, this is £9.90 per item. Each item on a prescription is charged separately, so if your GP prescribes three medications, you pay three times.

There are important exemptions — the following groups pay nothing for prescriptions in England:

If you take regular medication and need multiple items per month, a Prescription Prepayment Certificate (PPC) is worth buying. A PPC currently costs around £111 annually and covers an unlimited number of prescriptions for that year. For anyone on two or more repeat prescriptions per quarter, it pays for itself quickly.

[!TIP] Prescriptions are entirely free in Wales, Scotland, and Northern Ireland, regardless of age or income. If you are relocating to Edinburgh, Cardiff, or Belfast rather than London, you will not pay anything at the pharmacy.

Step 4: Dental Care — Where the NHS Gets Complicated

Dental care is one of the biggest surprises for expats. Unlike GP services, NHS dental treatment is not free for working-age adults (unless you fall into one of the exemption categories listed above).

NHS dental treatment in England is structured into three fixed charge bands:

These charges cover the entire course of treatment, not individual appointments. A single Band 2 charge of £73.50 covers however many fillings you need in that course.

The NHS Dentist Shortage

The biggest practical problem is simply finding one. NHS dentists in London and most major UK cities have very long waiting lists — some are not accepting new patients at all. When you arrive, it is worth registering with an NHS dentist as early as possible, even before you have any dental issues.

If you cannot find an NHS dentist, you have two options:

1. Dental Access Centers: Some areas have NHS dental access centers that handle patients without a dentist — check your local NHS trust's website.
2. Private dental care: Private dentists are widely available but can be expensive. A routine checkup runs approximately £60–£100, and more complex work costs significantly more.

Step 5: Optical Care

Unlike GP services, eye tests and glasses are not covered by the NHS for most working-age adults. You will pay for both.

A routine eye test at a high street optician (Specsavers, Vision Express, Boots Opticians) typically costs £25–£50. The cost of glasses or contact lenses is on top of that.

Exemptions do apply — children, adults on certain benefits, and those with specific eye conditions are eligible for free NHS sight tests and a contribution towards the cost of glasses via an optical voucher. Check eligibility at nhs.uk.

When to Call 111 vs 999 vs Going to A&E

This is possibly the most practically important section. Knowing which number to call — or whether to go to hospital at all — saves time, money, and stress.

NHS 111

111 is a free phone and online triage service available 24/7. When you call, a trained adviser (often a nurse) will ask about your symptoms and direct you to the most appropriate service. They can book you an appointment at an out-of-hours GP clinic, direct you to a pharmacy, send an ambulance if needed, or advise you to go to A&E.

Calling 111 before going to A&E is strongly encouraged unless you are facing a genuine emergency. It saves you time waiting in a busy A&E department and reduces pressure on the system.

A&E (Accident & Emergency)

A&E departments are for genuine medical emergencies. They are free to use for NHS-entitled patients, but they are extremely busy and operate on clinical priority, not arrival order. A minor issue might see you waiting five or six hours while more serious cases are treated first. Using A&E for a cold or a sprained wrist is strongly discouraged and actively puts pressure on emergency care.

Walk-in Centres and Urgent Treatment Centres

Many areas have Walk-in Centres or Urgent Treatment Centres (UTCs) — these sit between a GP and A&E. No appointment needed, open long hours, and staffed by nurses and GPs who can handle minor injuries, infections, and things that cannot wait for a GP appointment but are not emergencies. Excellent for things like minor wounds, suspected fractures, ear infections, or UTIs.

Mental Health: An Often-Overlooked Part of the NHS

The NHS provides mental health services, but accessing them can take time. The most common route is:

1. Speak to your GP: They will assess you and can refer you to local NHS talking therapies (IAPT — Improving Access to Psychological Therapies), which include CBT and counselling.
2. Self-refer to IAPT: In most areas, you can self-refer without going through your GP first at nhs.uk/mental-health.
3. Private therapy: If NHS waiting times are too long (which they often can be), many expats opt for private therapy via platforms like BetterHelp or Spill. Costs vary from around £50–£150 per session.

Moving to a new country is genuinely hard on mental health. The adjustment, the loneliness, the new work culture — all of it is real. Do not hesitate to use these services.

Practical Tips for Expat NHS Life

• Register with a GP immediately on arrival — do not wait until you are unwell.
• Keep your NHS number safe once assigned. It is useful for any future NHS interaction.
• Download the NHS App and set up your nominated pharmacy early.
• Set up repeat prescriptions if you have an ongoing condition — do not let yourself run out of medication.
• Get a European Health Insurance Card (EHIC) equivalent: If you travel within Europe, the UK now issues a Global Health Insurance Card (GHIC), which gives access to state healthcare in EU countries at a reduced cost or free. Apply free at nhs.uk/using-the-nhs/healthcare-abroad.
• Check if your employer offers private healthcare: Many UK tech companies and corporates include private medical insurance as a benefit. It dramatically reduces waiting times for specialists and is worth asking about during the offer negotiation process.

Conclusion: The NHS Is Yours to Use

If you are paying the Immigration Health Surcharge or National Insurance contributions, the NHS is not a privilege you are borrowing — it is a service you are contributing to and entitled to use. Register early, understand the triage system (111 → GP → Specialist → A&E), and make use of the NHS App.

The system is imperfect and under strain, but it remains one of the most comprehensive public healthcare systems in the world. Once you know how it works, navigating it becomes far less daunting.

For more on managing your budget as a UK expat, check out my breakdown of the London cost of living, which includes typical monthly spend on prescriptions and healthcare. If you are still sorting out your visa status and what healthcare access it grants you, my UK visa guide 2026 covers the Immigration Health Surcharge in more detail.

Official resource: For the most up-to-date NHS guidance, visit nhs.uk — it is comprehensive, well-maintained, and free to browse.