Author: Dr Lucy Hooper MB BS BSc MRCGP MA DRCOG DCH

What changes when your family moves from American healthcare to the NHS, what you need to arrange in your first few weeks, and where the gaps are that you may want to fill yourself.

We have been looking after American and Canadian families in London since Coyne Medical opened in 2016, many of them here on corporate relocations or on embassy and diplomatic postings. Almost everyone arrives without a clear picture of how the system works, because nobody sits you down and explains it and there is no obvious place to ask. Knowing what changes, and what to arrange in your first few weeks, makes the whole thing considerably smoother, and that is what this guide is for.

The same handful of things comes up again and again. The appointment that cannot simply be booked. The child who needs a paediatrician and is seen by a GP instead. The ADHD prescription that runs out with no obvious way to replace it. The screening test that was routine at home and is not offered here at all. None of it is hard to sort out. It is far less stressful to know about it in advance than to work it out on the day somebody is unwell.

Can Americans use the NHS? Entitlement and the immigration health surcharge

Yes. Almost everyone moving to live in the UK is entitled to NHS care on the same basis as a British citizen. Entitlement rests on being ordinarily resident here rather than on nationality, employment or tax status.

If you are coming on a visa of more than six months, you will almost certainly have paid the immigration health surcharge as part of your visa application. That is a single payment made up front, covering the length of your visa, and it is what buys your NHS access. It belongs in your moving budget alongside flights and visa fees rather than in your monthly costs, and once paid there is nothing further to arrange and no premium, deductible or claim.

Some services still carry a charge even for people who are fully entitled. Prescriptions, dental treatment and eye tests are the main ones, and they are covered further down. Emergency treatment in an accident and emergency department is free to everyone, whatever their status.

Rules and rates change, so check the current position before you apply rather than relying on what a colleague paid last year. The government guidance sets out who has to pay, how much, and what it does and does not cover: Pay for UK healthcare as part of your immigration application.

How to register with an NHS GP when you move to the UK

Register with a GP practice near your home as soon as you have an address, even if you plan to use private care for most things. We recommend it to all of our patients. Registering is what generates your NHS number, and that number is what gets you into emergency care, hospital services, the national screening programmes and NHS prescriptions if you ever need them. It stays with you for life and links your records together, so write it down when it comes through.

Practices take patients from a defined local area, so you register with one close to where you live rather than choosing freely across the city. Registration is usually a short form, either online or at the practice. You do not need proof of immigration status and you do not need to have paid anything to register.

Once you are registered you can set up the NHS App, which gives you your records, test results, repeat prescriptions and appointment booking in one place.

Booking a GP appointment works differently here

Most NHS practices now triage before they book, so you are unlikely to be able to choose your doctor, your time and your date in the way you could at home. This is the difference that American families notice first.

Triage usually means completing an online form describing the problem, or having a telephone call, before an appointment is offered. What you are then offered depends on what the practice judges you need. It might be a GP, but it might equally be a practice nurse, a pharmacist, a physiotherapist or advice by telephone.

In practice this means that seeing a named doctor of your choosing, in person, on the day you ask, is often difficult, and that continuity with one particular GP is harder to build than most American families expect. Appointment lengths are shorter too. Ten minutes is the standard NHS slot, which works well for one clear problem and less well for a complicated one or for several at once.

This is the gap private general practice fills, and it is about more than being seen quickly. At Coyne Medical you book directly rather than being triaged, we can almost always see you the same day, and appointments are thirty minutes as standard rather than ten. You choose the GP you see and stay with them, so the person examining your child today is the one who saw them last winter and knows what is normal for them. Blood tests and ECGs can usually be done at the same visit rather than at a separate appointment weeks later, and imaging can often be arranged the same day. And when you do need a specialist, we refer you to a named consultant we know and work with regularly, rather than to whoever the list allocates. Most of our American and Canadian patients use us for exactly that, while keeping their NHS practice registered in the background.

