Welcome to my new Going to the Doctor Abroad series—a series of interviews with expats living abroad about how healthcare differs in their adopted country. The experiences below belong to the interviewees and may not be representative of every person’s experience. Love it? Hate it? Find it useful? Let me know.
First, tell us about you.
Hi, we are Drew and Julie. We have been married for eight years and are from the US, most recently living in Portland, Maine, and New York City. We relocated from NYC to London two years ago when Julie received an assignment here from her market research firm. Our move inspired us to develop our blog, Drive on the Left, which Drew works on full-time now. He spent his career in restaurant management and took the opportunity to pursue something different while living abroad. We have taken full advantage of our move and have traveled like crazy, giving us plenty of material for our blog!
Talk to us about average run-of-the-mill doctor visits. How do they work in the UK? How are they different from the US?
A basic doctor’s visit means going to a nearby Health Centre and meeting with a General Practitioner (GP). In our experience, making appointments is almost impossible, with slots only open a few weeks out. The system of calling to make an appointment is really only beneficial for patients that need to see a GP on a regular basis.
So if you are feeling unwell, you walk to your local Health Centre (sometimes called “Surgeries,” which was confusing at first) in the morning and put your name on a list. They will give you a time to return later that morning or early afternoon for an appointment. If you need to see a doctor outside those hours, Urgent Care Centers exist that only allow drop-in patients for basic appointments. Unlike the US, you rarely visit the same GP, as you see whoever is available at the time.
In addition, GPs typically don’t do as many basic procedures, like taking your temperature or blood pressure every time you visit. GPs have a 15-minute time slot with each patient, so they solely focus on the purpose of the visit. Yearly physicals are also not done here. When Drew brought it up with a GP on his first visit, the GP was not sure what he was talking about.
The other odd thing is the appearance of doctors’ offices. They remind us more of a college professor’s office than a medical office. Both in the NHS and with private specialists, the doctor sits behind a large wooden desk and you talk about your medical concerns. There is usually a small corner or side room that contains the usual medical table and equipment. The doctors themselves are even dressed business casual, without the normal white coat.
Let’s talk about specialists. How do you get in to see a specialist if you need to? Can you schedule a dermatologist or other specialist appointment on your own or do you need a referral from your family doctor?
Going to a specialist can vary depending on whether you use the National Healthcare System (NHS) or have access to private insurance. If you are using the NHS system, the GP acts as the middleman between patients and specialists. The GP has to authorize you to make an appointment with a specialist. If you have private insurance, you can call any specialist directly without having to consult at GP.
Are there any other ways visiting a specialist is different in the UK?
If you are going through the NHS and get approval to see a specialist from your GP, it can take a few months to get an appointment. With private insurance, you can call the specialist directly and arrange an initial consultation. You can usually get an appointment within a week, a big difference compared to the NHS.
The downside is that by circumventing the NHS, there is a charge for all appointments and procedures, similar to the US, and costs will vary depending on your individual insurance plan. While there are exclusively private hospitals, many specialists see both NHS patients and private patients, but there are fewer slots available to the NHS patients, resulting in the longer wait times.
Let’s talk about pharmacies and prescriptions. Are they any different from the US?
Pharmacies are similar to the US, with many located inside large, chain drug stores like Boots. There are some medicines that are prescription in the US that are over-the-counter in the UK. Codeine, for example, is included in some basic pain medication. Drew’s mother, while visiting from the US, bought some muscle pain cream over-the-counter that is normally a prescription in the US. The cost was also about half that of the same medication in the US.
In an emergency situation, what is the protocol in the UK?
In case of an emergency, dial 999, the UK equivalent of 911.
How is a hospital visit different than in the US?
Drew has had a few procedures done here in the UK, all for gastro issues. We have private insurance through Julie’s employer, so we used a private hospital. Not having spent much time in hospitals in the US, it would be hard for us to compare. But Drew does have a gluten allergy and the hospital provided a full range of gluten-free sandwiches and cookies afterward, plus a whole fresh fruit basket, which was a nice touch!
What about homeopathic practitioners, acupuncture, and other non-medical treatment options? Are they accessible? How do you go about finding them? How are they different from the US?
Since we live in London, there are a lot of alternative medicine options, from herbalists to acupuncturists. They are not part of the NHS, but are readily available. Alternative medical practitioners are not regulated in any way in the UK, and while there are some online directories, it is up to the patient to find an acceptable practitioner.
What about health insurance? What kind of insurance is available to expats in the UK? Would you recommend it? What’s the cost?
For everyone in the UK, healthcare is free through the NHS. All visits to the GP and medical procedures or surgeries are no additional cost. If you want to use private insurance, it works a lot like US insurance, involving deductibles and co-pays. Our personal plan is an 80/20, meaning 80% of the cost is covered. The cost ranges from £20/month per person for a basic plan to upwards of £100 for more coverage. Our insurance was included in our expat package when relocating, which we’ve found to be pretty common among US expats.
Does health insurance cover everything or is it a co-pay system? If so, how much are you generally paying for things?
The NHS system covers the full cost of everything. With private insurance, it depends on the individual plan. Initial consultations with private doctors and specialists are expensive, costing up to £250 before reimbursement, which is why we use the NHS for basic GP visits. Drew’s medical procedures, done through a private hospital, ranged from £800 to £1500 and we paid 20% of the cost.
What about the cost of pharmaceuticals? How does it compare to the US?
Drugs prescribed from your GP costs a flat rate of £8.20, no matter the medicine. Certain prescriptions like birth control are always free, while there is no charge for medicine for children under 16 and adults over 60. That is a massive savings compared to the US, even with a good insurance.
If you get a prescription from a private doctor, the cost would be similar to the US, except with most insurance plans, you pay the full price up front than get reimbursed later.
Anything else people should know about doing to the doctor in the UK?
A person’s experience can vary a lot depending on if they are using the NHS or going private. The NHS system works a lot differently than the US, as we’ve described. One key thing to remember is that the NHS has to work within a federal budget and they tend to limit the amount of diagnostic testing per patient when someone has a complaint. When Julie thought she might have a food allergy, the GP said that she would not recommend her as a good candidate for full allergy testing, as her symptoms weren’t bad enough and she knew the likely culprit.
The private sector is more equivalent to the US. Since the doctor gets paid for each procedure, they tend to do more testing and check ups. If Julie had wanted the allergy testing, we could have easily called an allergy specialist and had the testing done if we wanted.
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