Navigating the NHS: All-in-One Guide for International Students

CLICK HERE FOR THE SPANISH VERSION

By Paulina Guerrero Gutiérrez, KCL Mexican Society President 2014-17 
Revised by Rodrigo Orcajo Castelan MD, Alumni Officer

Given that most students are relatively young people, it is frequent for us not to worry too much about our health. However, this is a mistake. One of the first things that you should do when you arrive to the UK is to register with the National Health Service (NHS), the British “public and free” healthcare system, even if it is just to be on the safe side. It is important to register soon for two reasons: many universities and dorms require it and private healthcare is extremely expensive. The lowest fees that a private doctor will charge you will be £80-100 per appointment, if you’re lucky and don’t need any additional test or procedure. Finally, in case of an emergency – yes, we all say it won’t happen – everything will be speedier and better if you know how to use the system.

Just as any other public healthcare system, the NHS is bureaucratic, complicated, and sometimes exasperatingly slow. However, if you know how to navigate it and use it smartly, you’ll get exceptional, quality care which will be nearly or completely free. This is something students in the US can’t say, having to subject themselves to expensive, private health-insurance companies that don’t necessarily cover everything, even if they can be tax-deductible.

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1. Generalities

The NHS’s provides a “so-so” service with its good and bad things. This, of course, is our opinion as immigrants: watch your tongue saying anything bad about the NHS with an actual British person. Some of them can get very patriotic about it and will take it personal. Better don't risk it. We should say the NHS is ranked as one of the best public healthcare systems in the world. Even if it is not comparable to the Mayo Clinic, it will not charge you as the Mayo Clinic. Rodrigo defines it as a “Mexican healthcare system on steroids”: just as in our third-world country, it is oversaturated when it comes to General Practitioners (GPs: your small, first-contact clinics), and therefore, appointments are short, and frequently miss serious problems. However, once you pass the gatekeepers and get to the specialists, hospitals and physicians are truly excellent, even if they are still bureaucratic and slow. Therefore, in order to truly take advantage of the NHS, it is necessary to know the system and how to navigate it, and to be truly full of patience: A LOT of patience. That is why we are bringing you this all-in-one guide.

These are the services that the NHS offers:

• General Practices or GPs: These will always be your first point of contact. They will have all your personal data and medical history. Also, they will be the ones responsible to transfer you to specialists, should you need them. They have short, routine appointments, and will usually be staffed by general physicians, specialised in family medicine. 
  
• Walk-in centres, Minor Injury Units and Urgent Care Services: These services are responsible for small, urgent things which are NOT life-threatening. These include cuts, burns, digestive problems, emergency contraception, stitches, bites, and, just for the last two, broken bones, sprains, and strains. Evidently, you can use these services without having to make an appointment and without being referred by your GP. Usually, you’ll be seen by nurses, who in the UK are very professional. They’ll only send you to a doctor if they have no clue about what you have. Note that you can also get emergency contraception directly in some pharmacies.
  
• Accident and Emergency Services (A&E): Their name says it all: they are only for emergencies. An “emergency” is something that puts your life at risk, so when Paulina says “life-threatening”, take it literally. In general, if your problem has been present for more than 5 days and is not getting worse, it is NOT life-threatening. You can find the closest A&E here or call 999, the UK’s emergency number. If you’re not dying, you should call the non-emergency number, which is 111. A Brazilian friend from the KCL Latin American Society gave us the tip to exaggerate how bad your problem is when you really, really, really need an ambulance. Rodrigo had to request one for a friend who had a severe concussion and he got it in 5 minutes doing that. Note, however, that you should only do this if you're sure it's an emergency, because exaggerating your symptoms might make you jump places in a queue full of people that might need it more than you. 
  
• Secondary-treatment centres: These include medium health centres, specialized clinics, and general hospitals. To use these services, you must first go to your GP and ask them to refer you. You can’t access them on your own. 
  