Urgent care in the UK: 999, 111 and accident and emergency explained

Learn this before you need it, because the American map does not transfer. There are four levels of urgent care here, not two.

Call 999 for a genuine emergency, meaning anything you would have called 911 for. Go to an accident and emergency department, always called A and E, for serious injury or sudden serious illness. A and E is the equivalent of the emergency room and is free at the point of use.

For everything in between there is NHS 111, a free telephone and online service that runs at any hour of the day or night and is the usual way to reach NHS care outside GP opening times. You describe the problem and are directed to the right place, whether that is your own GP the next morning, an urgent appointment somewhere else, or accident and emergency. It can also arrange a call back from a clinician.

It is worth knowing how it works. The people answering the phone are usually trained call handlers working through a structured set of questions rather than doctors or nurses, and they will pass you to a clinician if your answers suggest it is needed. The system is designed to be cautious, so it will often send you somewhere rather than tell you to wait. Use it as a way of finding the right door quickly, not as a substitute for clinical assessment.

Urgent treatment centres and walk in centres sit between the GP and A and E, and handle sprains, minor cuts, suspected simple fractures and similar problems without an appointment. Pharmacies also do more here than in the United States. Community pharmacists can assess and treat a defined list of common conditions directly, including earache in children, sore throats, urinary infections in women and shingles, and can supply prescription medicines for them without you seeing a GP at all.

Do you need a private GP in the UK?

Most families who use a private GP do so for the same handful of reasons. To be seen at the point something is worrying them. To have long enough in the room to work through the whole picture rather than one problem at a time. And to keep seeing the same doctor, so that a symptom can be explored properly, a plan explained, and the result reviewed a few weeks later rather than left to a follow up that never quite happens. Using a private GP does not affect your NHS registration or entitlement in any way.

A private GP can do essentially everything an NHS GP can do. That includes acute illness, long term condition reviews, contraception and cervical screening, menopause care, vaccinations, blood tests and imaging, and referrals to hospital consultants. A GP can advise on whether a private or an NHS referral makes more sense for what you need, and help you take the right route.

A private GP can also do the preventive work the NHS has no route for: child health and development checks, screening earlier than the national programmes begin, and reviewing a family who have just arrived from another health system and want to know where they stand.

What medical records to bring from the US

Download everything from your patient portal before you leave, while you still have access. UK practices cannot see American records, so having your own copy makes everything easier once you are here and saves piecing a history together from memory.

Aim for a problem list, current medications with doses, allergies, immunisation records, recent blood and imaging results, and copies of specialist letters for anything ongoing. Most American states also hold vaccination records on a state immunisation information system, so you can request them even if you have changed doctors.

If anyone in the family has a long term condition or is under specialist care, those letters matter enormously. They are what allows a UK clinician to pick up where your American one left off rather than starting the assessment again from the beginning. Hand the records to your new GP practice and ask for them to be added to your notes.

Do children see a paediatrician in the UK?

Usually not. In the UK, GPs see children of all ages from birth, and paediatricians are mostly hospital based specialists who look after children needing specialist input or admission to hospital.

All GPs here are trained in child health. Fever, cough, earache, rashes, tummy pain and the rest of ordinary childhood illness are firmly general practice territory, and you would see a paediatrician only after a GP referral. There is no tradition of a family having its own paediatrician the way there is in the United States, and this is often the change American parents find hardest.

You may also be contacted by a health visitor, particularly if you have a child under five. Health visitors usually have a nursing or midwifery background and work in the community, offering support with feeding, sleep, development and parental wellbeing. How much contact you have varies a good deal between areas, and families who arrive partway through the early years sometimes have very little, so it is worth asking your GP practice what is available locally rather than waiting to hear.

Why the NHS has no routine well child checks

The NHS does not offer well child visits in the way American paediatric practices do. There is no annual appointment, and after the first two years there is no scheduled contact at all until school entry.

