Eligibility for secondary care services without charge

A patient being registered at a GP practice or having a NHS number does not mean they are necessarily eligible for other NHS treatment without charge.

Patients can access NHS care in relevant, non-primary care settings without charge if they:

• are ordinarily resident in the UK;
• qualify for one of the exemptions set out in the regulations; or
• require a service which is exempt from charge in the regulations.

Relevant care settings under the regulations include hospitals, non-NHS providers of NHS-funded care (including private and voluntary sectors), some community services and NHS-funded public health services provided by local authorities.

Relevant NHS bodies are required to make enquiries that are reasonable in the circumstances, to identify whether a patient is eligible for free NHS care.

Services provided by GPs, school nurses and health visitors are outside the scope of the regulations and are not chargeable.

Ordinary residency is not based on nationality, whether a patient holds a British passport or previous residency status. Broadly, to be ordinarily resident is to be residing lawfully in the UK for settled purposes as part of the regular order of a person’s life. This is decided on a case-by-case basis. In general, there is no specific amount of time an individual must be in the UK for them to be ordinarily resident, although non-EEA patients must have indefinite leave to remain.

Patients who are not ordinarily resident are classed as 'overseas visitors'. If they or the service they access are not exempt under the regulations, they are liable to pay for treatment they receive. If the patient is a child (under 18 years of age), the person with parental responsibility is liable for the charge. Although patients will be charged for treatment, trusts can write off and not pursue debts if a patient is destitute or without funds.

Patient groups exempt from charges in secondary care

Some groups of patients are exempt from charge under the regulations, irrespective of their residency status.

Exemptions include patients from an EEA member state exercising EU rights and other countries with which the UK has a reciprocal health arrangement. Treatment permitted under these exemptions can be limited to that which is medically necessary during a stay or which has been agreed prior to the visit. Patients from outside the EEA, including students, who have paid the health surcharge are also exempt from charge and are able to access most services in the same way as patients who are ordinarily resident in the UK.*

Exemptions from charge also exist to protect vulnerable patients, who have access to the NHS in the same way as patients who are ordinarily resident:

• refugees – ie individuals granted asylum
• asylum seekers – ie individuals with an outstanding asylum claim or appeal
• refused asylum seekers supported by the Home Office
• victims or suspected victims of modern slavery
• unaccompanied children under the care of local authorities
• prisoners and people being held in immigration detention
• anyone receiving compulsory treatment under a court order or who is detained in a hospital or deprived of their liberty under mental health legislation.

An "easement clause" in the regulations states that if the exempt status of certain categories of patient changes to chargeable part-way through a course of treatment, relevant bodies cannot charge for the remainder of that course of treatment. It is a clinical decision as to what constitutes a course of treatment under this clause.

*Assisted conception services are not included within the scope of the health surcharge and remain chargeable.

Secondary care services exempt from charges for all patients

There are a range of services which are exempt from charge irrespective of the residency status of the patient*.  Services are generally exempt because they help protect against public health risks, or for humanitarian reasons, for example:

• accident and emergency services (including A&E, walk-in clinics, urgent care centres, minor injuries units or similar), including any investigations, prior to a patient being admitted as an inpatient
• diagnosis and treatment of communicable diseases listed in the regulations – examples include HIV, pandemic influenza, tuberculosis. The exemption includes routine screening and vaccinations, but not the treatment of secondary illnesses associated with an infection
• screening, diagnosis and treatment of sexually transmitted infections
• family planning services
• palliative care provided by a registered palliative care charity or community interest company (palliative care provided by a relevant NHS body remains chargeable)
• treatment required when detained under mental health legislation
• services provided to treat physical or mental illness caused by torture, female genital mutilation or domestic and sexual violence. This applies irrespective of where the violence took place, provided that a patient had not travelled to the UK solely to obtain treatment.
• services provided by health visitors
• services provided by school nurses.

*Charges can still be claimed back from the home country of EU patients.