England is an amazing place to visit and to live! It’s one of the world’s top destinations for visitors and expats, and many of the world’s top tourist attractions are found there.
England is one of the four countries that make up the United Kingdom (UK), an island nation separated from Europe by the English Channel. Its population stands at just over 53 million. Most of which is located around London, the largest city in Europe.
Yet, there are many smaller cities, such as Bath and Oxford, that are not only fascinating and culturally rich, but less crowded and less expensive to visit. England is home to the birthplace of the Beatles, Stonehenge, Hadrian’s Wall, the rolling hills of Lancaster and Cornwall, and over 600 miles of striking coastline.
If you’re planning to visit or move to England, it’s important to become familiar with their healthcare system. The United Kingdom has a universal healthcare system called the National Health Service (NHS), that was founded in 1946. It is one of the largest public health systems in the world, covering about 58 million people and serving an average of 1 million people every 36 hours.
England’s Health Care System: NHS
For the United Kingdom citizens and residents who qualify for a NHS number, the NHS covers all aspects of medical services free of charge. This includes ambulance rides, emergency room visits, preventative measures, surgical procedures, and ongoing treatment programs like chemotherapy. There are no copays or deductibles. Medications associated with hospital visits are free of charge, while prescription medication from pharmacies is either free or subsidized from the NHS.
The NHS is paid for by general taxation. About 18% of a citizen’s income tax goes towards healthcare, which is about 4.5% of the average citizen’s income. Overall, around 8.4 percent of the UK’s gross domestic product is spent on healthcare.
Since the 1980’s, total healthcare expenditure as a percentage of GDP has in general trended up. Also, the private sector for health insurance has taken on a more prominent role, accounting for about 16.7% of healthcare spending in 1999, up from 10.6% in 1980.
In the NHS system, the first point of contact for health-related matters is a General Practitioner (GP). According to government data from 2022, there are about 2,300 patients for each fully-qualified GP in England. All hospitals in the UK are run by NHS trusts, which are healthcare providers set up to deliver hospital and community services. There are 219 trusts in the UK, with each trust running multiple hospitals.
What Healthcare Does the NHS Provide?
By global standards, the NHS provides an excellent standard of care. The healthcare system in the UK is ranked 10th overall in the 2021 World Index of Health Innovation. In the United Kingdom’s public health system, the NHS covers or subsidizes many areas of care, including:
Dental: The NHS provides subsidized coverage of dental care, which means you must pay a portion of the cost of your care.
Optical: The NHS provides free eye tests for many people. If you are an adult in good health, you can expect to pay for an eye exam or glasses prescription and for your eyeglasses, too. If you are eligible for a free eye test, you may also be eligible for an optical voucher towards vision aids.
Mental Health: The NHS provides free mental health services. Most mental health services are accessed through a GP referral.
Physical Therapy: The NHS provides free physiotherapy to patients who have a referral from a GP, a doctor, or through occupational health services.
Alternative Care: In most cases, the NHS does not cover alternative care. It may cover a few physical or herbal treatments in rare circumstances.
Prescription Drugs: The NHS subsidizes prescription medication. You need to pay a portion of your prescription costs in some parts of the U.K., such as England.
What Concerns Do People Have About the NHS?
Although the citizens of England appreciate the NHS in general, many voice complaints about it. Some of these include long wait times, outdated equipment/technology, and limited healthcare choices.
Long wait times
The NHS has earned a reputation for long waiting times in both emergency rooms and offices with scheduled appointments. With recent stresses on the NHS – including reduced funding and too few staff – these waits have grown longer than ever. People must wait even longer to get referrals to specialists.
It’s believed that these wait times are impacting patients’ health. About 26% of patients wait more than 6 weeks for a diagnostic test (suspected cancer) and many wait over 13 weeks. Around 39% of patients with cancer do not get their first treatment within two months.
Key targets for cancer, hospital care and A&E are also routinely missed. Up to 25% of people seeking NHS mental health care wait more than 12 weeks. In some areas of England, people face a three-year wait for dentist appointments.
Outdated equipment and technology
There have been recent criticisms that the public NHS is relying on outdated equipment and technology. That contributes to slow care delivery. This is of greater concern to those anticipating surgery or those having specialized needs.
