In the UK we are very lucky to have the National Health Service (NHS), which gives us healthcare free when we need it. It is funded through taxes and National Insurance contributions, on the principle of being "free at the point of delivery". As healthcare becomes ever more complicated, it becomes harder to know what we should do when we are ill. There sometimes seem to be a bewildering array of options.
This leaflet tries to explain the options we have available to us and in what situation to use each option. It explains NHS and private options and what happens when we choose to swap between them.
What is the NHS?
The National Health Service (NHS) was founded in the UK in 1948. It was based on the fact that good-quality healthcare should be available free to everyone. The principle is that access to care should be based on need rather than ability to pay. It was launched by the health minister at the time, Aneurin Bevan. Because we have this system in the UK, we can obtain medical care without paying for it at the time we need it. It is paid for mostly by the tax and National Insurance contributions we pay.
England, Scotland, Wales and Northern Ireland all have their own NHS, run separately. The information in this leaflet applies mainly to England and may vary slightly in other nations. The NHS websites for all nations are listed at the end of this leaflet for more specific information.
Who is entitled to free NHS treatment?
Anyone who lives in the UK is entitled to free treatment with the NHS. It does not matter if you do not pay taxes, or whether you are registered with a general practitioner (GP). It does not matter what nationality you are. This applies to all NHS services, including GP surgeries and hospitals.
How do visitors to the UK obtain medical treatment through the NHS?
If you are visiting the UK, you may have to pay for any medical treatment you need. Those who will NOT be charged for NHS treatment include:
- Visitors from the European Economic Area (EEA) or Switzerland. You will need a European Health Insurance Card (EHIC) from your home country (unless you are from Switzerland). If you do not have an EHIC you may be charged for treatment. (The EEA includes all countries from the European Union (EU), Iceland, Norway and Lichtenstein. For many medical problems, there is a reciprocal arrangement with these countries, and with Switzerland. Visitors can access care in each other's country. This does not include planned treatment.)
- People who need to be seen in the Accident and Emergency (A&E) department.
- People who need family planning services.
- People who need hospital treatment for most infectious diseases, including sexually transmitted infections (STIs).
- People who need hospital treatment for a physical or mental condition caused by torture, female genital mutilation (FGM), domestic violence or sexual violence
- People granted refugee status in the UK, or seeking asylum.
- People needing compulsory psychiatric treatment.
- People who are working or living abroad because they are members of the armed forces, on government work, etc.
For full details for visitors accessing healthcare, please look on the individual websites for NHS England, NHS Scotland, NHS Wales and the NHS in Northern Ireland.
What services are available on the NHS?
The NHS provides a large number of medical and related services. Some of the more common ones are briefly described below.
Your GP is often your first point of contact in the NHS. GPs can diagnose and treat a wide range of medical problems. Your GP works in a team which may include practice nurses, nurse practitioners and administrative staff. They liaise with community teams of district nurses, health visitors, midwives and social workers. Your (confidential) medical records are held with your GP and your GP is the central person looking after your healthcare. Although other specialists may be involved, they will be dealing with one particular issue. Your GP is looking after you as a whole person and may liaise with other professionals about particular aspects of your care. Where your GP and their team cannot help, they may refer you to a specialist, often based in hospital.
As well as dealing with medical problems, other services usually offered at GP surgeries include:
- Antenatal care during pregnancy and postnatal care after your baby is born.
- Health education.
- Health checks.
- Clinics for long-standing conditions, such as diabetes, asthma or heart disease.
- Minor operations.
- Family planning (contraceptive) services.
- Patient participation groups.
If your GP surgery is closed and you feel your health problem cannot wait until they open, their services are covered by one of the urgent care services mentioned below.
Normally for hospital services you will be referred by a GP, unless you are referred through A&E, hospitals offer many medical services including:
- Outpatient appointments with specialist doctors.
- Tests including blood tests, X-rays, ultrasounds, CT scans, MRI scans and many more.
- Specialist investigations such as biopsies, endoscopies, tests on the heart and many more.
- Antenatal care and delivery units.
- Cancer treatment, such as chemotherapy or radiotherapy.
- Inpatient care on a ward for patients who are unwell or recovering from an operation.
- Intensive care treatment for very unwell people.
- Intensive care units for newborn babies.
- A&E departments.
