Executive summary

The NHS is four systems (England, Scotland, Wales, Northern Ireland) with shared principles but different rules for some charges and entitlements. Your route to care depends on (1) where you are in the UK, (2) your immigration status/visa, and (3) whether your need is emergency, urgent, or routine. Core actions: register with a GP (family doctor) promptly, set up the NHS App (England & Wales) or NHS login equivalents, learn when to use 999 vs 111, and understand what you may need to pay (IHS, prescriptions, dental). This paper gives step-by-step pathways, eligibility snapshots, and scripts you can use at reception desks. Key figures and rules are cited to official guidance current to October 2025. 

1) How the NHS is structured

The “NHS” is devolved:

NHS England (England) NHS Scotland (Scotland) NHS Wales (Wales) Health and Social Care (HSCNI) (Northern Ireland)

They share emergency access principles, but charges differ—notably prescriptions and dental. Always check local nation rules for costs and entitlements. 

2) Immediate care: emergencies and urgent help

Life-threatening emergencies: Call 999 or go to A&E (Accident & Emergency). Emergency treatment in A&E is free to everyone, but admission or follow-up may be chargeable for some overseas visitors in England. 

Urgent but not life-threatening: Use NHS 111 (phone or 111.nhs.uk) in England/Wales for triage, out-of-hours GP, urgent prescriptions, dental/mental health sign-posting. Scotland uses NHS 24 (111). 111 can arrange care and advise next steps. 

Quick decision aid

Chest pain, severe breathlessness, stroke signs, heavy bleeding → 999/A&E Worsening illness, high fever, non-stop vomiting, urgent meds/dental help → 111 Routine issues, ongoing conditions, referrals, vaccinations → GP (register early)

3) Your legal status and what it means for costs (England focus; nation differences noted)

Ordinary residence (lawfully living in the UK on a properly settled basis): hospital treatment is free (not dependent on nationality, taxes, or having an NHS number). Visitors and some temporary residents may be charged under the NHS (Charges to Overseas Visitors) Regulations 2015. Trust “Overseas Visitor Managers” assess liability. 

Immigration Health Surcharge (IHS): Most non-EEA and EEA visa applicants staying >6 months pay the IHS with their visa (students £776/year; most others £1,035/year). Paying IHS gives access to the NHS largely like a resident in the UK nation you’re living in (still pay normal user charges like prescriptions/dental in England). 

EU/EEA/Swiss visitors: With GHIC/EHIC or S1 forms, you can access medically necessary care during a temporary stay per NHS guidance; planned care requires prior arrangements. (Country rules differ—always check the nation you’re visiting.) 

Refugees, asylum seekers, victims of trafficking, and certain public health conditions often have specific exemptions from charges for hospital care in England; A&E, GP primary care and infectious disease treatment have broad exemptions. Check local Overseas Visitor guidance if challenged. 

4) Registering with a GP (family doctor)

Do this as soon as you arrive in your UK nation of residence. GP registration enables referrals to specialists, routine care, vaccinations, fitness-to-work notes, and access to your NHS number (or creation of one if you’ve never had one). If you don’t have an NHS number yet, registering with a GP will create it. 

England: NHS policy says you don’t need proof of address, ID, immigration status, or an NHS number to register (though surgeries often ask; lack of documents alone is not a lawful reason to refuse). If refused, politely cite the guidance and ask to speak to the practice manager. 

Scotland: Use NHS Inform to find and register; providing ID/address is recommended but alternatives should be accepted if absent. If capacity or boundary issues block registration, contact the national registration team for help. 

Wales: Similar GP registration principles apply; see NHS Wales advice and Health Boards if you struggle. (Use 111 for interim help.) 

Practical script at reception (England):

“Hi, I’d like to register as a new NHS patient. I understand NHS England guidance says I don’t need ID, proof of address, immigration status, or an NHS number to register. Could you please provide the GMS1 form or your online link?”

5) Digital access: NHS App / NHS login

Set up NHS App (England & Wales) to order repeat prescriptions, view test results, and manage referrals. You’ll verify identity with photo ID and a short face-matching video (alternatives exist if no photo ID). 

6) What you may need to pay (by service and nation)

Prescriptions

England: £9.90 per item (2025/26), with Prescription Prepayment Certificates (PPCs) to save money if you need many items. Some medicines (e.g., contraception) are always free.  Scotland & Wales: Free NHS prescriptions for residents (rules on where the prescription is dispensed and GP registration may apply near borders). 

Dental (England; NHS dental systems vary and access can be limited)

Band 1: £27.40 (exam, diagnosis, advice) Band 2: £75.30 (e.g., fillings) Band 3: £326.70 (e.g., crowns/dentures) From 1 April 2025 in England. Scotland and Wales have different charging structures—check locally. 

Hospital care charges (England)

If you’re not ordinarily resident and don’t have an exemption (e.g., IHS, reciprocal right, protected group), non-emergency hospital care is usually chargeable, sometimes up-front, and can be at 150% of the NHS tariff under cost-recovery rules. Essential treatment must not be withheld if clinically immediately necessary or urgent, but billing can still occur. Work with the hospital’s Overseas Visitor Team to establish your status. 

7) Typical user journeys

A) Worker or family member on a skilled visa (in England)

Pay IHS during visa application.  On arrival: Register with a GP → NHS number created/linked.  Set up NHS App for repeats, results, referrals.  Pay standard user charges (e.g., prescriptions, dental). 