• Specialist Hospitals: These are those hospitals with the best specialists in a particular area. For Mexicans, these are similar to our “National Institutes” (such as Cardiology, Psychiatry, etc). Usually you’ll only be transferred there if you already have a diagnosis, or if you’re transferred by a secondary treatment centre for being a special case. Examples of these are the Royal National Orthopaedic Hospital and the Royal National Hospital For Rheumatic Diseases.
  

2. What are my rights in the NHS?

Regarding service:

• You have the right to a free, clean, and adequate service that treats you with dignity and that doesn’t discriminate you based on gender, race, disability, age, sexual orientation, beliefs, religion, gender reassignment, pregnancy, maternity, or marital status. 
  
• You have the right for your data to be private and confidential, to complain if something goes wrong, and to get involved in the improvement and planning of the NHS. 
  

Regarding choice:

• You have the right to choose your GP practice. Any GP should accept you unless they have “good reasons not to” (such as distance from your house or their number of pre-existing patients). You can also choose which physicians/nurses you want to see in that practice, ant to have a chaperone if you request one during physical exams. 
  
• When you are referred for treatment, you have the right to choose which clinic or hospital you want (except in urgent treatments, maternity and mental health), and to be seen in that centre within maximum waiting times (18 weeks from referral for non-urgent conditions or 2 weeks if cancer is suspected). If this is not possible, you have the right to be offered suitable alternatives. 
• You have the right to make decisions about your treatment, to be informed about it, and to reject any physical examination you don’t feel comfortable with. 

Regarding treatments and disease prevention:

• You have the right to receive any treatment recommended by NICE (the National Institute for Health and Care Excellence) for your problem. If the NHS chooses not to pay for a particular treatment, this has to be evidence-based and explained to you.
• You have the right to receive those vaccinations recommended for you, and to participate in recommended early detection protocols, such as cervical cancer screenings. 
  

For more info on this, you can read the NHS constitution and its handbook.


3. What am I entitled to in the NHS?

Emergency services, the treatment of sexually transmitted diseases and some infectious diseases, family planning, and mandatory psychiatric treatments are free for everyone, regardless of immigration status in the UK. European Nationals with an EHIC card (see section 9 of this post) are entitled to free healthcare just as if they were in their home country. If you're not a European national, want anything else, and you’ll be in the UK less than 6 months, then you’ll have to pay for your treatment. In those cases, it is recommended to get private health insurance. However, if you are studying in a program longer than 6 months and you paid the NHS levy during your visa application, both primary (GP) and secondary care (additional treatments) will be free. 


4. What am I not entitled to?

The NHS doesn’t cover cosmetic procedures, treatments for problems that can be cured on their own, or treatments that are not science-based. It covers your medicines, but it doesn’t distribute them, so you’ll have to pay £8.05 for every prescription in any designated pharmacy. However, if you suffer from a chronic condition, you’ll get an exemption card, and you’ll be able to get your prescriptions for free. All contraceptives are also free, including pills and patches in pharmacies, or condoms in your health centre. Recommended vaccinations will also be free. However, if you want additional vaccinations, you’ll have to pay for them. This is the case with vaccinations for travel, or when you’re not included in the targeted demographic for a given vaccine. As an example, the flu vaccine is only free for children and people over 60, whereas the HPV vaccine is only free until you’re 18.

The NHS also won’t give you full dental care. In these cases, you’ll have to pay a subsidised price which will depend on the type of treatment you need. To find an NHS dentist, you can check here which are close to you and book an appointment. However, these dentists are absolutely packed and it is highly probable that you’ll have to wait for ages to get an appointment. In this case, it might be more convenient to book a private appointment with that same dentist, or with another one. An alternative if you don't want to pay for the dentist is to go to the King's Dental Institute, where you can bee treated by an undergraduate dental student for free. For more information about dental care, you can read this page.

Finally, the NHS does not cover eye tests or optometrists, unless you are under 18 and studying, over 60, have serious visual problems, diabetes, glaucoma, or if there is glaucoma in your family history. In any other case, you’ll have to pay for the services should you need them.


