How the NHS Works: A Complete Guide for Expats (2026)

What is the NHS?

The National Health Service — universally known as the NHS — is the UK's publicly funded healthcare system. Founded on 5 July 1948, it was the first health service in the world to offer comprehensive medical care free at the point of use to an entire population, regardless of income. The core principle has not changed: if you are eligible, you can see a doctor, receive hospital treatment, or access mental health services without being charged at the time of your appointment.

That founding idea remains the foundation of the NHS in 2026, although the system itself has evolved considerably. The NHS is now a vast, complex network of organisations covering primary care (GP surgeries, pharmacies, dentists), secondary care (hospitals, specialists), and community services including mental health, maternity, and disability support. For expats arriving in the UK, understanding how these pieces fit together is one of the most practically useful things you can learn.

The Four NHS Systems

Health is a devolved matter in the UK, meaning that Scotland, Wales, and Northern Ireland each run their own health service alongside NHS England. While they all share the same founding principles, the practical differences matter to expats — particularly around prescriptions, waiting time targets, and some services.

Most expats settle in England, so this guide primarily focuses on NHS England. However, if you are moving to Scotland, Wales, or Northern Ireland, check the relevant national health authority's website for the rules specific to your location.

How the NHS is Structured in 2026

The most significant structural development in 2026 is the ongoing reintegration of NHS England into the Department of Health and Social Care (DHSC). Initiated in 2025 under Health Secretary Wes Streeting MP, this change represents a shift away from the "arm's-length body" model toward direct government accountability over operational NHS delivery. Full merger is expected by April 2027, with NHS England's brand retained for public-facing services.

Below NHS England at a national level, local health needs are managed by 42 Integrated Care Boards (ICBs). These replaced the old Clinical Commissioning Groups (CCGs) under the Health and Care Act 2022 and took on statutory responsibility for planning and funding NHS services in their areas from July 2022. Each ICB brings together NHS organisations, local councils, and community partners to design care around the population it serves.

Within each ICB area, GP practices are grouped into Primary Care Networks (PCNs) — collaborative groups of surgeries that share staff and services to deliver more joined-up local care. From 1 April 2026, an updated Network Contract Directed Enhanced Service (DES) came into force, introducing new requirements around continuity of care, vaccination delivery, and proactive care for at-risk populations.

The Neighbourhood Health Model

The NHS 10 Year Health Plan, published in July 2025, sets out the ambition to shift care from hospital settings into local communities through what it calls "neighbourhood health." The plan describes three fundamental shifts: from hospital to community, from analogue to digital, and from sickness to prevention. For expats, this means that over the next decade you can expect more services — including mental health support and some specialist outpatient appointments — to be delivered closer to home rather than in large hospital buildings.

How is the NHS Funded?

The NHS in England operates on a budget of approximately £164 billion for 2024/25. The largest single source of funding — around 80% — is general taxation, meaning income tax, VAT, and other levies paid by everyone who works or spends money in the UK. National Insurance contributions are the second-largest source, and they have a specific purpose within the NHS funding formula.

A third, smaller source is the Immigration Health Surcharge (IHS). Foreign nationals on visas longer than six months pay this upfront when making their visa application. In 2023/24, the IHS raised £1.7 billion gross for the government — a substantial but relatively small share of total NHS spending. Since February 2024, the standard IHS rate has been £1,035 per year for most adult visa applicants, with a reduced rate of £776 per year for students, under-18s, and Youth Mobility Scheme visa holders.

Who Can Access NHS Care?

NHS treatment is free for people who are "ordinarily resident" in the UK — a legal concept meaning you are lawfully living here and the UK is your regular, settled home. For most expats on a visa longer than six months who have paid the IHS, you will be treated as ordinarily resident for NHS purposes for the duration of your immigration permission. This means you can access GP care, hospital treatment, and emergency services on the same basis as a British citizen.

There are important exceptions. Standard patient charges still apply even with IHS coverage: these include prescription charges in England, NHS dental treatment bands, and optical costs. The IHS does not make all healthcare free — it grants access to NHS services, not exemption from the charges that UK residents also pay.

Short-term visitors — those on Standard Visitor visas or staying fewer than six months — are generally chargeable for NHS treatment at 150% of the cost. Emergency treatment at A&E departments is the one area where everyone is seen and treated, regardless of residency or visa status. You will not be asked for proof of insurance before receiving emergency care.

For a complete breakdown of NHS eligibility rules, read our dedicated guide: NHS eligibility in the UK: who can get free NHS treatment.

How to Access NHS Care as an Expat

The entry point to the NHS for most non-emergency care is your GP — your general practitioner. Registering with a local GP surgery is one of the first practical steps you should take after arriving in the UK. Once registered, your GP becomes your gateway to the wider NHS: they can diagnose and treat conditions directly, refer you to hospital specialists, arrange tests and scans, prescribe medication, and connect you to mental health services.

