NHS entitlement: ordinary residence and visas

Free NHS hospital care depends on two things: being 'ordinarily resident' in the UK, or having paid the Immigration Health Surcharge (IHS) when you arrived on a long-term visa. If you are ordinarily resident, you have full access to NHS services for free. However, GP visits, A&E emergency treatment, and care for infectious diseases are free for everyone—regardless of immigration status or residence—so don't delay seeking help if you need urgent care.

What 'ordinarily resident' really means

Ordinary residence is not defined in UK law by any Act of Parliament. Instead, it has been developed through court decisions and is a key concept used by immigration authorities, the Home Office, and the NHS to decide who can access free healthcare. The term is not based on nationality or passport—it is based on where you are actually living and under what circumstances.

According to the Home Office's official guidance, a person is ordinarily resident if they are living in the United Kingdom lawfully, voluntarily, and for settled purposes as part of the regular order of their life. This can be for a long or short duration. Your residence must be lawful (so you must have valid leave to remain), voluntary (you chose to live here), and settled (you are not just passing through on holiday).

The test is primarily objective—based on evidence of your pattern of life—rather than your personal feelings or intentions. For example, short-term tourists visiting on a Standard Visitor visa are not considered ordinarily resident, even if they have a valid visa, because they are visiting temporarily rather than settling. By contrast, someone on a Skilled Worker visa working in the UK for two years, living in rented accommodation, and with family commitments here would typically be ordinarily resident. The distinction matters: if you are ordinarily resident, you get free NHS care. If you are not, you are classified as an overseas visitor and may be charged for hospital treatment.

The Immigration Health Surcharge: your shortcut to free NHS care

Most foreign nationals applying for a UK visa longer than six months are required to pay the Immigration Health Surcharge (IHS) as part of their visa application. This is a mandatory fee, separate from the visa application fee itself, designed to ensure that temporary migrants make a contribution to NHS costs.

Current IHS costs

As of February 2024, the standard IHS rate is £1,035 per year of your visa, paid upfront. Reduced rates apply in some cases: students pay £776 per year, as do holders of the Youth Mobility Visa. The Health and Care Worker visa route is completely exempt from the IHS—a special recognition of the contribution made by healthcare and care professionals to the NHS.

Each person must pay their own IHS, including your spouse and dependent children. If you are extending your visa or switching to a different long-term visa route, you will need to pay the IHS again for the new period. If you are granted Indefinite Leave to Remain (ILR), you do not need to pay the IHS.

What the IHS covers

Paying the IHS entitles you to use NHS services on broadly the same basis as a UK resident throughout the period your visa is valid. This means free GP consultations, hospital treatment, A&E emergency care, maternity services, and mental health services. The IHS does not create ordinary residence status itself; rather, it is a formal exemption that gives you access to free NHS care during your visa period.

Importantly, the IHS does not cover or remove standard NHS charges that apply to everyone. You still pay for prescriptions in England, dental treatment, eye tests, and optical care. These charges apply to UK residents too, so paying the IHS does not exempt you from them.

GP registration and A&E: free for everyone

One of the most important things to know is that GP registration and A&E emergency treatment are free for absolutely everyone in the UK, regardless of immigration status or how long you have been here. This applies to tourists, short-term visitors, asylum seekers, and anyone else.

To register with a GP (General Practitioner), simply contact a surgery in your area and complete the registration process. Immigration status makes no difference—any person in the UK is able to register with a GP practice and receive NHS primary medical services free of charge. You do not need to prove your immigration status, address, or even have an NHS number at the point of registration, though you may be asked for ID and proof of address if you have it. Once registered, all your GP consultations and treatments are free.

Accident and Emergency (A&E) departments are open 24 hours and free for emergencies. If you need urgent treatment for a serious condition—severe pain, heavy bleeding, suspected heart attack, or severe injury—go to A&E or call 999 (the emergency number). A&E treatment itself is always free, though follow-up treatment after an emergency may be charged to overseas visitors who are not ordinarily resident.