What the NHS does provide is a newborn physical examination shortly after birth and a further examination at six to eight weeks with the GP. Health visitor reviews are usually offered at around one year and again between two and two and a half years, though how much of this happens in practice varies between areas. Newborn screening also differs. The heel prick blood spot test in the UK screens for nine conditions, where most American states screen for thirty or more, so your baby has been screened, but not against the same list.

For parents used to an annual visit this is a real gap, because those appointments were never only about height and weight. They are the point at which you raise the question about weaning, or fussy eating, or speech, or a child who seems anxious, and have it looked at properly before it becomes a problem. Many private GP clinics, ours included, offer child health and development checks for that reason, so growth, development, nutrition and wellbeing can be reviewed on a regular basis.

Do UK schools require vaccination records?

No. UK schools do not require proof of vaccination for entry, unlike most American states, so nobody will ask you for a record. Your GP practice may send a reminder if a child appears to be behind, but nothing follows it up in the way an American school or paediatric practice would. Because there are also no routine well child visits, there is no appointment at which somebody would notice, and it is easy to get behind without realising.

Teenage vaccinations are given in school by a separate immunisation service rather than by your GP, so consent is requested by the school rather than arranged at an appointment. Requests often arrive by email rather than on paper, and are easy to miss among everything else a school sends. If the request is missed, the vaccine is missed, and nothing will prompt you afterwards. If your child has asthma or a significant allergy, ask the school about their policy on holding a spare inhaler or adrenaline autoinjector and about written care plans. The arrangements exist, but they work differently from the American ones and they are not automatic.

Is there an annual physical in the UK?

No. There is no annual physical in UK primary care, and no expectation that a healthy adult will see a doctor at all in a given year. This is probably the single biggest cultural difference in adult healthcare between the two countries.

NHS GPs manage both ends of adult medicine, from acute problems like back pain and chest infections to long term conditions like high blood pressure, diabetes, asthma and thyroid disease. Long term condition reviews are usually run by practice nurses on an annual cycle, and for many otherwise healthy adults that review is the only routine appointment they will ever have.

The nearest thing to an annual physical is the NHS Health Check, offered once every five years to people aged 40 to 74. It is a cardiovascular risk assessment covering blood pressure, cholesterol and lifestyle, not a general review of your health, and it does not include most of what an American annual physical would have covered.

This is the gap our health screening was built to fill, and it is what most of our American and Canadian patients come to us for. A screening appointment covers a detailed blood panel, cardiovascular assessment including an ECG, body composition, and a long consultation with a GP to work through what the results actually mean for you and what to do next. Fuller levels add whole body MRI, cardiorespiratory fitness testing, and cancer and genetic testing. For families used to an annual physical, it is the closest equivalent to what you had at home, and it is where the screening gaps described further down this page get picked up.

Maternity care in the UK compared with the US

NHS pregnancy care is led by midwives, not obstetricians. You will see a midwife for most of your antenatal care, with an obstetrician involved where there is a clinical reason, and many women give birth without ever meeting one. Private maternity care in the UK works the other way round and is usually consultant led, with a named obstetrician looking after you throughout, which is closer to the model most American women are used to.

Routine NHS care includes two scans, at around twelve weeks and around twenty weeks, rather than the frequent ultrasound scans common in American practice. Midwife led birth units and home birth are mainstream options, and continuity is with the midwifery team rather than with a named consultant. All standard NHS maternity care is free, including delivery.

The NHS model is a good one with good outcomes, but it is different in ways that are worth understanding early rather than at thirty weeks. Private antenatal care, consultant led maternity and additional scanning are all available, and your GP can talk through how the options fit together and what a combination of the two would look like.

Women’s health: cervical screening, contraception and menopause

Your GP handles most of what you would have seen a gynaecologist for at home. Cervical screening, contraception including coils and implants, menopause care and hormone replacement therapy are all core general practice here, on the NHS and privately.

