Healthcare in the UK: what the NHS gives everyone for free, what prescriptions and dentists cost, and who pays under the 150% rule

The National Health Service is at once Britain's pride and its favourite thing to complain about. For a newcomer the key is to grasp one simple structure: basic care here is free for everyone physically in the country, a set of services carries flat tariffs identical for a millionaire and a student, and planned hospital treatment is billed to those who never paid the health surcharge. Floor by floor.

What is free for everyone — regardless of visa or status?

Four things in England are free for any person in the country — a tourist or someone with an expired visa alike. First, the family doctor: GP and nurse consultations in primary care are free of charge to all, and that is the official position. Second, emergency care: A&E will see anyone, and no bill follows. Third, the 111 line: the NHS's round-the-clock phone service, which will tell you where to turn and can bring an interpreter onto the call, Russian included. Fourth, diagnosis and treatment of a range of infectious diseases (including TB and HIV), plus sexual health services and contraception: the state finds it cheaper to treat infections for free than to let them spread. In a life-threatening emergency call 999 — the ambulance comes with no questions about status.

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How do you register with a GP — and why do it immediately?

The GP is the doorway to the whole system: no specialist, prescription or referral comes without one. Register with a nearby practice as soon as you move, before you are ill. And a rule the practices themselves sometimes 'forget': under the official guidance they are not required to ask for, and cannot refuse registration over, proof of address or immigration status. If the receptionist demands a council tax bill you do not have — cite NHS England's patient registration guidance. Appointments can take a while, so learn the ladder of urgency in parallel: pharmacy (a pharmacist advises free, no appointment) → GP → 111 → A&E.

What do prescription medicines cost?

In England a prescribed medicine costs the same whatever it is — £9.90 per item (per item, not per prescription: three drugs on one form means three charges). If you need many, there is a 'season ticket': the PPC certificate at £32.05 for 3 months or £114.50 for a year — it pays for itself from four items a quarter or twelve a year. Prescriptions are free for children under 16, for 16-18s in full-time education, for everyone from 60, for pregnant women and mothers up to 12 months after birth (maternity exemption certificate), for people with certain chronic conditions holding a medical exemption certificate, for Universal Credit recipients on low pay and for holders of the HC2 low-income certificate. Contraception and hospital inpatient medicines are always free. Unsure whether you qualify — pay and take an FP57 form at the pharmacy: the money comes back after a check. And note: Scotland and Wales have free prescriptions for everyone — the £9.90 charge is England's.

Dentistry: how do the three NHS bands work?

NHS dentistry in England runs on three flat bands. Band 1, £27.90 — examination, X-rays, scaling. Band 2, £76.60 — all of that plus fillings, extractions and root canals. Band 3, £332.10 — crowns, bridges and dentures. An urgent appointment for acute pain is £27.90. You pay only the highest band of a course of treatment: three fillings in one course is a single £76.60 charge, and follow-up work in the same or a lower band within two months is free. Stitch removal and stopping post-extraction bleeding are always free. An honest warning: finding a dentist taking new NHS patients can be hard — ring several practices and join waiting lists; private prices run several times the NHS bands.

Who pays for hospital care: the IHS surcharge and the 150% rule

Now for where the horror stories about four-figure bills come from. Everyone taking a visa longer than six months pays the immigration health surcharge — £1,035 a year (£776 for students, their dependants and applicants under 18). Pay it and you use the NHS like a resident, adding only the standard prescription and dental tariffs. Tourists and those without the surcharge get the basic services above free — but planned and inpatient treatment, 'secondary care', is billed at 150% of the NHS tariff, and non-urgent treatment can require payment upfront. Hence the practical conclusion for visitors: travel insurance for a UK trip is not a formality but protection against a bill set at one and a half times the cost of your care.

What to remember

Register with a GP in your first week — it is free and needs no status documents. Learn the ladder: pharmacy → GP → 111 → A&E → 999. A prescription is £9.90 and the dentist starts at £27.90, and both carry exemptions — check yourself on the NHSBSA site rather than paying 'just in case'. Visitors — insurance. And one right even many Britons don't know: if someone close to you is deteriorating in hospital and nobody is listening, you can summon a rapid review team yourself — how 'Martha's Rule' works, we explain in a separate piece.