Finding a doctor is one of the first things people usually do when relocating to another country. It may be for different reasons, not necessarily an actual need for one, but most of it for peace of mind, especially if moving with children. Signing up to a General Practitioner (family doctor) in the UK is even more important because it simply makes your life easier in case you end up in hospital or look for a specialty doctor. This article is about the NHS and will tell you how to deal with your medical needs when living in the United Kingdom as an expat.
This post will be dead serious, it’s about health after all. There will be some personal opinions based on years of living here in London as an expat and I admit, some of them may not be very popular. I am simply so frustrated by the English medical system that I had to express it somehow. But this is not only about its problems, also about its positive aspects. It would be wrong to criticise everything because the NHS is still filled with amazing people trying to do their best no matter what the politicians say. So, join me and learn how a person keeps oneself alive in the UK using the National Health Service.
First of all, do not take me wrong, I love NHS. As every Polish, I love to complain, and let’s face it, the British do not really understand me. I cannot give a proper Polish answer, every time I am asked “how are you”, I am mentally forced to say “I’m fine, thank you”. There are two exceptions though – the London Tube and NHS. You are not only allowed to complain about them, but it’s even warmly welcomed if you do. And yes, there is a lot to complain of!
For majority of my clients, the NHS is a wonderful idea and there would be nothing to whine about. I forgive you Americans, I know your system is wrong on so many levels unless you have a very expensive private insurance. For majority of Europeans though, the British health system is not that good, and definitely not unique at all. It’s common in Europe that your health is taken care of, for better or worse, for free, or I’d rather say for the taxes you’re paying. And it’s scientifically proven that whatever you pay for in private insurance, call it a medical, personal liability, property, etc. is more expensive. There is no way you would pay so much for any procedure in Europe as you pay in the US. Obviously, when travelling, buy one, it will ease your mind, but don’t loose sleep on worrying that you will pay hefty American price. Anyway, back to the UK.
When you relocate to the UK, signing up to a GP practise, sometimes referred as Surgery (do not get confused with a US English meaning) is crucial, because they are the first to contact in case of health problems. You are normally limited to a practice near your home (although it does not have to be the closest clinic, they all have their coverage areas and moving 1 house further, means sometimes that you would have to find another doctor). In some cases you can register with a practice which is located more conveniently for you because of your work, for example, but they can refuse to register you there if they do not take more new patients or you require home visits and you live too far. Remember that these practices would need to refer you sometimes to hospital and that would not be the ones nearest your home but part of the NHS trust your GP is signed to, so think wisely and reconsider registering closer.
You need to choose carefully, you need a good family doctor who will direct you to a specialist when you need it. And that may happen sooner than you may think. Unfortunately, the best medicine for a British, or at least English, doctor is paracetamol. It is available everywhere, so you actually do not need to see your GP too often, because you would quickly realize that going there is just a waste of time. Employers are also aware of it – in Great Britain you don’t need a doctor’s certificate stating that you cannot appear at work (usually up to a week). You just stay at home and try to get rid of all the bacteria or viruses you may have.
You need someone who will send you to do some tests you may need, and not the one who is convinced what is your problem at once. It is especially valid when you suffer from something with not so obvious symptoms. You need to do your research, good news is that you do not need to stay with a chosen practice; you are always free to go somewhere else. I cannot recommend highly enough the NHS website providing information including ways to find and register for a family doctor (with practices star rating).
Registering for GP surgery is free in England, it’s considered human right and there is no need for you to proof your immigration status, address, ID nor an NHS number!
Exercising access to medical tests and hospitals requires lots of bureaucracy, therefore GP is required. Even if using a private health insurance, you will usually not be able to go to your chosen specialist consultant/clinic without being referred first. And obviously you can use either private or public GP as your designated one. I would highly recommend you the former. The good thing is that every time you need this kind of consultation, you go to your GP and he/she sends a request to a central database (that’s in case of public system). Then you are posted the place and time of your appointment (remember, you do not need a day off, you just tell at work that you have to see the doctor). And here the good ends – you have to wait a lot. Recently, because of one huge mess, you would receive a letter after around 2 months of waiting that you still haven’t made an appointment yet, so you need to do it online again.
The best thing about the NHS service is that is free of charge, because it is based upon principle that treatment should be provided according to needs and not ability to pay by an individual. It is nothing unusual for a Polish, but if you are here because you moved from the US, for example, you will appreciate it quite quickly. The NHS quality declined drastically at the time of the recent coronavirus pandemic, of course it has started many years ago. That is normal when politicians decide that there are more important issues than health. When promoting “leave campaign” before Brexit referendum, there was even a special bus claiming that instead of sending 350 million a week to European Union, this money should go directly to the NHS. The lie was blatant, but still many people believed it. And the very next morning the leave side immediately stated that 350 million a week was just a metaphor.