Limited choice in making healthcare decisions
Patients may feel like they have very little control over their health under the NHS. This is because they can only see a specialist if referred to one by a GP. There is also very little choice in choosing a specialist, and there might be limited treatments offered.
Health plans vary by region
One challenge about the healthcare system in the U.K. is that healthcare differs in different regions. England, Northern Ireland, Scotland, and Wales each have their own NHS healthcare system. For example, prescription prices and care can vary widely from one region to another.
Insufficient care in rural areas
If you’re in a rural area, you will have limited access to GPs and specialists. This can include maternity care, dentists, and opticians.
England’s Private Health Care System
Due to the long NHS wait times, many people have turned to the private health system to get the care they need in time. The private healthcare sector consists of hospitals and clinics run independently of the NHS. They are typically managed by companies, charities, or nonprofit organizations.
There are 515 private hospitals in the UK offering a range of world-class services and treatments. However, they generally do not have emergency, trauma, or intensive-care facilities.
Private health care patients can register for a private GP instead of relying on an NHS one. With a private GP, patients can often get same-day appointments. Although these GPs can refer patients to a specialist, referrals aren’t required, and patients are free to choose any specialist.
Growth in Private Healthcare
The number of patients paying for private hospital care increased 34% from 2019 to 2022. Over that period, there was a 184% jump in people paying privately for hip replacements, a 153% increase in private knee replacements and a 42% rise in private cataract surgeries. However, this strike fueled an even greater boom in demand for private healthcare from a broader swathe of England’s population.
Private healthcare offers shorter waiting times, better facilities, and more freedom in making healthcare decisions. However, it’s also more expensive. Private health care can be accessed by either paying out-of-pocket or buying private health insurance. The increased usage of private healthcare in England has led to more people buying private health insurance.
Largest Strike in NHS History
The largest strike in NHS history occurred in February 2023 by thousands of nurses and ambulance workers. This came after years of falling wages, stretched budgets, staff shortages and overall poor working conditions.
By November 2022, a record 7.2 million patients in England were waiting for elective care, such as diagnostic tests, cancer treatments, or surgeries. More than half of them had been waiting up to 18 weeks, and 400,000 of them had waited over a year.
Can Expats Get Healthcare?
Expats who are legally residing in England are entitled to NHS healthcare services. Expats who are from outside Europe are required to pay an immigration health surcharge.
Visitors to England can be treated in a hospital with an emergency room without an NHS number. But, they will pay for treatment at 150% of the NHS rate. As a result, most visitors and short-term residents buy travel medical insurance.
Expats wishing to use NHS healthcare services must find a GP and register for an NHS number either online, by phone, or in person. This process takes patience and preparation. Many expats supplement their NHS healthcare with private health insurance.
How Do I Get Health Care in England?
If you’re not sure how to get the healthcare assistance you need, use this checklist to guide you:
- Call 999 if someone is seriously ill or injured and their life is at risk.
- Call NHS 111 if you urgently need medical help or advice but it’s not a life-threatening situation. You can also call NHS 111 if you’re not sure which NHS service you need.
- Go to NHS 111 online to get help for your symptoms.
- Go to a walk-in centre, minor injuries unit or urgent treatment centre, if you have a minor illness or injury (cuts, sprains or rashes) and it cannot wait until your GP surgery is open.
- Ask a local pharmacist for advice – a pharmacist can give you advice about many common minor illnesses, such as diarrhea, minor infections, headaches, sore throats, or travel health.
- Make an appointment with your GP if you’re feeling unwell and it’s not an emergency.
Travelers and Expats in England Need Medical Insurance
England offers a national public health care system to its citizens that reduces their healthcare expenses. However, due to limitations in this system, many of their citizens buy private insurance. Many visiting tourists and expats also purchase their own private health insurance because of these same limitations.
If you’re traveling to England, be sure to purchase travel health insurance. If you’re moving to England for an extended period, you may want to purchase expat insurance. Good Neighbor Insurance brokerage firm provides private health insurance coverage in England for US and non-US citizens via international health insurance plans like IMG, GeoBlue, Cigna, and other overseas health insurance companies.
Enjoy your next adventure to England!