Not all hospitals offer all services. Certain hospitals specialise in certain areas and have more specialist services, others are more general hospitals. You have the right to choose which hospital you are referred to, and more information on how to do so is available on each of the NHS websites.
A&E departments are for serious life-threatening illnesses or injuries. Examples of the types of conditions for which it would be appropriate to attend A&E (or call an ambulance, which would take you to A&E) include:
- Suspected stroke.
- Severe chest pain and/or breathing difficulty.
- Being unconscious.
- Heavy bleeding which you cannot stop.
- Serious injuries following a road traffic accident.
- Severe allergic reactions.
- Severe burns.
A&E departments are open all hours, every day of the year.
The NHS has a several urgent care options for problems which are urgent but not immediately life-threatening. These include:
- Minor injuries units.
- Urgent care centres.
- Walk-in centres.
- NHS advice lines:
- 111 for England and Scotland.
- 0845 46 47 for Wales.
- See the out of hours service details for Northern Ireland.
Mental health services
Mental health services within the NHS include:
- Cognitive behavioural therapy (CBT).
- Adult mental health team (includes specialist doctors in psychiatry, specialist community psychiatric nurse (CPN), specialist mental health social workers, and psychologists).
- Child and adolescent mental health services (CAMHS) - talking therapy and treatment for under-18s.
- Eating disorder clinics.
- Drug and alcohol addiction support services.
For most mental health services, you have to be referred by your GP. However, you can usually refer yourself to the local drug and alcohol service. Many areas in England also have direct access to talking treatments through the Improving Access to Psychological Therapies (IAPT) scheme.
Family planning services
Most GPs provide family planning services (advice on contraception, prescriptions for contraceptive pills, coil fitting, etc). The NHS also provides family planning clinics. These provide all contraceptive options, as well as providing condoms for free. You often do not need an appointment for a family planning clinic. For your nearest clinic, visit your NHS website.
Sexual health services
Genitourinary medicine (GUM) clinics provide tests for people who think they may have a sexually transmitted infection (STI). You do not need a referral from your GP to attend. The service is confidential and the clinic will not send any results to your GP unless you ask them to do so. To find your nearest sexual health clinic, visit your NHS website.
Everybody in the UK is entitled to treatment by an NHS dentist. Standard charges apply for dental procedures. Some people do not have to pay (are exempt from charges) - for example children. See each NHS website for full details of charges and exemptions. Some dentists may only be able to take on a certain amount of NHS patients, so you may need to search for one who has space. Not all procedures or options are available through the NHS. In this case you may choose to have certain treatments privately and pay for them. Charges for dental treatment may vary between the four nations of the UK. See the separate leaflet called Help With Health Costs for more details.
Eye care services
Eye tests are free with the NHS in certain situations. This varies between the four countries in the UK. In England, children are not charged for eye tests, nor are people at high risk of conditions such as glaucoma. See the separate leaflet called Help With Health Costs for more details.
Pharmacies work closely with the NHS, providing the medications which doctors and other health professionals prescribe. They provide repeat prescription services and many deliver medication to people who are housebound. Pharmacists are experts in medicines. They will explain to you how to take your prescribed medication, and warn of side-effects. They can advise on self-help remedies and on medication which does not need a prescription. There are many other services which pharmacies may provide, either as part of the NHS, or privately. These include (amongst many others):
- Flu vaccination
- Travel vaccinations
- Stop smoking advice
- Medication reviews
- Screening for chlamydia
- Emergency contraception
- Pregnancy testing
Prescriptions may be either on a traditional prescription form, or sent electronically directly to a pharmacy of your choice. There is a standard charge per item on a prescription. If you have more than two items regularly, it may be cheaper to choose a pre-payment certificate. Your pharmacist can advise. Certain groups of people do not have to pay prescription charges. This includes:
- Children under the age of 16, or teenagers aged 16-18 in full-time education.
- People over the age of 60.
- People on certain benefits.
- People who are receiving treatment for cancer.
- People who have certain conditions (such as diabetes for which treatment is needed, thyroid conditions, epilepsy).
- Pregnant women - during pregnancy and for one year after the baby is born.
- People who are inpatients in hospital.
Can I choose who treats me in the NHS?
In the NHS you have the right to choose:
- Your GP practice.
- The hospital to which you are referred.
- The consultant who treats you (although it may be a member of his/her team).
- Which pharmacy you collect your prescription from.
- Which optician or dentist you go to.
