Free Healthcare in the UK: What the NHS Covers and What It Doesn't

Is the NHS Really Free?

The short answer is: mostly, but not entirely. The NHS operates on the principle of being free at the point of use — meaning that when you see a GP, receive hospital treatment, or call an ambulance, you are not charged at the moment you receive care. That distinguishes it from insurance-based or fee-for-service systems where you pay upfront or receive a bill afterwards.

But free at the point of use does not mean free across the board. The NHS has always applied charges for certain services — most notably prescription medicines in England, NHS dental treatment, and optical care. These are not quirks or recent cuts; they have been part of the NHS system since the 1950s. Understanding which services attract charges and which do not is essential practical knowledge for anyone moving to the UK.

What Is Free and What Is Not

The clearest way to understand NHS coverage is to separate services that are genuinely free for eligible residents from those that carry standard charges.

It is worth noting that this split applies specifically to NHS England. In Scotland, Wales, and Northern Ireland, prescriptions are free for all residents — a significant difference if you take regular medication. The devolved nations also have some variation in dental and optical charges.

Free NHS Services in Detail

GP Appointments

Consultations with your NHS GP are free for registered patients. This includes face-to-face appointments, telephone consultations, and video appointments. Referrals from your GP to see a hospital specialist are also free. If your GP orders blood tests, scans, or other investigations through the NHS, these are carried out at no cost to you. The only circumstance in which a GP appointment could attract a charge is if you are seeking a private GP service — a separate system that runs alongside the NHS.

Hospital Treatment

Inpatient and outpatient treatment at NHS hospitals is free for eligible residents. This includes surgical procedures, diagnostic tests, specialist consultations following GP referral, chemotherapy, radiotherapy, dialysis, physiotherapy, and occupational therapy. If you are admitted to hospital, your bed, nursing care, meals, and treatment are all provided without charge. The exception is if you choose to be treated in a private room or as a private patient within an NHS hospital — these are optional upgrades that carry a fee.

Maternity Care

Maternity care is one of the most comprehensive free services the NHS provides. All antenatal appointments, ultrasound scans, midwife consultations, labour and delivery care, and postnatal check-ups are free for eligible residents. Pregnant women also receive free prescriptions for the entire duration of pregnancy and for 12 months after the baby's due date — a significant exemption. NHS dental care is also free during pregnancy and for the same 12-month period. To access free prescriptions and dental care during pregnancy, you need a Maternity Exemption Certificate, which your midwife or GP can arrange.

Mental Health Services

NHS mental health services are free for eligible residents. These include IAPT (Improving Access to Psychological Therapies) services such as cognitive behavioural therapy (CBT) for anxiety and depression, community mental health team support, crisis services, inpatient psychiatric care, and specialist services for conditions including eating disorders, psychosis, and PTSD. Access is typically through a GP referral, though some services accept self-referral. Waiting times for some psychological therapies can be lengthy — this is one area where some expats consider private provision to access treatment faster.

Vaccinations and Screening

All vaccinations on the NHS routine immunisation schedule are free. For adults, this includes flu vaccines for eligible groups, COVID-19 boosters, shingles vaccines for those over 70, and pneumococcal vaccines. For children, the full childhood vaccination schedule is free. NHS cancer screening programmes — bowel, breast, and cervical — are free and offered routinely based on age. Diabetic eye screening is free for those with diabetes. The exception is travel vaccinations: some are available free on the NHS (such as hepatitis A and typhoid for travel to high-risk areas), but others must be obtained privately at a travel clinic.

What Still Costs Money on the NHS

Prescriptions in England

Each prescription item dispensed in England costs £9.90 as of April 2026. This charge applies per item, not per prescription form — so if your GP prescribes three different medications on one form, you pay £9.90 for each, totalling £29.70. In Scotland, Wales, and Northern Ireland, all prescriptions are free regardless of the medication or the person's circumstances.