5. How to register?

The first thing you should do to receive healthcare is to register with a GP (General Practice). As a student, you’ll generally have two options: to register in your university’s clinic (if it is a big university, such as King’s or UCL), or to register in a GP close-by which includes your address within their catchment area (the list of post codes they accept). You can check here for your closest GP. Before going to register, call them and ask whether they receive patients from your post-code.

If you decide to register in your university’s clinic, you’ll only need your student ID. For other GPs, you’ll probably need an ID and a proof of address. When you arrive, you’ll be asked to sign a form with your personal information, your family history, your current conditions, etc. You will be able to book appointments from the moment you hand in those forms. After 2-3 weeks, you’ll receive a letter with your NHS number.
 

6. What should I consider to choose a GP?

The first thing you should consider when choosing your GP is the waiting times for normal appointments. In the King’s Health Centre, for example, average waiting times to see a doctor are 1 ½ to 2 weeks, unless you have an emergency. In that case, you can request an “emergency appointment”. This very long time can be very frustrating, especially when you’re experiencing pain. In other health centres, you can only book same-day appointments by calling early in the morning. Other clinics combine same-day appointments with those made in advance. It will always be important to call beforehand and request info on the inner workings of the clinic before making your decision.

The second thing to consider is the quality of the service you’ll receive. As an international student, it is difficult to get references from other people, but if you have friends that live close to you, ask whether they would recommend their GP. Personally, Paulina doesn’t recommend King’s Health Centre too much, because it takes ages to book an appointment, and the nurses and one of the doctors have made some mistakes regarding her care. However, other people have had good experiences. Another option is to use the webpage we mentioned above, which includes the rating other patients have given the clinic, as well as the percentage of their patients that would recommend it to others.

Finally, it is important for you to consider the gender of the healthcare professionals working in each particular GP. Even though we are in favour of gender equality and against discrimination of any kind, it is perfectly valid to feel more comfortable being examined by a person of a given gender, especially when it comes to “private” matters. Therefore, when you’re looking up your options, check that the personnel includes people of the gender you’re looking for. If you’re a transgender or non-binary individual, there is a list of recommended GPs here. Also, there are clinics which specialise on the needs of the Gay & Lesbian community, such as 56 Dean Street.


7. How do GPs work?

There are various types of services in most GPs:

• Walk-in services: In this type of service, you arrive to your clinic within certain times, queue, and wait for a nurse to see you. This is very convenient for blood, urine or stool tests, as well as swabs and small problems. It works even if you need a mild prescription, in which case the nurse can send your prescription to a doctor to sign and give it to you right there. 
  
• Normal appointments: Depending on your GP, you will usually be able to book appointments for the same day if you call really early, or to book an appointment in advance. This can be either with doctors or nurses. Generally speaking, there will be shorter waiting times for nurses’ rather than doctors’ appointments. You can read some recommendations on how to make the best out of your appointment time here. 
  
• Emergency appointments: Those GPs that don’t have same-day appointments usually allocate some time for emergencies. Therefore, if you’re dying, don’t panic because you will be able to see your GP in those cases. King’s Health Centre does have emergency appointments, but receptionists never offer them, so if your problem is urgent, specify that you need one. 
  

Particularly in the case of females, once that you register, you’ll get a yearly letter from your GP inviting you for cervical swabs. They will insist until you do it or answer them saying that you’re deciding not to have it done.

You should note that GPs tend to minimise your symptoms and they rarely prescribe antibiotics. This has a reason: they are the gatekeepers of a system that forces them to solve 80% of problems and penalises them if they refer too many cases. Therefore, they will try to fix everything by themselves and only refer you to a specialist as a last resort, because that’s more expensive for the NHS. This means that sometimes you’ll get instructions that you should better check with a physician you trust. It also means they’ll be very conservative with referrals and additional studies. The key question you should ask yourself is whether you’re getting better with the treatment they gave you in a reasonable time. For example, if your pain doesn’t go down after a week, something is probably wrong. If you see something like that happening or you have a more specific need, then be very emphatic on what you want: receiving an appropriate diagnosis and treatment is your right! If you’re not getting better and you think you need a specialist, then you’re probably right. Paulina once had to go to 2 nurse and 2 doctor appointments for her symptoms to be taken seriously and for her to be referred, even though she had complained about her pain for more than two months. One of Rodrigo’s friends from LSE took 5 months (and 10 kilograms) to be diagnosed as gluten-intolerant. We have also seen cases in which someone requests insoles for flat feet and they get told that they are not necessary, and that they should buy generic ones in a sports shop. If you want to be referred to a specialist, you’ll have to insist!