B) Student (in Wales)

Pay student IHS rate with visa.  Register with a GP near your term address; set up NHS App.  Prescriptions are free if resident and using Welsh services; confirm local rules if you live near the border. 

C) Short-term visitor (tourist) in England

For emergencies, go to A&E or call 999 (A&E treatment itself is free).  For urgent but non-emergency needs, use NHS 111 for direction, or attend Urgent Treatment Centre as advised.  You may be charged for non-emergency hospital care; carry travel insurance and, if eligible, a GHIC/EHIC. 

D) EU pensioner moving to the UK with an S1

Present S1 for healthcare coverage; register with a GP; hospital care should be covered per reciprocal arrangements. 

8) Referrals, specialists, and the road ahead

The GP is your gatekeeper for most specialist referrals. England is expanding digital pathways (e.g., NHS Online “virtual hospital” planned for roll-out from 2027 via the NHS App), which may change referral flows—watch this space. 

9) Special service areas

Maternity: Antenatal, intrapartum, and postnatal care are accessed via GP or midwifery self-referral; entitlements follow your residency/visa status (urgent and immediately necessary maternity care must be provided). 

Mental health: For urgent concerns, use 111 (or 999 for crisis). Routine care starts with GP referral to Talking Therapies/secondary services; pathways vary by nation. 

Infectious diseases & public health: Diagnosis and treatment for certain communicable diseases are free for all, due to public health exemptions. 

Dental & Eye care: NHS capacity is constrained in some areas—expect waiting lists or redirection to private care. Verify banded dental charges (England) and local policies in Scotland/Wales/NI before treatment. 

10) Practical checklists & scripts

Arrival checklist (residents & students)

☐ Proofs you could use if asked: passport/BRP/visa, tenancy or letter from university/employer (in England, lack of these shouldn’t stop GP registration).  ☐ Register with a GP (ask for GMS1 form or online link). ☐ Ask the practice for your NHS number once registered (or use “Find my NHS number”).  ☐ Set up NHS App / NHS login (ID + face-match or alternatives).  ☐ Learn 999 vs 111 rules; save local urgent care details.  ☐ If in England and you pay for scripts, consider a PPC to reduce costs. 

If a GP reception says “we need ID/address” (England)

“I’m happy to provide anything I have, but NHS England guidance says lack of ID, proof of address, immigration status, or NHS number isn’t grounds to refuse GP registration. Could we proceed or involve the practice manager?” 

If a hospital asks for payment (England)

“Could I speak with the Overseas Visitor Team? I believe I’m exempt/covered via IHS/EU rights/reciprocal agreement. If the care is urgent or immediately necessary, I understand it should proceed while we clarify.” 

11) Costs & budgeting at a glance (2025)

IHS (visa add-on): £776/year (students, Youth Mobility, under-18s); £1,035/year others. (Paid up front for the visa term.)  Prescriptions (England): £9.90 per item; free in Scotland & Wales for eligible residents.  Dental (England): Bands £27.40 / £75.30 / £326.70 from 1 Apr 2025. Scotland/Wales differ. 

12) Common pitfalls (and how to avoid them)

Waiting to register until you’re ill → register with a GP immediately on arrival. Assuming UK-wide uniformity → verify nation-specific rules for costs.  Confusing A&E with urgent care → use 111 for non-life-threatening issues to get the right venue.  No travel insurance as a visitor → emergency A&E is free, but admissions & non-emergency hospital care can be chargeable.  Digital access delay → set up NHS App/login early; identity checks can take time. 

13) Devolved-nation notes

Scotland

Prescriptions free; English forms dispensed at the English rate if used in Scotland. Register via NHS Inform; ID/address recommended but alternatives possible. 

Wales

Prescriptions free for residents; nuances for English prescription forms dispensed in Wales—charges may apply unless you have a qualifying exemption. 

Northern Ireland

Generally free prescriptions (policy separate from this paper’s main citations); check HSCNI for specifics if you’re based there.

14) Looking ahead

England plans an NHS Online “virtual hospital” model (from 2027) to accelerate access to specialists via the NHS App. Expect more digital triage, e-referrals, and remote monitoring to complement in-person care. Keep your app identity verified and contact details current. 

15) Resources & links (authoritative)

Charging Overseas Visitors (England)—legal guidance for providers (useful to quote if challenged).  NHS migrant entitlements overview (ordinary residence test).  IHS amounts and who pays.  NHS 111 (online).  NHS App: identity verification and NHS login help.  Prescription charges (England) and dental bands (England).  Prescriptions free: Scotland & Wales.  How to access NHS services if visiting England from abroad (visitor-specific guidance). 

16) One-page action plan (print this)

If you’re living in the UK:

Register with a GP near your address (don’t delay, even if you lack documents in England). Ask for/locate your NHS number; set up NHS App/login. 

If you’re visiting:

For life-threatening issues, 999/A&E; otherwise use 111 for triage. Carry GHIC/EHIC (if eligible) and travel insurance. 

Budgeting:

England: plan for £9.90 per prescription item; consider a PPC if on multiple meds; check dental band costs. Scotland/Wales: prescriptions are free for residents; confirm local rules at borders. 

If challenged on access or charges:

Ask for the practice manager (GP) or Overseas Visitor Team (hospital). Reference NHS England registration policy and the Overseas Visitors guidance. 

Final note

Rules evolve—especially around cost-recovery, digital services, and devolved-nation policies. The citations above point to official pages you can keep checking for updates. If you want, tell me which UK nation you’ll be in and your visa category; I can tailor a personal step-by-step plan and include local GP options and a registration script.