How the NHS works for Americans in London: what to expect

If you’re relocating to London from the US, healthcare is likely one of your biggest question marks. No co-pays? No insurance cards? What do you mean “free at the point of use”?

Welcome to the NHS: the UK’s publicly funded healthcare system. While it can feel like a complete departure from the US model, once you understand how it works, it’s actually quite straightforward – and often a pleasant surprise.

Here’s what you need to know before your first GP appointment or late-night A&E (Accidents & Emergencies) dash.

How the NHS works for Americans in London: what to expect (and what not to panic about)

1. Step one: register with a GP (General Practitioner)

Think of your GP as your gateway to the NHS. Once you’ve settled into your new London home, your first priority should be finding a local GP surgery (the UK term for a doctor’s office) and registering there. This will give you access to primary care and referrals to specialists, if needed.

Every surgery has its own system for booking appointments – some use online forms, others require phone calls. The key is: you can’t just walk into any doctor’s office. You need to be registered. Well you can walk in, but nothing will happen if you are not registered.

2. How emergency and urgent care works

You don’t need to be registered to access emergency services. In a genuine emergency, you can go straight to A&E (Accident & Emergency – the UK version of the ER) or call 999.

For urgent but non-life-threatening situations, there are also walk-in centres and a free 111 helpline where you can speak to trained medical staff who will direct you to the appropriate care.

Important: If you use NHS emergency services but haven’t registered and don’t yet have an NHS number, you may be sent an invoice, particularly if your immigration status doesn’t include access to NHS care (such as short-term visitors or those still setting up residency). That’s why it’s best to register with a GP and confirm your NHS access as soon as possible after arrival.

3. Cost: mostly free, sometimes flat-fee, rarely a surprise

One of the most reassuring aspects of the NHS is its simplicity when it comes to cost. Routine GP appointments, tests, treatments, hospital stays, and even surgeries are usually free at the point of use.

There’s a flat fee for prescription medication in England: about £10 per item.

If you ever do need to go private, prices tend to be far more reasonable than in the US – and always made clear up front.

> A quick heads-up for newcomers:
NHS coverage for dentistry and eye care is much more limited than general medical care. Routine dental check-ups and most dental treatments require a fee, and NHS dentists can be harder to find in some areas. Similarly, eye tests and glasses are not fully covered on the NHS for most adults, though children and certain groups are eligible for free tests or vouchers.

Because of this, many people choose to use private dentists and opticians, which are plentiful in London and offer transparent, upfront pricing.

4. Managing expectations: less is more

Healthcare in the UK generally takes a more conservative approach. You may notice fewer tests, fewer referrals, and a general focus on treating symptoms efficiently without excessive diagnostics. For those used to the US system, this can feel a little hands-off at first.

That said, you’re encouraged to advocate for your care. The NHS is designed to serve the public as efficiently as possible, so it’s perfectly acceptable to push for a second opinion or ask for clarification.

5. Mental health: be proactive

Mental health support in the UK is available through the NHS, but it can be a very different experience compared to the US. Access to therapists and psychiatrists can involve long wait times, and medications prescribed in the US are not always approved or commonly prescribed in the UK.

Some expats have found that UK GPs are more cautious about prescribing certain antidepressants, ADHD medications, or anti-anxiety treatments, even when these were previously prescribed by a US doctor.

To avoid disruptions in care, we recommend:

• Bringing a sufficient supply of any essential mental health medication when moving (as regulations allow).

• Stocking up during visits back to the US, if that’s an option for you.

• Considering a private psychiatrist in the UK for continuity, especially if your medication isn’t typically prescribed on the NHS.

Planning ahead for mental health needs can make a significant difference during your transition.

6. Quality of care varies by GP

Just like in the US, the quality of care can vary depending on your GP surgery. Some are oversubscribed and have limited appointment availability, while others are more flexible and responsive. Fortunately, if you’re not happy with your current surgery, you can change to another one in your area.

Londoners are particularly fortunate: the capital is well-served with doctors, hospitals, and specialists, which can lead to shorter wait times than in more rural parts of the UK.

7. Tech helps: download the NHS app

Once registered, you can download the NHS App, which lets you manage appointments, request prescriptions, and view your health records. It’s not quite as slick as some US healthcare portals, but it’s functional and saves time.

8. Private insurance: a helpful supplement

While NHS care covers most needs, many expats choose to take out private health insurance, often to access private hospitals, avoid long waits, or expand coverage to include things like dental, optical, or specialist consultations.

Private insurance is considerably more affordable in the UK than in the US, but be aware:

• Pre-existing conditions are typically not covered right away. Most insurers impose a waiting period (often up to two years) or exclude them altogether. It’s important to check your policy closely before buying.

Many expats use a hybrid approach: relying on the NHS for general healthcare and known conditions, while using private insurance for speed and convenience when needed.

Final thought: don’t panic, just prepare

Adjusting to the NHS takes a bit of a mindset shift, but many Americans find it liberating. No surprise bills, no insurance middlemen, and no need to comparison shop for providers. It’s not perfect (what system is?), but it’s functional, fair, and refreshingly straightforward once you’re settled.

Need help?

Need help registering with a GP, understanding your NHS eligibility, or arranging private health insurance? Simply London is here to make your relocation smooth, and that includes your healthcare setup. Get in touch here to discuss how we can help.