Finally, you should always keep in mind that most GPs have a policy for no-shows and lateness. For example: King’s Health Centre kicks you out if you miss 3 appointments during an academic year. If you arrive more than 10 minutes late for your appointment, then you won’t be received. It is very important for you to check this at the start to avoid surprises.


8. What if I need to be treated by a specialist?

As we said in the previous sections, your GP will refer you as a last resource. First, they will try to “fix” you themselves. Usually they won’t refer you until you have a diagnosis or until they have run out of options with the equipment they have. Keep in mind that only physicians can transfer you, so don’t book appointments with nurses for this purpose. Rodrigo mentions that physicians are not going to guess that you’re not getting better, so you will have to insist repeatedly, with many appointments, until they realise you need to be referred.

In general, the process for a referral is as follows, regardless of what you need. This includes mental health issues and pregnancies.

• After evaluating your case, your doctor will give you a form, specifying the service you need, together with your symptoms or diagnosis (such as cervical pain, ultrasound, physiotherapy, X rays, etc.). You will have to turn in this form with the admin personnel, who will add it to the centralised referral system. 
  
• From that centralised system, they will call you on your phone in approximately 1 or 2 weeks, unless your physician flagged it as urgent. You might be given a choice between two or more health centres close to you, or you might just be told where you’re going to be sent. If they can’t communicate with you on this only occasion, they won’t call again. You will be assigned to whichever clinic they believe better and will notify you with a letter on the post, noting the date and time of your appointment. Therefore, if they haven’t called you after a reasonable time, you can call the number from the referral forms. 
  
• Depending on the health centre or hospital you are assigned to, you’ll be able to re-book if necessary either online or on the phone. Each clinic has a different policy. Some places will even ask you to fill out a questionnaire online or on paper on the day of your first appointment with your symptoms and clinical history. 
  
• IT IS VERY IMPORTANT THAT YOU DON’T MISS YOUR REFERRAL APPOINTMENTS. Many centres will delete you from their patient list if this happens, and you’ll have to start over with your GP. The personnel from the new clinic will treat you until they solve your problem. During this time, you’ll be able to call the clinic, book appointments, or change the ones you’ve already booked. Once you have been discharged, if you want to be treated in that health centre again, you’ll have to go through the whole referral process again. During your treatment, it will be commonplace for the health centre to send letters to your GP detailing your condition so that they put it in your medical records. You’ll be given a copy of these. 
  

The process described above is the one used in most GP practices. However, it has been promised that soon there will be a national e-Referral Service, which will be online, fast and efficient. As soon as we have experience with this new service, we’ll update this post.
 

9. What if I want to go on holiday to another European country?

If you visit another European Union country, as well as Switzerland, Iceland, Liechtenstein or Norway while you’re a regular resident in the UK, you can request the “European Health Insurance Card”. This card gives you the right to be received in the public healthcare providers of these countries in the same way as their own residents. It can either be free or at a reduced cost. To request the card, you can fill this online application, call them on 0300 3301350, or download this form and send it by post. For more information, you can read this page o this other one.

Unfortunately, you are only eligible for this card if you are a European  (including Schengen countries, the UK, Norway, Iceland or Liechtenstein), or if you are an "ordinary resident" of the UK. Note that Tier 4 visa holders are not considered ordinary residents, because they intend to return to their home countries after their studies. However, if you hold another type of visa (such as a spouse, Tier 2 dependant, or refugee visa), you might be able to apply for the EHIC. Note that  if you are not a European Economic Area national or a Swiss national, you cannot use your EHIC in Denmark, Iceland, Liechtenstein, Norway or Switzerland.
 

