Healthcare in London: how the NHS actually works day to day, and when to go private

The biggest culture shock isn't the accents in the waiting room. It's walking out of a doctor's appointment without a bill, a copay or a surprise statement from an insurance company three weeks later.

The short version

• If you're in London on a visa of more than six months, you've almost certainly paid the Immigration Health Surcharge, and you use the NHS on largely the same terms as British residents. Our NHS guide covers the surcharge and registering with a GP.
• Your GP (general practitioner) is your front door. Specialists are usually by referral, not direct booking.
• For urgent problems that aren't emergencies, use NHS 111 online or call 111. For emergencies, call 999 or go to A&E [1].
• In England you pay a fixed £9.90 per prescription item in 2026/27, with prepayment certificates if you need a lot of medicine [2].
• NHS dental care isn't free for most adults: charges run from £27.90 to £332.10 per course of treatment [3].

USD conversions use the Federal Reserve H.10 rate of October 30, 2026: £1 = USD 1.3398 [4].

How it fits together

Back home, you pick a plan, check whether a doctor is in-network, and pay a deductible. In London, NHS care is funded through taxes (and for most visa holders, the surcharge). There's no network to check and no claims to file for most care.

Your GP: the front door

Once you're registered, your GP practice handles almost everything non-urgent: coughs that won't quit, blood tests, repeat prescriptions, mental health support, contraception and referrals to hospital specialists. Most London practices now use online request forms and the NHS App for booking and messages, so expect a triage step before an appointment. Some appointments are by phone or video.

What's different from the States:

• No direct specialist booking on the NHS. Want a dermatologist or a cardiologist? You ask your GP, who refers you. Waits for non-urgent hospital appointments can be long.
• Hospitals are for hospital things. You won't see a hospital-based doctor for a routine checkup.
• Fewer routine screenings. The NHS invites people for specific screenings at set ages. If you're used to an annual physical with a full panel, that's not the default here. Ask your GP if you have a family history that matters.

NHS 111, urgent treatment centers and A&E

NHS 111

NHS 111 is the number for "I need help now but it's not a 999 emergency." You can use it online, in the NHS App or by phone [1]. The NHS says 111 is especially useful when you can't reach your GP or the practice is closed. It can direct you to A&E, an urgent treatment center, an out-of-hours GP, a pharmacist or a dentist, and it can arrange a callback from a nurse [1]. Use 111 online if the patient is 5 or older; call 111 for a child under 5 [1].

Ran out of a regular medicine on a long weekend? NHS 111 online can send a request to a local pharmacy for a limited supply until you can get your repeat prescription [1].

Urgent treatment centers

Think of these as the NHS version of urgent care back home. They treat sprains, suspected broken bones, cuts, stomach pain, rashes, high temperatures and similar problems, and they can do X-rays, ECGs and blood tests [5]. You may be able to book an arrival time through 111 online, which lets the center know you're coming [5].

A&E

A&E (accident and emergency) is the ER. Go, or call 999 for an ambulance, for anything life-threatening: chest pain, severe bleeding, signs of stroke, serious injury or breathing trouble [1]. Expect waits for less urgent cases, because patients are seen in order of clinical need, not arrival.

1. Life-threatening? Call 999.
2. Urgent but not life-threatening? Start with 111 online or by phone.
3. Minor and can wait? Your pharmacy or GP.

Prescriptions in England

England charges a single fixed fee per item, and it's been frozen at £9.90 per item (about USD 13) for 2026/27 [2]. That's for each drug, not each visit, regardless of what the medicine costs the NHS. Scotland, Wales and Northern Ireland don't charge, but London is in England, so you'll pay.

If you take regular medication, a Prescription Prepayment Certificate (PPC) caps your costs [2]:

Rule of thumb: if you need more than about one item a month, the 12-month PPC is a no-brainer. Some groups, including children under 16 and people 60 and over, get free prescriptions in England; check the NHS exemption list for the full rules.

Bringing medication from the States? Bring enough to cover your first weeks, keep it in original packaging with a copy of the prescription, and register with a GP quickly. UK doctors prescribe from the UK formulary, so some US brand names will become a different brand or a generic. A few drugs common in the US are controlled differently here, so ask your GP early.

Dentists

This is where the NHS surprises Americans the other way. Dentistry isn't free for most adults. NHS dental care in England is charged in bands per course of treatment [3]:

Those prices apply from April 1, 2026 [3][6]. The catch is availability: many London practices aren't taking new NHS adult patients, so plenty of Americans end up at a private dentist, paying private prices or using dental insurance. You don't register with a dentist the way you register with a GP; you contact practices directly and ask whether they're accepting NHS patients.

Private health insurance: when it's worth it

Plenty of Londoners use both systems: the NHS for emergencies, GP care and prescriptions, and private cover for faster specialist appointments and elective surgery. Many employers include private medical insurance as a benefit. Major UK insurers include Bupa, AXA Health, Aviva and Vitality.

What private cover typically does and doesn't do:

• Does: faster access to specialists, diagnostics and elective procedures; a private room; more choice of consultant and hospital.
• Usually doesn't: replace A&E (private hospitals generally don't run full emergency departments), cover pre-existing conditions in the first years, or cover routine GP care unless you add it.
• Usually needs a referral: many policies still want a GP referral before you see a specialist.

Read the fine print on excess (the UK word for a deductible), outpatient limits and mental health cover. It's a different market from US employer plans, and policies vary a lot.

What about your US coverage?

Medicare doesn't pay for care outside the US except in rare cases, so it won't help you in London. If you're nearing 65, the decision about enrolling in Part B while abroad has long-term penalties attached. Our Medicare guide walks through it. If you travel back to the States often, check whether your UK private policy covers the US; many exclude it or charge much more for it, and a US emergency without coverage gets expensive fast.

Getting set up

1. Register with a GP near your home as soon as you have an address.
2. Download the NHS App and link it to your practice.
3. Find a dentist early, before you have a toothache.
4. Buy a PPC if you take regular medication.
5. Save 111 and 999 in your cell phone and know your nearest A&E and urgent treatment center.
6. Check your employer's private cover and what it excludes.

Questions about which practices are taking patients in your neighborhood come up all the time in our community group for Americans in the UK.

Sources

1. NHS: When to use NHS 111 online or call 111
2. Community Pharmacy England: NHS prescription charges frozen for the second year running
3. NHS Business Services Authority: NHS dental charges from 1 April 2026
4. Federal Reserve: H.10 foreign exchange rates
5. NHS: When to go to an urgent treatment center (UTC)
6. NHS: How much will I pay for NHS dental treatment?

Keep reading

• The NHS for Americans: registering with a GP and the health surcharge
• Cost of living in London vs New York
• Medicare when you live abroad
• Health insurance between countries