Reflections on the UK Health System

I have talked to several Americans who've had really horrible experiences with the UK's National Health Service. Others have been full of praise and thoroughly surprised by the level of attentive care they were given. Here are my general reflections about how you might find the care over here, especially as it differs from the American system. I realize being totally unbiased is not possible, but I'll do the best I can.

The fundamental thing to remember about the NHS is that because they are a branch of the government, they do not function like the American private practice system. In short, their primary aim is not to please you. Health care workers have little incentive to make concessions, do things your way or bend over backwards for you. This is because their livelihood does not depend on your satisfaction with their work--they are paid by the government, not by you. This is not to say, of course, that health care professionals in the UK are heartless and lazy. I cringe just typing that sentence. I have had some wonderful doctors here who have worked hard on my behalf and shown a great deal of care about me and my family. I have also had some who nearly put me in tears because of their calloused, unconcerned and unmotivated air. The funny thing is, I could say the same thing about doctors I've had in the US. The difference is, in the US, you have the choice to leave and go find a doctor you like better. Your options here are much more limited, often non-existent.

As a result of this foundational difference, here are some things you might face (based on my experience and that of friends):

Negatives:

1. Dead ends: You may feel that your doctor in the UK will not try as hard you think he/she could to find solutions to your health concerns, particularly if the problem is complicated. For instance, a friend in his 30's, after snapping the arch in his foot, was told by his UK doctor that he would never walk again. He was offered no further assistance. He flew back to the US to see his doctor at home and was walking again within a week.

2. Rigid Compliance to Rules: You may feel your health care provider cares more about the rules or the system than about your needs. We recently had a friend whose NHS prenatal classes were completely canceled. When she asked her midwife how to proceed, i.e., how/where to get the replacement classes, she was told she'd just have to go without because the other classes were full. Another friend was forced to leave her doctor's appointment after 10 minutes because her time was up. They didn't care that she had more questions and concerns to discuss.

3. Limited Options: As I said above, your choice of a health care provider will likely be somewhat limited. If you don't like the practice you're at, changing practices will not necessarily be a sinch if it's possible at all. In my experience, you are only permitted to register at the practice that is nearest where you live. The exception is if there is a practice that generally accomodates the University students, though these practices often have heavy burdens placed on their resources and you may find better care at the one closer to home.

Positive:

Remember, it's free. Whenever I face something unpleasant, I remind myself that the care I'm getting is 100% free. I was talking to a friend in the US last week who's about to have a baby. Adding herself and the new baby to her husband's insurance plan is going to cost them $700/month. Having the baby, even with insurance, will cost them several thousand dollars. Sometimes I can hardly believe we don't have to think about those enormous expenses!

Having a Baby in the UK: What to Expect for Delivery and Recovery

I already posted on what you might be able to expect from the antenatal (prenatal) maternity care in the UK. Here are some thoughts on the delivery side of things.

1. The NHS midwives generally give you the option to have your baby in the hospital or in your own home under their care. Some areas also have birthing centres.

2. Your antenatal midwife will almost certainly not be the one to deliver your baby. Antenatal midwives and birthing midwives typically have distinct and separate jobs here.

3. If you choose to have your baby in the hospital, you will be given a private room for delivery. After delivery you will be transferred to a recovery room. Recovery rooms are typically shared with up to three other postnatal women and their babies.

4. Your baby will typically be left with you after delivery and throughout recovery, not taken to a nursery.

5. I think it's fair to say that the midwives treat delivery in a less medical way than it is often treated in the States. It will not be normal for you to be strapped down with IV's and other tubes connected to you. You should be a be able to move about freely during labor if you want to.

6. In my experience, your husband will not be allowed to stay at the hospital with you overnight.

Things you might not have expected to have to take to the hospital, but probably should:

1. A gown or something you don't mind giving birth in. That's right, the hospital does not typically provide you with a hospital gown to wear.

2. Nappies/Diapers. The hospital staff will expect you to have brought your own supply. They may send your husband to the store to buy some if you haven't.

3. Flip flops. Without going into too much detail, just remember you may be sharing a shower with up to three other post-natal women.

Getting a National Health Service (NHS) Number

Remember, as an American studying in the UK for more than six months, you have access to the UK's National Health Service (NHS). This means that you do not need seperate health insurance like you would in the US because the NHS is government operated and functions without the involvement of private insurance companies.

Obtaining your NHS number is pretty simple. All you have to do is register with a GP. (GP means General Practitioner, or doctor.) After your successful registration you will receive, by post, a yellow mailing from the NHS--hopefully within a week or two. This mailing will contain your NHS number in the upper right hand corner. It will also contain your surgery (a.k.a. doctor's office) details and Community Health Index (CHI) Number. Make sure you keep it in a safe place.

Unfortunately, since you need to register at the GP in order to get your NHS number, you cannot apply for it long distance. You must already be residing in the UK.

European Health Insurance Card

If you plan to travel to the Continent during your stay in Britain, you'll want to make sure you apply for a European Health Insurance card. This card, which is FREE to obtain, entitles you to health care while you are away. "The EHIC covers any medical treatment that becomes necessary during your trip...(you'll have) access to state-provided medical treatment...and...be treated on the same basis as an 'insured' person living in the country you're visiting. Remember, this...may mean that you have to make a financial contribution to the cost of your care (a 'co-payment')." The card is valid for five years and can be renewed when it expires. "People who are ordinarily resident in the UK are entitled to a UK-issued EHIC (but it is not valid for people who are going to live abroad)."