You do not need to show proof of your immigration status or IHS payment to register with a GP. This is a point that confuses many expats. NHS England guidance is clear that GP surgeries should not turn patients away on the basis of immigration documentation. You find your nearest GP using the NHS website's service search tool at nhs.uk, and you apply to join the surgery's patient list directly.

NHS 111 — Urgent but Non-Emergency Care

For health concerns that are urgent but not life-threatening, NHS 111 is a free 24-hour service available by phone or online at 111.nhs.uk. Clinical advisers assess your symptoms and direct you to the most appropriate care — which might be a pharmacy, an urgent treatment centre, a GP out-of-hours service, or, when necessary, A&E. Using 111 before attending A&E is strongly recommended for non-emergency situations, as it reduces pressure on emergency departments and usually results in faster care.

Emergency Care — 999 and A&E

For genuine emergencies — chest pain, difficulty breathing, suspected stroke, serious injury, or situations where you believe life is at risk — call 999 immediately. Ambulances are free and attend anyone who needs them. Accident and Emergency (A&E) departments provide treatment for serious or life-threatening conditions, and this treatment is always free regardless of your visa or residency status.

For more on how emergency and urgent care works in the UK, see our guide: Emergency healthcare in the UK: ambulance, A&E and urgent care explained.

What Does the NHS Cover?

For eligible residents, the NHS covers a wide range of services at no direct cost at the point of use. These include GP consultations, outpatient specialist appointments following a GP referral, hospital treatment including surgery, maternity care, mental health services, community nursing, physiotherapy, and palliative care. Vaccinations on the NHS immunisation schedule are free, as are screenings for conditions such as bowel cancer, breast cancer, and cervical cancer.

Prescriptions issued in England cost £9.90 per item as of April 2026, but many people qualify for free prescriptions — including those under 16, those over 60, pregnant women, people on certain benefits, and those with one of over 60 specified medical conditions. A Prepayment Certificate (PPC) at £111.60 per year covers unlimited prescriptions and is worth buying if you take more than one or two items regularly.

Dental and optical services are partially subsidised through the NHS but are not free for most adults. NHS dental treatment is structured in three charge bands: £26.80 for a check-up and cleaning, £73.50 for fillings and extractions, and £284.30 for more complex work including crowns and dentures. Eye tests are free for some groups, including children and those with diabetes, but most adults pay around £25 to £35 for an NHS eye test.

For a full breakdown of what is and is not free on the NHS, see: Free healthcare in the UK: what the NHS covers and what it doesn't.

What Has Changed in 2026?

Several significant changes have come into effect in 2026 that are particularly relevant to expats and newcomers. The DHSC reintegration of NHS England has moved from announcement to active implementation, with structural changes to how national oversight and operational delivery work together. For patients, the most visible changes in 2026 are at the primary care level, where PCNs have new responsibilities and updated contractual requirements effective from April 2026.

The NHS 10 Year Health Plan, published in July 2025, sets ambitious performance targets. In 2025/26, all NHS bodies were required to ensure 65% of elective care waiting list patients are seen within 18 weeks, 78% of A&E patients are seen within four hours, and 78% of community health services are delivered within 18 weeks — rising targets that continue into 2026/27. For expats planning to use NHS care, understanding waiting times for elective treatment is important when deciding whether private health insurance may be worth considering.

The NHS App has expanded significantly, with the majority of eligible patients now able to access their records, book appointments, and order repeat prescriptions digitally. This is part of the broader digital transformation described in the 10 Year Health Plan as the shift from "analogue to digital." For expats unfamiliar with the NHS, downloading the NHS App early and linking it to your NHS number after GP registration is a practical first step.

NHS vs Private Healthcare

Many expats ask whether they should use the NHS exclusively or supplement it with private health insurance. The NHS covers all serious and emergency healthcare free of charge for eligible residents, and for most conditions the quality of treatment is very high. The main limitation is waiting time for elective (non-urgent) procedures, which can extend to several months for some specialisms.

Private health insurance — purchased independently from the NHS — allows faster access to elective consultations and treatment, often in private hospitals or private wings of NHS hospitals. It does not replace the NHS for emergency care, where the NHS is always the right first port of call. For a detailed comparison, see: NHS vs private healthcare in the UK: which is right for you?

If you are looking for vetted healthcare providers and private health services in your area, browse our Healthcare Expat Directory.

Registering with a GP — First Steps

Once you have a UK address, finding and registering with a GP surgery should be a priority. Use nhs.uk to search for GP practices accepting new patients in your postcode. Some practices have closed lists due to capacity, so it is worth applying to your nearest two or three and explaining your situation clearly when completing the registration form.

After registration, you will be issued an NHS Number — a ten-digit identifier that connects all your NHS records across the country. This number stays with you for life in the UK. Keep a note of it and use it when booking appointments, ordering prescriptions, or accessing the NHS App.

For a step-by-step guide, see: How to register with a GP in the UK as an expat.

This article is for general information purposes only and does not constitute medical or legal advice. NHS rules, charges, and eligibility criteria can change — always check with NHS England, your GP surgery, or GOV.UK for the most current guidance applicable to your circumstances.