10. My problem is very serious and I would like to choose the best healthcare available. What can I do?

If your problem is fairly common, such as physiotherapy, gynaecology, X rays, etc. the NHS’s secondary services are quite good, regardless of the clinic you are referred to. However, there are special cases in which you will want the best service possible. For example, if you require surgery, you’ll probably want to choose a particular hospital or surgeon that you can trust.

For these scenarios, the good news is that the NHS has a policy called “NHS choices”, which states that it is your right as a patient to make decisions regarding your treatment. This includes both the health centre and the physician: “If you need to go to hospital to see a specialist, you have the right to choose which hospital you're referred to by your GP. This legal right lets you choose from any hospital offering a suitable treatment that meets NHS standards and costs”. Therefore, we recommend that you research the best hospitals in the particular specialty that you need so you can make an informed choice. In general, the best thing you can aspire to is to be received in the National hospitals, such as the Royal National Throat, Nose and Ear Hospital or the Royal National Orthopaedic Hospital. However, there are many excellent places that you can compare here. You can sort services by area, procedure, physicians or departments.

The issue here is that you need to prove that you are indeed requesting something viable and necessary. For this there are two possibilities:

• If you don’t have a diagnosis: In this case, you’ll just have to deal with it and go with the flow. You’ll have to accept whichever referral you get, until you have a diagnosis. When you have one, then you’ll be able to request a referral to another service either at your GP or in the health centre to which you were referred in the first place. 
  
• If you already have a diagnosis: This can either be because you went to a private physician or because you got it from someone in the NHS. In this case, you’ll be able to go to your GP and request to be referred to x or y hospital. If you pick a high-specialty hospital, such as one of the National hospitals, your GP will try to dissuade you saying that it will take a long time for them to see you, and will recommend a smaller hospital. However, if your treatment is not urgent and you’re willing to suffer the bureaucracy, it will totally be worth it to wait for a better treatment in a better hospital. 
  

You must be aware that the better the hospital, the longer the waiting times. For more details about waiting times, you can read this article. You will have to be really patient or give up. Just so that you can have an idea about how long it can take, here are the details about Paulina’s experience waiting for an ankle surgery that she needs, for which she requested to be referred to the Royal National Orthopaedic Hospital, the best in the discipline:

• Paulina got her diagnosis in Mexico in December 2014. When she went back to London, she had to wait 2 weeks to get an appointment with her GP. 
  
• The GP requested the diagnosis to be written down and detailed. Paulina had to call her doctor in Mexico, ask for a note and get it translated. This meant another 2 weeks.
  
• When she had her written diagnosis, she was referred. After 3 weeks, she received an appointment letter for the Royal National Orthopaedic Hospital 1 ½ months later. 
  
• One week before the appointment, she was called from the hospital, asking her to book a magnetic resonance. She was lucky, because the MRI people had a last-minute cancellation. Otherwise, average waiting times for MRIs are 6-8 weeks, and she would have had to re-book her appointment for who-knows-when.
  
• During her appointment, the consultant told her she needed orthotics before the surgery. She was sent to the Orthotics department in the same hospital, and was offered an appointment for a month and a half later. 
  
• After her appointment in orthotics, it took 1 ½ months to actually get her insoles. 
• The surgery is now scheduled for November-December 2015.

Total waiting time so far: almost 9 months
Time to wait still: 3 months

Yes, the NHS is highly bureaucratic and is in the middle of a financial crisis. The key is PATIENCE.
 

11. What is something goes wrong? Complaints

In the NHS, if you’re not happy with your treatment, you have the right to complain. You also have the right for your complaint to be investigated, and to be notified of the results of that investigation. If you are still not satisfied with the way they managed you complaint, you can take it to the Parliamentary and Health Service Ombudsman or to a judicial revision if you think there was something illegal. Also, you have the right to receive compensation if you were harmed.