I registered to my GP over 10 years ago, yes it’s still the same one, even though I’m not happy about the service they provide. It doesn’t really matter anyway. They used to have an amazing nurse who did lots of work, by the way, the nurses’ jobs here in the UK are not appreciated enough, they are the hardest workers in the whole system including the doctors! Can you imagine that my practice is still not available for face to face appointments? And they are not the only ones, that’s why I didn’t change them. There is no sense in going to look for another terrible doctor. Every time when even simple blood tests are needed, the nurse is not there like she used to before. Now you are being sent to the hospital when you need an appointment, never immediately, in 2 weeks if you’re lucky and basically waste another day to do something which should take an hour in total. There are still nurses in some practices, so chose wisely!
Back complaining – the doctor’s status in the UK is very high, and the majority of general practitioners my friends and I met here, is rude, not competent, do not have time to see their patients and consider you a pest. You should worship them instead of bothering with your carnal issues. It is really a shame, you are reminded about it every minute of his/her precious time. If you are a foreigner and English is not your first language, no matter how good it is or how well educated you are, I am sure you would not be able to tell exactly how your condition is. You probably know the basic anatomy-themed vocabulary: arm, leg, heart, stomach, if you are really good you can also recognize the words like larynx, thyroid, femur or a gland. However, do you know what pancreas, ventricle, occiput or ulna are? This is a perfect moment for your doctor to show you your place. You are supposed to listen to them and do exactly what they tell you, never question their position. And if your symptoms are not typical, you might as well go home, unless you are really stubborn. It happens with me once in a while (and the problem with me as a patient is that I come from a large family of doctors and I could take care of myself). My kidney stones give me pain in a place where most of the doctors expect gallstones. It took me half an hour to convince my GP to treat my urinary tract not a gallbladder. Oh, he didn’t look happy when the results came in, showing I was right. After all he prescribed me a medicine I cannot take because of my liver condition, this time he knew better. And now I can understand why going to a “ethnic” clinic in London makes sense for many expats.
I could write new post only about other examples of lack of competence or empathy. I do not want to make you bored, so I will only mention 2. My English (which is important) friend’s 14 year old son broke his arm and he was asked by the doctor how big his pain was. He is a very “logical” oriented boy, so he asked about the scale. The doctor’s answer was – 0 no pain, 10 giving birth. The other situation was when my other friend demanded a throat swab because of his tonsils condition (just after he was advised to use paracetamol and mouthwash to get rid of the bacteria). After a week he has learnt that his ears are all right.
When it comes to using services of the NHS they are not only the aforementioned issues. It’s roots are about genuinely helping and caring and the moment you would end up in hospital, it would be seen. No, it won’t be quick, there is not enough employees available and the ones who are need to do 10 things at the time, yes, nurses again. They are the ones who will check on you every 15 minutes, ask if you require a painkiller, say sorry that you still need to wait because the doctors are busy, etc. When you go for a procedure, you would be given a brochure explaining everything, and I mean what I say. When I had an emergency eye surgery I was only scared at the beginning. I was told about every step in a simple English, the same way you talk to a 5 year old. It is reassuring. And they do not want to keep you too long at the hospital, so you can usually quickly go back home.
The NHS is generally free, apart from dental (unless you’re a child or a pensioner). The only payment required is a prescription charge, which right now is £9.35 for an item (regardless if it’s private or public doctor prescribing). If you need a longer medication, your GP can write you medicines up to 2 months’ therapy, they are considered one item as well. You are encouraged to buy PPC (prescription prepayment certificate) – £30.25 for 3 months or £108.10 for a year. This means that all the medicines on your prescriptions are free of charge during the prepaid period. This way you could save a lot. Also there are many exemptions for some people or medical conditions which entitles for a free medicines, among other they include: contraceptives, cancer related medicines, STD remedies, age below 16 and above 60 years.
In case of accident you should immediately go to A&E (accidents and emergency unit), if you are in doubt, or first call one of 2 emergency numbers, both operating 24/7, different than in the US! In case of a non life-threatening situation it is 111. The call handlers will assess the case and will advise you what to do. It’s quick, but simple. Think of it as a professional help instead of googling what to do. Then, there is 999 which is the number you should call in case of emergency. By the way, the whole European Union and some non-EU countries have a special pan-European emergency response helpline. Anytime you travel in Europe, it is 112 you should call and then, it is the equivalent of the US 911.
At the end of this article, a word of advice. It’s better than it looks like, but if you can, I would advise you to use private clinics. There are different providers, the most popular would probably be Bupa, Axa and Aviva. You may not necessarily be able to chose one you want, usually the companies buy them in bulk quantities for all employees with a coverage depending on their seniority and position. They are still worth to have nevertheless.