NRPF and Healthcare

Scotland’s healthcare system is the National Health Service Scotland (NHS Scotland). NHS Scotland works on a needs-based system. You’ll get the treatment that you need – not the treatment you can afford. This model has been in place since the inception of the service in 1948.

Upon moving to Scotland, you will need to register with a General Practitioner (GP) at your local medical centre. A GP is a family doctor, a provider of primary care and generally your first point of contact within the NHS. NHS Scotland provides clear guidance which lays out how to register with a GP. You are only able to register with a GP that covers the area you live in.

GPs are legally not allowed to reject people with NRPF from registering at their practice unless they are closing applications for all potential applicants – this may be the case if they are working at full capacity. If you have been refused registration, you should be provided with a letter explaining such a decision. If you feel that the decision was made on grounds that are unfair, you are entitled to appeal using anti-discrimination laws. Should you be in this situation and based in the North East of Scotland, we recommend you contact GREC immediately.

Visa applications are controlled by the UK government and, as part of your application, you may have to pay a healthcare surcharge, also known as an Immigration Health Surcharge (IHS). However, this will depend on the immigration status you are applying for. 

Fees for the IHS are not considered in the broader context of immigration and visa fees. The purpose of the policy is to cover the costs incurred by migrants through NHS services – the money raised is intended only to be used in this capacity and is not retained by the Home Office. When introduced in April 2015, the surcharge fee was £200. In the following decade, the fee has quintupled and sits at around £1000 for most applicants. Although, the price one pays depends on their age and the type of visa they have applied for; for example, at the time of writing, individuals need to pay

The price you pay will depend on your age and the type of visa you are applying for. For example, individuals will need to pay: 

• £776 per year for each year you remain in the UK if you’re applying for a Student or Youth Mobility Scheme visa 
• £776 per year if you’re under the age of 18 at the time of application 
• £1035 per year for all other visa and immigration applications 

Lead applicants will also need to pay the surcharge for spouses, dependent children and partners coming to the UK. This amount paid is to cover your entire stay and has to be paid up-front; this leads to situations where families are forced to pay over £20,000 in one go, alongside other relevant fees.

Generally, all foreign nationals are expected to pay the surcharge if they

• Are applying to come to the UK for longer than six months; or
• They are applying from within the UK for permission to stay (including for stays of six months or less)

In practice, this means that the vast majority of people immigrating to the UK are expected to pay, including spouse and work visa arrivals. It is estimated that in the first decade of charging, the Home Office has collected around £7 billion pounds in fees.

People with visitor visas don’t have to pay the charge. Instead, they pay for healthcare at the point of access, should they need NHS treatment while in the UK. People seeking asylum are also exempt from IHS fees. Individuals may be eligible for a partial or total refund of the fee should the following circumstances apply:

• work in the health and social care sector in the UK 
• study a full-time course of higher education in the UK, have a student visa which started on or after 1 January 2021 and do not work while you are here 
• moved to the UK on or after 1 January 2021 and have been issued with an S1 document by an EU Member State 
• Approved for a fee waiver (read more here about the waiver and the eligibility criteria)

You do not have to pay if you are applying for a visitor visa, seeking asylum, or applying for indefinite leave to remain. Irish citizens, Hong Kong BNO applicants, and victims of modern slavery with leave to remain are also exempt. British citizens are not required to pay. 

Despite sounding similar, in our context the distinction between a refund and a reimbursement is clear and important to recognise. 

• A refund is the return of funds to someone who has paid for something they did not receive. This occurs when someone pays the IHS twice due to a technical error. Refunds are automatic in principle. This can happen to anyone. 
• A reimbursement is the return of funds to someone who has paid but receives government financial support for policy reasons. In this context, this includes, for example, health and/or care workers not sponsored on a health and care worker visa but who are nevertheless contributing directly to the NHS. 

You will get an automatic refund if your visa application is refused or withdrawn, or if you paid too much or paid twice. You can apply for a reimbursement if you work in health or social care for at least sixteen hours a week, if you are an EU student in certain cases, or if you hold an S1 certificate. All individuals can apply for an IHS fee waiver; where they have an opportunity to evidence that their income is not sufficient to meet their child’s needs, or payment of the fee would leave them unable to meet their child’s needs.  

We suggest that you seek legal support before making any attempt to secure a reimbursement or fee waiver. 

Third-sector organisations consistently call for an end to the IHS, also known as NHS charging or fee charging. Leading the call are English organisations Project 17 and United Impact, their lived experience group.Both parties have written extensively on the topic, providing clear insight and experience as to why charging for healthcare is unjust and dangerous – you can read their thoughts in full here, and listen to the experiences of their members in their recent video below.