For those who do not have UK nationality (such as Americans living in the UK), this health insurance is valid in all EU countries, but not in Denmark, Norway, Liechtenstein or Switzerland. Iceland will treat patients for emergency care only.

Here's what you need to do to apply.

1. Go to your local Post Office and request an application form for the European Health Insurance Card. They may tell you just to apply online. If they do, tell them you can't and that you need a paper form. Currently (at the time of writing this post) it is not possible for non-UK nationals to apply online, therefore you need to get an application from the Post Office.

2. Fill out the form. You will need your NHS number or, alternatively, your National Insurance Number. You need only one form per family.

3. In the envelope provided, mail the form to the EHIC Applications Centre. You should receive your new card within 2-3 weeks.

For further information, see the following website:

https://www.ehic.org.uk/Internet/home.do

General Info About UK Maternity Care

Here's a little general info about the antenatal (prenatal) maternity care I received in the UK.

1. Generally, all maternity care is handled by midwives, not doctors. If you have complications, doctors will likely take a more active role. Otherwise, you may see a doctor only at the very beginning and very end (38 weeks) of your pregnancy.

2. I had appointments every four weeks with the midwife, 36 weeks being my last visit. As I said, I saw the GP at 38 weeks.

3. Last year in Edinburgh, pregnant women were only entitled to one scan (ultrasound) during their pregnancy: around 10 weeks. They have just switched it to two scans: around 10 weeks and 22 weeks. I think this probably varies depending on your location. If you want more scans, you would have to go to a private practice and pay for them.

4. Many hospitals/districts have non-disclosure policies about divulging the gender of your baby. You may or may not be able to find out what you're having before-hand depending on your location.

5. There are birthing classes (called "antenatal classes") available, usually through your local GP.

6. It was made clear that epidurals would be an option for delivery only if an anesthesiologist was on duty when I was in labor. No promises. I had a friend, though, who was given more solid assurance that that would be an option.

7. Prescriptions are free of charge during pregnancy and for the 12 months following the birth of your child. So is all dental care.

Questions? Feel free to ask!

Registering with a Doctor: the Gateway to the Healthcare System

One of the first things you will want to do upon your arrival (after you've secured housing) is to register at your local surgery (doctor's office). As you've no doubt heard by now, most health care in the UK is free if you (or your spouse) are studying for more than six months. However, there are some things you need to do in order to be able to access it. Registering with a GP (General Practitioner or Doctor) is the first step. It is important to do this as soon as you have housing because it can take up to several weeks to get the process sorted out. If you are pregnant, or have an ongoing medical condition, those weeks can be really frustrating.

1.) Find the surgery that is nearest to your flat. You can do this online by clicking on the following links. For England click here. For Scotland, click here.

2.) They will need to see:

a. Your proof of address. You MUST take either a copy of your rental agreement or a piece of official mail (such as a phone bill) with you to the GP's. A hand-addressed envelope will not work. Believe me, I tried it.

b. Your passport with visa inside.

c. It's worth mentioning that they will need to see you too. You cannot register for your spouse. Again, tried it.

3.) They will give you paperwork to fill out--nothing too long or scary. You should be able to fill it out while in the office.

4.) If you don't need to see a doctor immediately you’re done. If you do, you can try making an appointment while you’re there.

If you are pregnant or need to see a specialist, there may be a further wait as you will now need a referral from your new doctor.

Here is a timeline from my experience for accessing specialized care:

1.) Two weeks after settling in at our flat, we received our first official piece of mail. (Want a tip for speeding that up? Sign up for a phone and/or internet plan as soon as you move in. The phone company should send you a piece of mail within a couple of days. This will be helpful, especially if you don't receive a copy of your rental agreement right away as proof of address.) As you know from above, official mail meant we could register with the GP which was the first step.

2.) At the time of my registration, I made another appointment with the GP to go over my general medical history. Just more paperwork, really. This was a necessary prerequisite to being referred to the midwife. The first available option for this appointment was a week after initial registration.

3.) Only after this appointment, did my GP make the referral to the midwives. A week and a half later, I got a letter from the midwives offering me an appointment for the following week.

So, I had been in the UK a total of 5 1/2 weeks before I was seen by my midwife. I believe the process would be the same with any specialist, though with some specialists I imagine the wait would be longer.

My point in telling you this is so that you will not arrive in the UK (as I did) with the expectation that you can go right to the doctor. It may be several weeks before you can be seen, especially if you need to see a specialist.

UK Dental Costs for Foreign Students

While the NHS offers free medical care to those who are studying here for more than six months (and their dependents), there are some medical expenses you will have to factor in to your budget. Here's what you need to know about dental expenses.

All NHS dental examinations in Scotland are free of charge. Take note--that's just NHS dental examinations. There are plenty of private dentists around which you would be expected to pay for. If you want a free exam, be sure you make it clear that you want NHS treatment. (Sometimes the same dentist will do both private and NHS treatment. Confusing, I know.)

An examination will NOT NECESSARILY include a cleaning. (We've heard rumors that some have gotten a free cleaning at their exam, but this is not standard.) It will definitely include a general check-up to see that all looks well and is healthy. A standard cleaning fee is around £10. An intensive cleaning might run you £25. If further work is needed, you will be informed and you would need to schedule an appointment which you would be required to pay for. Click here for a sampling of dental prices in Scotland.

In England exams are not free of charge. However, they're not terribly pricey. Click here for a regularly updated list of dental costs in England.

Exceptions exist, however, in both England and Scotland. All children under 18, for instance, receive free dental care. If you are pregnant or have had a baby in the last 12 months, you will also receive free care. There are lots of other exceptions too, but I don't think they would apply to folks like us who have no recourse to public funds.