NRPF and Healthcare
NHS Scotland does not share your details with the Home Office for the purpose of immigration enforcement
National Health Service (NHS) treatment is not classed as a public fund for immigration purposes and can be accessed by a person who has the No Recourse to Public Funds (NRPF) condition.
If a person with NRPF has paid the Immigration Health Surcharge (IHS), they can access most healthcare services without further charges. They are mostly subject to the same NHS charges as British citizens. However, the restrictions imposed by the NRPF condition can impact people’s health and how they access health services.
People with NRPF can be reluctant to access NHS services for several reasons; uncertainty over their rights and entitlements, the difficulty experienced when registering with a GP or fear that their private information may be passed on to the Home Office and UKVI.
Use the toggle below to learn more about the NHS, the IHS, what it covers, and where to find the most up-to-date information.
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.
Regardless of immigration status, most people in Scotland can access the following NHS services for free: GP registration and appointments, accident and emergency treatment, hospital treatment, prescriptions, dental treatment, optometry, and maternity services.
For a full breakdown of eligibility by immigration status, see the relevant section of COSLA’s Migrants’ Rights and Entitlements.
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. Whilst ID and proof of address are almost always asked for, you shouldn’t be refused registration if you can’t provide them, and you don’t have to disclose your immigration status if you don’t want to. This should always be an optional field on any GP registration form.
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 the Grampian Regional Equality Council (GREC) immediately.
NHS Inform hosts three excellent factsheets which set the stage for healthcare and accessing it as a migrant in Scotland.
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:
- £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.
Please see the UK Governments dedicated IHS page for further guidance.
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.
EU nationals applying for leave to remain under the EU Settlement Scheme (EUSS) don’t have to pay the IHS; however, if they have come to the UK after Brexit and are not joining a family member with relevant status under the EUSS who can sponsor them, they will pay the IHS if it applies to their visa route.
The Home Office provides guidance for those who need to pay the IHS and explains how to do so.
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 thiscontext 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.
Individuals will get an automatic refund if their visa application is refused or withdrawn, or if they paid too much or paid twice.
Individuals can apply for a reimbursement if they work in health or social care for at least sixteen hours a week, if they are an EU student in certain cases, or if you they an S1 certificate. This is done online, on the government’s website.
The Home Office has specific guidance for those who work in the health and care section sector a reimbursement.
Fee waivers are available for specified human rights applications where charging a fee would be incompatible with the applicant’s rights under the European Convention of Human Rights (ECHR). A fee waiver will only be granted where the ECHR claim forms a substantive basis of the application, and not where an ECHR article is mentioned only in passing. For further guidance into the application, who can make one and how to do so we recommend you read the Home Office’s detailed guidance.
For more information we suggest that you read the relevant pages found in COSLA’s Migrants Rights and Entitlements Guidance and the NRPF Network’s Guidance.
It is advised that individuals 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.