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How the NHS works

doctor explains to patient

The National Health Service (NHS) is the publicly funded healthcare system of the United Kingdom.

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What does the NHS do?

The NHS gives people who are 'ordinarily resident' in the UK access to general and specialist healthcare when they need it.

It provides most healthcare including general practitioners, dentists, and hospital services, including HIV services.

To be ordinarily resident you must be:

  • a British citizen, or
  • naturalised within the UK, or
  • settled within the UK (commonly referred to as holding Indefinite Leave to Remain).

There are alternative arrangements for access to NHS services for those who are not ordinarily resident in the UK.

Are NHS services free?

NHS services are free at the point of care, with the exception of some charges, such as prescriptions, optical services and dental services.

All HIV treatment is free while resident in the UK, regardless of your immigration status. You can contact an HIV clinic of your choice.

If you're a visitor from the European Economic Area (EEA) and you fall ill or have a medical emergency during your temporary stay in England, then you'll need a valid European Health Insurance Card (EHIC) issued by your home country. If you can't show a valid EHIC, you may be charged for your treatment. The regulations on access to healthcare in the EEA also apply to Switzerland.

Your EHIC will cover you for treatment that becomes necessary during a visit to England, until you return to your country. It also covers you for the treatment of pre-existing medical conditions and for routine maternity care, providing the reason for your visit is not specifically to give birth.

If you're visiting England from a non-EEA country, even if you're a former UK resident, you need to ensure you're covered for healthcare through personal medical or travel insurance for the duration of your visit.

If you need NHS treatment and you have not arranged insurance, you'll be charged at 150% of the standard NHS rate, unless an exemption category applies to either you or the treatment.

There are some exceptions to this:

Primary care and secondary care – hospitals and GPs

Primary care is the first point of contact that you have with the NHS and includes:

If your GP cannot give you the care and help you need they will refer you on to a secondary care service.

Secondary care means more specialist care that you would mostly find in hospitals. This includes specialist HIV care.

However, for HIV care you do not need a referral so you can go straight to an HIV or sexual health clinic without speaking to your GP first.

GP or HIV clinic - which one should I go to?

GPs have a lot of experience treating common conditions and long-term conditions such as diabetes, asthma and depression.

GPs are also able to prescribe drugs or give vaccines that aren't available from your HIV clinic, such as antidepressants, blood pressure and cholesterol drugs, flu vaccines, and so on.

GP and other surgery staff can work with you as you try to lead a healthy lifestyle, offering advice and help on eating well, maintaining a healthy weight, doing exercise or giving up smoking, for example. And your GP is often the person who will need to refer you to specialist services if you need them for a health condition.

Should I tell my GP that I have HIV?

It’s important to be registered with a GP as well as an HIV clinic. Although you're not obliged to tell your GP that you have HIV, there are good medical reasons to do so. When treating you and giving you prescriptions, your doctor should know about other health issues you have, and all other medicines you're taking.

Some drugs your GP may prescribe (for example, oral contraceptives and antihistamines) can interact with HIV medicines.

Because of rules of confidentiality, the HIV clinic needs your permission before it can discuss your health with your GP.

GPs will not get involved in HIV treatment decisions, which are left to the HIV clinic.

How should I tackle a problem with my health care?

If you're not happy with the care you have received from any healthcare provider, here's what you can do:

1. Try to deal with the problem informally.

You could speak directly to the member of staff concerned or someone more senior (for example, the practice manager at a GP surgery).

There's good chance that they will appreciate the problem, apologise, and try to put things right.

2. Make a complaint.

If talking doesn’t resolve the problem, try getting things in writing. A letter may help convince the organisation that the problem is serious. Keep a copy of your letter, and any replies you receive.

Every NHS organisation has a complaints procedure. Ask to see it if you haven’t already been told about it. This will set out how you can make a formal complaint and the timetable for a response to it.

3. Complain to the ombudsman.

If you're not happy with the way your complaint is handled, you can complain to the ombudsman – a body that looks at complaints about public organisations. You can find out about how to complain to the ombudsman on the Citizens Advice Bureau Advice Guide.

It’s also worth remembering that you don’t need to stay with the same doctor or the same clinic if you’re not happy. You can find another one that is accepting new patients. You don’t need to give a reason for switching, and you shouldn’t be treated any differently for doing so.

Here are some organisations that can advise you on what action to take if you are unhappy:

If you feel that you have been discriminated against because you have HIV, you can contact either the Equality Advisory and Support Service or THT Direct. They can give you advice about challenging discrimination and taking the case further.

More about the NHS:



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The Information Standard: Certified member

This article was last reviewed on 10/7/2017 by Anna Peters

Date due for the next review: 10/7/2020

Content Author: Roger Pebody (NAM)

Current Owner: Advice/Gillian Arrindell

More information:

About the National Health Service (NHS), NHS, April 2016

Information for those visiting or moving to England, NHS, June 2015

HIV and AIDS - Treatment, September 2014

NHS England

The NHS Constitution sets out your rights as a patient.

Health in Wales

NHS Scotland

Department of Health Guidance on overseas visitors hospital charging regulations updated October 2013