A wide range of people are exempt from prescription charges in England. You pay nothing if you are: under 16; 16 to 18 and in full-time education; aged 60 or over; pregnant or have had a baby in the last 12 months (with a valid Maternity Exemption Certificate); holding a valid Medical Exemption Certificate for one of over 60 specified conditions including diabetes, epilepsy, thyroid disorders, and certain other conditions; or receiving specific qualifying benefits such as Universal Credit, Income Support, or Pension Credit.

If you pay for prescriptions regularly and do not qualify for exemption, a Prepayment Certificate (PPC) at £111.60 per year covers unlimited items and is worth purchasing if you take more than around 11 items annually. PPCs can be bought online at the NHS Business Services Authority website.

NHS Dental Treatment

NHS dental care in England is structured around three charge bands. Band 1 — covering an examination, X-rays if needed, and a scale and polish — costs £26.80. Band 2 — which covers fillings, root canal treatment, and extractions — costs £73.50. Band 3 — covering more complex work including crowns, dentures, and bridges — costs £284.30. Once you start a course of treatment, you pay the band that covers the most complex treatment carried out, not each item separately.

Free NHS dental treatment is available for: children under 18; people who are pregnant or have had a baby in the last 12 months; those receiving qualifying benefits; and people who were under 18 when their dentist started a course of treatment. Emergency dental care is available through NHS dental services and urgent dental care centres, though access can vary by area.

Finding an NHS dentist accepting new patients can be challenging in some parts of the UK, particularly in cities and rural areas. If you cannot find an NHS dentist, 111 can direct you to an urgent dental service for acute pain and infection.

Optical Care

NHS sight tests cost around £25 to £35 for most adults, though prices vary by optician. Free NHS eye tests are available for: children under 16; people aged 60 or over; those on certain qualifying benefits; people with diabetes or glaucoma, or who are at risk of glaucoma; and people registered as partially sighted or blind. Following an NHS sight test, if glasses or contact lenses are required, most adults pay the full cost of frames and lenses — though NHS optical vouchers are available for children and some eligible adults to help with the cost.

Services the NHS Does Not Cover

Cosmetic procedures carried out for aesthetic rather than clinical reasons are not funded by the NHS. Certain fertility treatments — such as IVF — may be available on the NHS but are subject to strict eligibility criteria that vary by Integrated Care Board; many people do not qualify and pursue private treatment. Some newer or specialist drugs that have not received NICE approval for NHS use are not available through the NHS, though they may be accessible privately. Long-term social care — care homes, ongoing home care for elderly or disabled people — is assessed and funded separately from the NHS and is not free: it is means-tested and often carries significant costs.

What This Means for Expats

For expats who have paid the Immigration Health Surcharge (IHS) as part of their visa application, access to NHS services is broadly the same as for UK residents. The IHS — currently £1,035 per year for most adults — grants you access to the NHS during your period of immigration permission. This means you can see a GP, receive hospital treatment, access maternity care, and use mental health services on the same basis as someone who has lived in the UK their whole life.

What the IHS does not do is exempt you from the standard charges that UK residents also pay. Prescription charges in England, NHS dental treatment bands, and optical costs apply to IHS payers in exactly the same way as they apply to British citizens. If you qualify for an exemption — because you are pregnant, under 16, or on a qualifying benefit — those exemptions apply to you too.

Health and Care Worker visa holders and their dependants are exempt from the IHS entirely, which means they access NHS care without having paid the surcharge. Their exemption from the IHS does not, however, exempt them from prescription charges or dental charges — those still apply in the same way.

For a full breakdown of who qualifies for NHS care, read our guide on NHS eligibility in the UK. For information on whether private health insurance is worth considering alongside NHS access, see our comparison guide: NHS vs private healthcare in the UK. You can also explore vetted healthcare providers and services through our Healthcare Expat Directory.

This article is for general information purposes only and does not constitute medical, financial, or legal advice. NHS charges, exemptions, and eligibility rules can change. Always verify current charges and exemptions at nhs.uk or via your GP surgery.