"Ordinarily Resident" - when will NHS cover hospitals

I'm a dual US/UK citizen, but never lived in the UK. I will be moving to the UK with my wife (US citizen) who is getting a 2.5 year spouse visa. She will be paying the immigration health surcharge.

It sounds like we can use NHS for GP/emergency, if needed, basically from the day we arrive. We would need to pay for hospital stays until we are "ordinarily resident," the definition of which seems... complicated. It SOUNDS like we just need to prove our intent to stay 6+months (a lease, address, utility bills, etc.). I'm basing that on this document I found: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/430967/OR_Tool__1_.pdf [nofollow]

My question is, in practice how long will it really take to prove "ordinary residence" (again, neither of has lived permanently in the UK before)? Would it make sense for us to carry international health insurance for a period of months until that happens?

You should both be able to use the NHS immediately upon arriving in the UK. Insurance would only be needed if your wife was on a visa valid less than 6 months and/or if you were only visiting the UK and not moving permanently.

The fact that your wife is paying the IHS surcharge means she is entitled to full NHS care from day one. And as long as you are moving back to the U.K. permanently and are not just visiting, you should be able to use the NHS right away as well.

You will need proof of address in the U.K. in order to register with a GP (usually a council tax or utility bill), plus your UK passport and her US passport and BRP, but that should hopefully be all you need.



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All that being said,

Most people still have private insurance.  This allows you to "jump the queue" for NHS wait times.  For example, my baby had an "urgent" referral to a pediatrician (children don't normally have a pediatrician here) and the wait was over a month.

I also received a referral to a dermatologist for a few suspicious moles and the wait is six months.

If I had private insurance, I could call and likely reduce the wait times to days.

Most people still have private insurance. 

Perhaps you mean most US expats?   

Taking the UK population as a whole, most, by far, don’t have private insurance.

Perhaps you mean most US expats?   

Taking the UK population as a whole, most, by far, don’t have private insurance.

Lol!  You think?  I feel like everyone I know has it (and I have a lot of non-expat friends).

Perhaps you mean most US expats?   

Taking the UK population as a whole, most, by far, don’t have private insurance.

You are absolutely correct but it may be more than you think.

Even when I lived here back in the 80's my job came with free health insurance as a benefit and when my son arrived back last year and started a job an option he has is for low cost (company subsidized) health insurance. A good friend here is going to see a private dermatologist to have a skin tag removed next month - he doesn't have insurance but going private is not very expensive.

https://www.theguardian.com/business/2017/jan/16/private-medical-insurance-sales-surge-health-nhs

The rise in sales of private medical insurance (PMI) comes despite increases in insurance premium tax (IPT) during the period from 6% to 9.5%, which has made policies more expensive. But the private medical industry is still far below its peak in 2008, when 4.35 million people – 12.4% of the UK population – had private cover. After the rise in 2015, a total of 4,022,000 people have cover, or 10.6% of the population.

All of the rise in private cover is coming through company schemes, where the number of employees with medical insurance rose by 3.4% to 3,070,000 people, or 76.3% of the total. This suggests that the increased popularity of PMI may be down to a recovery in the economy and companies taking more staff, rather than fears about the state of the NHS.

Perhaps you mean most US expats?   

Taking the UK population as a whole, most, by far, don’t have private insurance.

Yeah, I don’t think it’s standard, at least as far as I know. I think some people have it if their employer offers it, but I’m not aware of many people taking it out themselves.

I’ve never bothered with private insurance myself because I haven’t needed any treatment that would warrant needing to use insurance.


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I also received a referral to a dermatologist for a few suspicious moles and the wait is six months.

6 months?!  You're meant to be seen within 2 weeks if there is even a hint of suspected skin cancer.

ETA: Maybe the 2WW is a local policy?  The difference in wait times is astonishing, if so.

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6 months?!  You're meant to be seen within 2 weeks if there is even a hint of suspected skin cancer.

ETA: Maybe the 2WW is a local policy?  The difference in wait times is astonishing, if so.

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I'm okay with the wait and told my GP I was fine with it.

I've actually had to go through a big song and dance to get the referral.  I have a history of malignant melanoma (had two) and my uncle has stage 4 melanoma.  I could not get referred for a skin check, as you have to go through the gp and need to have a suspicious mole.  I'm covered in moles.

Anyway, trip to Florida last year I paid to see my old dermatologist for a skin check.  She didn't like 4 moles but said it wasn't urgent.  I took that info to the gp and got my referral.  I'm fine waiting a few months.  I'm just SO RELIEVED to FINALLY be on the dermatology path with the NHS.  I will not allow them to discharge me.  I'm sure they'll be fine to schedule me for a skin check every six months when they see me.  lol!

I'm okay with the wait and told my GP I was fine with it.

I've actually had to go through a big song and dance to get the referral.  I have a history of malignant melanoma (had two) and my uncle has stage 4 melanoma.  I could not get referred for a skin check, as you have to go through the gp and need to have a suspicious mole.  I'm covered in moles.

Anyway, trip to Florida last year I paid to see my old dermatologist for a skin check.  She didn't like 4 moles but said it wasn't urgent.  I took that info to the gp and got my referral.  I'm fine waiting a few months.  I'm just SO RELIEVED to FINALLY be on the dermatology path with the NHS.  I will not allow them to discharge me.  I'm sure they'll be fine to schedule me for a skin check every six months when they see me.  lol!

Ahh, ok... Well if your old dermatologist wasn't especially concerned then I can understand being ok with the wait.

You should move to where I am - the hospital is particularly good at keeping track of MMs and following them up.  Probably helps that it has a dermatology department and a regional plastic surgery department, both of which deal with these things.    But I'm kind of surprised you couldn't at least get a referral from your GP for mole mapping or something, given you've already got personal and family history of MM.

It boggles the mind how the NHS works differently in different places.  At least you're on the pathway, as you say!

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You are absolutely correct but it may be more than you think.

Even when I lived here back in the 80's my job came with free health insurance as a benefit and when my son arrived back last year and started a job an option he has is for low cost (company subsidized) health insurance. A good friend here is going to see a private dermatologist to have a skin tag removed next month - he doesn't have insurance but going private is not very expensive.

https://www.theguardian.com/business/2017/jan/16/private-medical-insurance-sales-surge-health-nhs

Yes I saw that article.  I had a quick google before I posted because I realised that I may be more out of touch than I thought I was! 

https://www.theguardian.com/business/2017/jan/16/private-medical-insurance-sales-surge-health-nhs

Article is a year old but says peak of private insurance was around 14%, so still a minority of people.

"ordinarily resident," the definition of which seems... complicated.

The defination of "ordinarily resident" for bill free use of the NHS, was changed with the Immigration Act 2014. Under that Act, from 6 April 2015, a British citizen who resides in the UK and those with ILR who reside in the UK, are the people who are "ordinarily resident" for bill free use of the NHS. Prior to that Act, anyone who was lawfully residing in the UK was "ordinarily resident" for bill free use of the NHS.
http://www.fergusonsnell.com/news/immigration-update-nhs-surcharges-uk-migrants/

Your wife's bill free use of the NHS comes from her paying the Immigration Health Surcharge with her visa. That IHS allows the same bill free access that a British citizen living in the UK has, expect IVF.

When you can start to use the NHS

You can start using the National Health Service (NHS) when both:

    you’ve paid the healthcare surcharge (or are exempt from paying it)
    your visa or immigration application is granted

You’ll still need to pay for certain types of services, such as prescriptions, dental treatment and eye tests.

You should bring your biometric residence permit with you when you access healthcare in the UK.
https://www.gov.uk/healthcare-immigration-application