The NHS: not always "free at the point of use"

17 May 2013

At a time of wholesale change within the NHS, the Government has reiterated that NHS care is, and will remain, "free at the point of use".

But, as usual, there are some terms and conditions that you might want to read up on.

According to Section 3a of the 2009 NHS Constitution, a document that outlines "what staff, patients and the public can expect from the NHS",

"You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament."

So what are these "certain limited exceptions"?

Foreign patients

The Goverment has recently reminded overseas visitors of their rights to NHS care. Foreign or migrant patients are usually required to pay a fee for their treatment.

The NHS Charges of Overseas Visitors Regulations 2011 explain where this rule doesn't apply. The cost of care for EU nationals (as well as those living in Norway, Switzerland, Iceland and Liechtenstein) is covered by EU regulations 883/2004 and 987/2009. The UK also has bilateral agreements with several other countries including Australia, Kazakhstan and Russia. 

Trips to the optician and the dentist

Most people will pay a charge for an appointment at the optician or the dentist. Once again, there are exceptions

Some people receive dental care for free - for example, if you're under 18 years old, or pregnant, or you receive certain state benefits. Similarly, others will not pay anything for eye tests, and may receive vouchers towards the cost of their glasses or contact lenses. Once again, children, poorer pensioners and those on low incomes are among those spared the standard charges.


The standard prescription charge (as of 1 April 2013) is £7.85. However, in certain cases, a patient will be entitled to a free prescription. For instance, women don't pay for the contraceptive pill.

As a general rule, there's no cost for any medicine that's personally administered by a GP or provided during a patient's stay in hospital.


If you're jetting off abroad, the NHS will provide most of your vaccinations for free, although less common travel vaccines are only available privately (for instance, the rabies vaccine).

Optional treatment

Some other procedures also incur a charge. According to the Local Authorities Regulations 2013

"There is provision for local authorities to charge for certain services, but not those provided to an individual for the purpose of improving their health." 

This legislation doesn't spell out every situation in which charges apply. In certain cases, a patient might request treatment that isn't absolutely necessary but might improve their quality of life. In other words, if you're seeking treatment for "cosmetic reasons" you'll probably need to pay for it privately. 

The repair of varicose veins is an example that's often cited. As the NHS Choices website points out, unless you're experiencing pain and discomfort, "it's unlikely you'll receive treatment on the NHS". This means that to a certain extent whether you pay for your treatment will depend on a doctor's professional discretion.

As for IVF, the Department of Health says that it's up to a Clinical Commissioning Group (which buys healthcare for a community) whether or not a patient is offered treatment free of charge: "The decision whether to fund or not is a local decision." 

This is not a new arrangement. Before the latest re-structuring of the NHS, the cost of fertility treatment varied from region to region.


In the case of some procedures, whether or not a patient is instructed to 'go private' will depend on their medical history and the assessment of the doctor treating them.

GPs - via the new Clinical Commissioning Groups (CCGs) - now have a greater say in how the NHS budget is allocated. But with the current pressures on spending, it may be that we see more types of treatment being described as 'cosmetic' and more charges levied.

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