Sometimes your choice may be limited by what is available in your area and by practicalities. In an emergency you will not be able to choose which hospital the ambulance takes you to. Your chosen GP may not have the space to take you on, or there may not be an appointment with your preferred specialist. Within the bounds of what is practical, however, the NHS tries to give you what you choose.
Private medical treatment options in the UK
Why would I "go private"?
You can choose private treatment for most medical problems, as long as you are able to pay for it. Despite our NHS system, people choose to use private alternatives for many reasons. Some may not be eligible for NHS treatment (eg, visitors, see above.) Others may have private insurance, which allows them to access certain medical services privately. Sometimes this is a perk of a job; for others it is a choice they have made. Others wish to be seen more quickly than is possible on the NHS and are prepared or able to pay for that. In some cases, people choose to pay for a service which is not available on the NHS - for example, cosmetic surgery or some infertility treatments. Or, people wish to see a certain specialist whom they are unable to see on the NHS.
Put simply, choosing a private provider allows quicker and often more convenient treatment, but costs money.
How do I choose a private medical provider?
You may or may not wish to purchase private medical insurance. For a regular premium to the insurance company, you will have access to certain medical advice and/or treatments. Private medical insurance may come for some people with their job, as part of the workplace insurance scheme. There are various types of medical insurance policy. Before choosing one you will need to consider:
- How much it costs.
- What does it cover? Many policies exclude certain treatments. Many policies exclude conditions you have had before, or which are ongoing.
- Is there an "excess"? Some insurance policies ask you to pay a certain amount towards any bill, such as the first £200 for any treatment. Or, there may be an upper limit after which they will no longer pay.
- Can it only be used if your waiting time on the NHS will be excessive? This is the case for some policies; in others the NHS waiting time is irrelevant.
- Comparisons with other policies and insurance companies.
Alternatively, you may choose to pay for medical advice or treatment directly as you need it. Make sure you find a reputable professional. One way of doing this is to ask your GP to refer you to a private consultant. Or, your GP may be able to recommend a particular professional or location. Most professionals have qualifications which you can check. Some specialists have regulatory bodies and will have lists of accredited professionals. For example, many professions are regulated by the HCPC - Health & Care Professions Council. Professions regulated by the HCPC include:
- Arts therapists
- Biomedical scientists
- Chiropodists (podiatrists)
- Clinical scientists
- Hearing aid dispensers
- Occupational therapists
- Practitioner psychologists
- Social workers
- Speech and language therapists
What private medical services are available in the UK?
A vast number of options are available if you choose to pay for them.
Consultants (specialist doctors) usually practice from private consulting rooms or private hospitals. Some will only see patients through GP referral (so they have your full medical history); others will allow you to make an appointment without a referral. Remember if you do not have insurance and are considering an operation privately, there are a number of costs to pay. You will pay for the surgeon, the anaesthetist, the theatre staff and the equipment. As well as that you will pay for any inpatient stay in hospital which is needed, including bed, nursing staff and food. Also discuss whether the private facility has intensive care/emergency treatment options should any complications occur.
GPs may consult through private clinics or private hospitals. An increasing number of GP consultations (but also hospital consultants) are available by telephone, video link, email or the internet. Numerous private companies have been set up to provide private GP services to people who want to access advice conveniently from their phone, tablet or home. Check that the doctors are UK-registered with the General Medical Council (GMC) and ideally that the providing company is registered with the Care Quality Commission (CQC).
Clinical Editor's note
April 2018 - Dr Hayley Willacy draws your attention to the recently published guidance from the Royal College of GPs - see Further reading below. Online services provide a new way of consulting in general practice. Use of text-based or video digital technologies has some advantages over established ways of consulting such as face-to-face meetings or the use of the telephone. It also carries risks. The guidelines provide a series of questions that patients or healthcare professionals might wish to ask to get the most out of these new services.
Physiotherapy. If the NHS wait for a physiotherapist is long, or the appointment inconvenient, you can choose to pay to see a private physiotherapist. They practise from private practices or clinics, private hospitals, within some GP surgeries, or from their own homes. Physiotherapists should be chartered (they will have MCSP after their name) and registered with the HCPC.
Osteopathy. This is a physical treatment not normally available on the NHS, although private medical insurance may cover it. Practitioners can be chosen or checked on the General Osteopathic Council website.