The steps you must follow are:

• Before complaining, try to solve your problem off the record. You can book an appointment with the person you’re complaining about and see if you can talk it through, or you can meet with the manager of your health centre. If you’re a King’s student, you can check who the Deputy Practice Manager ir here. 
  
• If you’re not happy with how things went, you can make a formal complaint. You can do this by writing an email to the NHS complaints department at [email protected], with the subject line “For the attention of the complaints manager”. Here are some suggestions on how to file your complaint. It is recommended to proceed no later than 12 months after the event you’re unhappy about. After a short time, they will get in touch and conduct an investigation. 
  
• As your last resort, you can take your complaint to the Parliamentary and Health Service Ombudsman. If you do so, you’ll have to give a lot more detail on why you’re not happy with the response you got from the NHS. If you need more info on how to file your complaint in this case, you can read this page. 
  

12. Lastly

Always have a mental map of the services that are close to your house and campus. It is important for you to at least know where your GP and the nearest A&E are. For example, if you live in Brixton, it’s King’s College Hospital. If you’re in Whitechapel or Shoreditch, the Royal London Hospital is the closest. If you choke over a taco in Mestizo, University College Hospital is two blocks away. There won’t always be an ambulance at hand, so it might be quicker to get there yourself.


13. In Conclusion

The most important points for you to remember:

• Just as any other service, the NHS has good and bad personnel. It also has various levels of attention, and each one has an area in which they’re really good. In general, GP practices are specialised in routine, small things: painkillers, family planning, colds, and routine monitoring of diabetes and high blood pressure. These are things young people won’t use too frequently. For more complex or complicated matters, then the high-specialty centres are excellent. However, the process of getting there can be an ordeal.
  
• For nearly everything, you’ll first have to go to your GP. They will evaluate you, treat you, and refer you to other services if you need it. 
  
• The NHS is extremely slow and bureaucratic, so you’ll need to be really patient, especially for referrals. A useful tip is that if you have a critical problem, it might be quicker to get a diagnosis in your home country, together with a letter from your physician and the appropriate tests. Even so, you might need to insist and get pretty stubborn to be referred.
  
•  For life-threatening conditions, you can call 999 or go to an A&E. For other urgent but not life-threatening problems, you can go to a walk-in centre, a Minor Injury Unit or to Urgent Care Services, without an appointment. It’s very important to know that a life-threatening condition is a pain or weird feeling which is very intense and sudden. If you have been experiencing pain for 40 days and you want to get treatment via an A&E not only can they laugh at you, but they will probably kick you out. 
  
• Do your research before choosing a GP. Consider waiting times, recommendations of other people, and the personnel that works in each centre. A useful tip is to keep in mind that young, local GPs will tend to have fewer patients and to be nicer to you. “The more, the merrier” doesn’t really apply to the number of patients in a particular practice. 
  
• Always check your GP’s policies regarding no-shows and lateness. Also check the types of appointments they offer and how you can book these. It is convenient to choose a GP with many physicians, sufficient offices and urgent appointment slots. 
  
• You’ll have to pay a set fee for your medicines, for dental care, and for eye tests. Everything else will be free is you’re studying in the UK for more than 6 months. Family planning services, as well as A&Es and sexual health services are free for everyone, regardless of immigration status. 
  
• If you’re not convinced by what your GP told you, ask another doctor you trust. Be very emphatic with your symptoms and your lack of improvement. You can change your GP: it’s your right. If your symptoms continue, then insist and persevere. 
  
• Referrals are usually processed in 2 weeks, and it takes about a month to get an appointment. The health centre you’re referred to will treat you until they discharge you. The more prestigious the centre, the longer the waiting time. Think carefully about how delicate your condition is: if you have appendicitis or a common fracture, the best hospital is the closest one. If, like Paulina, you have a rare condition which only has 2 specialists in the country, wait for the best doctor you can get. 
  
• You have the right to make decisions about your treatment. Look for the best options according to your condition. If something goes wrong, you have the right to complain.