Hospital and secondary care: the key difference

Hospital treatment and specialist secondary care (such as consultant appointments or planned surgery) are the main areas where your status matters. If you are ordinarily resident, you receive this care free. If you have paid the IHS on a visa longer than six months, you also receive it free. If you are neither ordinarily resident nor covered by the IHS, you may be charged for hospital treatment at 150% of the NHS tariff—a significant cost.

When you are referred to hospital or a specialist by your GP, or if you need planned treatment, the NHS provider (the hospital) will assess your eligibility for free care. This is where your immigration status and residence status become relevant. If there is any doubt, you should provide documentation: a copy of your visa, a BRP (Biometric Residence Permit), evidence of the IHS payment, proof of address such as a tenancy agreement, or utility bills showing your name and UK address.

Prescriptions, dental, and optical charges

All residents in the UK, including those who have paid the IHS and those who are ordinarily resident, must pay standard charges for prescriptions, dental care, and eye tests. These are not covered by ordinary residence status or the IHS.

Prescriptions in England

In England, each prescription item costs £9.90. If you are on multiple medications, a Prescription Prepayment Certificate (PPC) can save money: £32.05 for three months or £114.50 for a full year, giving you unlimited prescriptions. About 89% of prescriptions are dispensed free under various exemptions, so check if you qualify. Children under 16, people over 60, pregnant women, and those with certain qualifying medical conditions receive free prescriptions.

NHS dental care in England

NHS dental treatment in England is provided on a banding system: Band 1 (routine examination and cleaning) costs £27.90; Band 2 (fillings, extractions, and minor oral surgery) costs £76.60; Band 3 (crowns, bridges, dentures, and more complex procedures) costs £332.10. The charge covers a full course of treatment, not individual procedures, so multiple appointments within one treatment plan are covered by a single payment.

Finding an NHS dentist in England is increasingly challenging—many practices are not taking new patients—so book early if you need dental care. Children under 18 receive free NHS dental treatment across the whole UK. In Scotland and Wales, dental arrangements differ significantly; Scotland and Wales both offer free NHS dental care for all residents.

Optical care

Eye tests through the NHS are not free for most working-age adults in England, and glasses or contact lenses are charged separately. Some groups qualify for help: children under 16, people over 60, those with certain eye conditions, and people receiving certain benefits. You can apply for help with optical costs through the NHS Low Income Scheme if you qualify.

Infectious disease care and specific exemptions

Certain NHS services are free to everyone, regardless of ordinary residence status or IHS payment. These include treatment for certain infectious diseases (such as tuberculosis and HIV), treatment for sexually transmitted infections, and treatment required as part of public health measures. If you need care for an infectious disease, seek treatment immediately without worrying about charges.

Proving your status to the NHS

When you access NHS services, particularly hospital care, you may be asked to prove your eligibility. Have the following documents ready: your passport, your visa and any visa stamps, your Biometric Residence Permit (if issued), a document proving you have paid the IHS (usually a confirmation email with your IHS reference number), proof of your UK address (tenancy agreement, utility bill, council tax bill, or bank statement showing your name and address), and an NHS number (if you have one).

The NHS uses a digital system called a share code for those with digital immigration status (such as eVisa holders). When you register with a GP or attend hospital, you may be asked to generate and share this code online, which allows the NHS to verify your status directly with the Home Office. If you have any difficulty providing proof of status, speak to the NHS staff—they are not immigration officials, and they should accept reasonable evidence.

Key scenarios: who pays for what

• You are ordinarily resident: free GP care, free hospital care, free A&E, but you pay standard charges for prescriptions, dental, and optical.
• You have paid the IHS on a long-term visa (longer than 6 months): free GP care, free hospital care, free A&E, but you pay standard charges for prescriptions, dental, and optical.
• You are a short-term visitor (tourist, Standard Visitor visa, fiancé visa): free GP care, free A&E emergency treatment, free infectious disease care, but you are charged at 150% of the NHS tariff for planned hospital care and specialist treatment.
• You are an asylum seeker or refugee: you may have different eligibility depending on your status—seek specific advice from Citizens Advice or your legal representative.