Alternative (complementary) therapies such as acupuncture. Acupuncture is available but limited on the NHS and you may prefer to access this privately. Most other alternative therapies are only available privately. Therapies available and regulatory bodies where available include:
- Acupuncture (search for practitioners on the website of The British Acupuncture Council).
- Chiropractor (all practitioners must be registered with the General Chiropractic Council).
- Herbal medicine. (A list of qualified practitioners is available on the National Institute of Medical Herbalists' website. Members of the National Institute of Medical Herbalists can use the letters MNIMH after their name.)
- Homeopathy (there are three homeopathic associations in the UK who have lists of members).
- Hypnotherapy (professionals can choose to register with the Complementary and Natural Healthcare Council (CNHC) below).
- Naturopathy (the General Council and Register of Naturopaths (GCRN) regulates and lists members).
- Reflexology (see the British Complementary Medicine Association below).
A broad range of complementary therapies is also regulated by the Complementary and Natural Healthcare Council (CNHC) and the British Complementary Medicine Association.
Dentists. Many dental surgeries have both NHS and private patients. Some are only private, particularly those which provide cosmetic dentistry. You can check a dentist's registration at the General Dental Council website.
Opticians. Most opticians have a range of NHS and private services. You may find your eye test is free through the NHS, but you have to buy the glasses you choose, for example.
Counselling and talking (psychological) therapy. Where you are not able to wait for counselling on the NHS, private counsellors are available who work from private hospitals, clinics, GP surgeries, or from home. The British Association for Counselling and Psychotherapy holds a register of therapists who meet their standards.
Charity organisations may offer counselling services, either free or for a small fee. For example, Relate helps with relationship counselling, and Cruse with bereavement counselling.
Drug and alcohol rehabilitation. There are private hospitals with clinics and wards available to people who wish to pay for help with their addictions.
Cosmetic surgery. Guidelines were introduced in 2016 by the GMC and the Royal College of Surgeons (RCS) to help regulate the cosmetic surgery industry and to protect customers. The RCS is planning a certification scheme to make it easier to search for reputable practitioners.
Infertility clinics. This is an area which is only partly covered by the NHS and people may choose to have infertility treatment privately. Often, if you are in this situation, you will have first seen a specialist in gynaecology, either on the NHS or privately. You could start by asking for their advice on where you may be able to obtain further treatment.
Chiropody (podiatry). Podiatry services are available on the NHS through referral, but are limited to certain groups of people and conditions. If you are not eligible for NHS treatment, you can see a podiatrist privately.
Vaccinations. Some travel vaccinations are provided by the NHS but many are not. Also some protective vaccinations (such as the "flu jab") are provided by the NHS only for certain more vulnerable people. If you wish to have a flu jab or vaccination which is not provided for you by the NHS, you may be able to have this done at certain pharmacies, or at a private travel clinic.
This list is by no means exhaustive. Any medical treatment or service available on the NHS, as well as many others that are not, can be paid for privately.
Can I swap between the NHS and private treatment?
Yes, you are entitled to choose either and therefore you can have some of your care privately and some on the NHS if you choose. Having had private treatment should make no difference to your entitlement to NHS treatment. However, your NHS and private treatment should be completely separate. Your private and NHS care should be in different places and at different times. For example, you would not be able to have an NHS operation, but with equipment purchased privately.
Examples of issues which sometimes come up include:
- You see a private consultant who recommends you take a certain medication for your blood pressure. As long as your GP agrees this is clinically necessary and it is within their own local prescribing guidelines, they can provide this on an NHS prescription.
- GPs do not charge for private referrals. They are not, however, obliged to make a referral they do not feel is clinically necessary. (However, many consultants will agree to see you without a GP referral if you still wish to do so.)
- NHS consultants cannot suggest to you that you see them privately, as this would be a "conflict of interest". However, if you wished for it, and asked if that would be an option, they can suggest your GP refer you privately. This is also the case the other way round. If you were seeing a consultant privately, but wished to change to the NHS, your consultant would usually write to your GP asking them to make an NHS referral.
- Being seen privately should not jump you up the NHS queue. Having had a private appointment should not make a difference in either direction to your place on an NHS waiting list. However, if you have had tests done privately, you do not need to have these again on the NHS.
Further reading and references
Online consultations in general practice: the questions to ask; Royal College of General Practitioners (2018)
Patient Choice; British Medical Association (BMA)
Choose well; NHS Wales
Health and Social care funding explained; The Health Foundation, January 2017
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