Cervical screening in the UK now tests for high risk HPV first, and only samples that test positive go on for analysis of the cells themselves. American practice has moved in the same direction, so HPV testing will not be new to you, but the age ranges and intervals are not the same. UK screening runs from 25 to 64, which is later than many American women are used to starting, and the invitation comes to you automatically rather than being arranged at an appointment.

Referral to a gynaecologist happens when there is a specific clinical reason for it, not as a matter of routine. If you have been seeing one annually for well woman care, that role is now your GP’s.

UK prescription costs and American drug names

NHS prescriptions in England are charged at a flat fee per item whatever the medicine actually costs, with exemptions for children, people over sixty, pregnant women and people receiving certain benefits. There is no prescription charge at all in Scotland, Wales or Northern Ireland. Private prescriptions are charged at the real cost of the medicine, which for common generic drugs is often less than the NHS flat fee and for newer drugs considerably more.

Most UK prescribing is generic, meaning by the drug name rather than the brand. Many of the same medicines exist in both countries but the names differ. Acetaminophen is paracetamol here. Albuterol is salbutamol. Epinephrine is adrenaline. Familiar American brands either do not exist or contain something different, and Benadryl in the UK is not the same drug as Benadryl in the United States. Pack sizes of painkillers sold without a prescription are also legally restricted, so you cannot buy a hundred tablets at a time.

If you are not sure what your American medicine corresponds to here, bring the packaging or a list of active ingredients rather than brand names.

Getting ADHD medication in the UK after moving from the US

Plan this before you move. NHS GPs are generally not able to initiate or independently prescribe ADHD medication, and you will usually need assessment by a specialist, typically a psychiatrist, before it can be supplied here. This applies even if you or your child has been stable on treatment in the United States for years.

Stimulant medications are controlled drugs in the UK and are subject to specific prescribing rules. NHS waiting lists for ADHD assessment are long, and in some parts of the country they run to years rather than months, which is why arriving without a plan causes real problems.

Bring medication with you, within the limits. You may bring up to a three month supply of a prescribed controlled medicine for personal use. It must travel in your hand luggage rather than in checked bags, and you must carry a letter from your prescriber listing the medicine, the dose and your travel dates. Without that it can be taken from you at the border.

That same letter is what shortens everything afterwards. Copies of specialist letters, previous prescriptions and assessment reports allow a UK clinician to treat you as an established patient rather than as a new diagnosis. Private GPs working alongside psychiatrists can often arrange review and prescribing considerably sooner than the NHS route.

Mental health support in the UK

You can refer yourself for talking therapy without seeing a GP first. NHS Talking Therapies takes self referrals online for anxiety and depression, and almost nobody moving here knows that.

Beyond that, waits for adult psychiatry and for child and adolescent mental health services are longer than most American families will be used to, and the threshold for being accepted into specialist services is higher. As with ADHD, records of previous treatment make a substantial difference to how quickly things move, and private psychiatry and psychology are widely available if you need to be seen sooner.

Cancer screening in the UK compared with the US

This is where the two systems differ most, and it is the area in which most people moving from the United States choose to arrange their own care. The UK runs a small number of national screening programmes with defined age ranges and intervals. Screening outside those programmes does exist, but it is restricted to people at high risk, such as women with a strong family history of breast cancer or a known genetic mutation, and the thresholds for qualifying are narrow.

Breast screening

NHS breast screening begins at 50 and is offered every three years. American women are generally used to starting at 40 and being screened more often, which reflects US guidance. We would usually recommend screening from 40, and we assess breast density as part of that. Dense breast tissue both raises the risk of breast cancer and makes cancers harder to see on a standard mammogram, which is why American mammography providers have been required by the FDA since September 2024 to tell every woman whether her breasts are dense. NHS screening does not report density to you, so unless you ask, or arrange screening privately, it is information you will no longer have.

Prostate screening

There is no national prostate screening programme. Men over 50 can request a PSA test from a GP under informed choice arrangements, but it is not offered proactively and many men never hear about it. We would usually suggest considering PSA testing from 40, interpreted alongside individual risk rather than as a single number in isolation.

Bowel screening

This is the sharpest difference of all. In the United States, colonoscopy is routine screening from 45. On the NHS, eligible adults are sent a home stool sample kit every two years between 50 and 74, and colonoscopy follows only if that test comes back positive. Stool testing is a good test but not a perfect one, and cancers are missed. We recommend testing from at least 45, annually rather than every two years, using a test that detects blood at a lower threshold than the NHS kit. Depending on your risk we can also discuss colonoscopy, which remains the gold standard for both detecting and preventing bowel cancer.

The other programmes, and the gaps between them

Two smaller programmes are worth knowing about. Men are invited for a single abdominal aortic aneurysm ultrasound at 65, which takes a few minutes and is worth accepting when the letter comes. People in eligible age groups with a significant smoking history are invited for targeted lung health checks, which include a low dose CT scan, although the programme is still being rolled out and availability depends on where you live.

Beyond that, nothing is screened. There is no routine skin or mole check, which matters given how many Americans are used to an annual dermatology appointment, and no national programme for ovarian, pancreatic, oesophageal, kidney or most of the other cancers. Some of those absences reflect the evidence rather than a shortfall in provision, because a screening test has to do more good than harm before it is worth offering to a whole population. The practical effect is the same either way: for most cancers, nothing is looking on your behalf.

Skin and mole checks are available privately and are simple to arrange. We also offer a multi cancer early detection blood test, which looks for signals from a wide range of cancers that have no screening programme of their own. It does not replace the national programmes, and it is not suitable for anyone with current symptoms or a previous cancer diagnosis, but for people used to a more active approach it is often the closest equivalent.

Vaccination schedules are not the same

The UK and US childhood schedules differ in several important ways, including when the second measles dose is given, and several vaccines that are routine in the United States are not offered routinely here at all. Adult vaccination differs too, particularly for flu and shingles.

We have covered this in full in a separate guide.

Dentistry, eye care and vitamin D

NHS dentistry is difficult to access in much of the country and particularly in London, and many families end up paying privately whether they intended to or not. It is worth starting the search early rather than when somebody has toothache. Dental care is free for children and for pregnant women where you can find an NHS dentist, and sight tests are free for under 16s and for adults over 60.

Vitamin D deserves a mention because of latitude. UK advice is that everyone should consider a daily supplement from October to March, and that babies and young children should have daily vitamin D drops all year round. Families arriving from most of the United States have never needed to think about this.

Allergy is one further area where NHS access is limited and waits for testing are long, so families with significant allergies often arrange assessment privately.

Health insurance and paying for private care

Check what you already hold before you pay out of pocket. Families arriving with global or international health insurance, either personally or through an employer, often do not realise it covers private primary care as well as hospital treatment.

In some cases we can bill your insurer directly. Where we cannot, we can provide the treatment codes and documentation you need to make a claim yourself. If you have no cover, private GP care is paid per appointment, and the price is known in advance rather than arriving as a bill afterwards.

We also offer membership, which is the closest thing here to the concierge arrangement some American families are used to. It works as a monthly subscription covering your GP care rather than paying visit by visit, with the higher tier including an annual health screening. It tends to suit families who expect to use a GP several times a year, or who want one doctor looking after everybody rather than booking each appointment as it comes up. Full details are on our membership page.

Using NHS and private care together

These are not competing options and you do not have to choose between them. We would always recommend registering with an NHS GP, because it is your route to emergency care, hospital services, prescriptions at NHS rates and the national screening programmes, and because you want it in place before you need it rather than after.

Private general practice then sits alongside that for whatever you want it for: quicker access when somebody is unwell, longer appointments, child health and development checks, screening beyond what the national programmes cover, and continuity with a doctor who knows your family. With your permission we share results, letters and prescription information with your NHS GP, so both records stay current and nothing falls between the two.