Provision of Medical Care

European Health Insurance Card (EHIC)

By law, the NHS ceases to have responsibility for the medical care of patients when they leave the UK.

  • People traveling within Europe (including Switzerland, Norway, Iceland and Liechtenstein) are advised to always carry an authorised European Health Insurance Card (EHIC) and this gives entitlement to reduced cost (and sometimes free) medical treatment.
  • The same applies to EU citizens who are in the UK.
  • The cards cover pre-existing medical conditions and routine maternity care, as well as emergency care.

As part of Brexit the UK and the EU agreed that the EHIC cards can still be used until their expiry dates.

It is anticipated that the government will issue a new Global Health Insurance Card (GHIC) which will replace the EHIC for the majority of UK citizens.

Global Health Insurance Card (GHIC)
  • The GHIC is free of charge
  • The GHIC will not be valid in Norway, Iceland, Liechtenstein or Switzerland.
  • The government website says that the GHIC is not an alternative to travel insurance  and everyone is advised to purchase travel insurance which includes health cover
  • GHIC and the EHIC do not cover any private medical healthcare such as mountain rescue in ski resorts or being flown back to the UK
  • Every family member requires a GHIC. You can make an application for yourself and on behalf of your partner and any dependent children under the age of 16.
  • Under the age of 16, a parent or guardian will need to apply.
  • Boarding school teaching staff can apply on behalf of any children in their care
  • If someone is planning to study in an EU country, they need to apply for a GHIC that’s time limited to the length of their course. You cannot apply for this online. They also need a letter from their university or college

What the GHIC covers

“You can use a GHIC to get “necessary healthcare” from state services when visiting an EU country.

Necessary healthcare means healthcare which becomes medically necessary during your stay, and you cannot reasonably wait until you’re back in the UK to get it.

This includes things like:

  • emergency treatment and visits to A&E
  • treatment for a long-term or pre-existing medical condition
  • routine medical care for pre-existing conditions that need monitoring
  • routine maternity care, as long as you’re not going abroad to give birth
  • oxygen and kidney dialysis
  • You’ll need to pre-arrange some treatments with the relevant healthcare provider in the country you are visiting, for example kidney dialysis or chemotherapy.
  • Check that you’re not booked with a private healthcare provider, as these are not covered by GHIC.
  • If you fall ill on a ship or plane, your GHIC also covers you for necessary treatment when you arrive in an EU country.
  • Not all state healthcare is free in the EU and you may have to pay for services that you’d get for free on the NHS.
  • Each country’s health system is different and might not include all the things you might expect to get free of charge from the NHS.
  • In some countries, you have to pay a percentage towards the cost of any state-provided treatment, known as a patient co-payment.
  • You’ll have to pay the same as a patient from that country.
  • Find out more in the GOV.UK country healthcare guides. Healthcare in the EU, Norway, Iceland, Liechtenstein and Switzerland – GOV.UK (”
Healthcare in Non-EU Countries

The UK has reciprocal health deals with for example Australia and New Zealand, under which visitors can receive urgent treatment at a reduced cost or for free but do not cover pre-existing conditions. Everyone is advised to check their travel policies depending on their travel destination.

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Prescriptions for Patients Travelling Out of the Country

Patients should be advised to check specific entitlements prior to travel.

  • For patients who will be out of the country for less than 3 months, it is reasonable to provide sufficient medicines for an existing condition (i.e., asthma, diabetes)
  • For patients leaving the country for more than 3 months, they should be advised to register with a local doctor for their continuing medical needs. It is reasonable for GPs to provide sufficient medication to give patients time to do this.
  • GPs are not required by their Terms of Service to provide prescriptions for the treatment of a condition that is not present and may arise while the patient is abroad.
  • Persons who have left the UK, or who are intending to leave the UK, for more than 3 months are not normally allowed to continue to be registered with a practice.
  • The NHS accepts responsibility for supplying ongoing medication for temporary periods abroad of up to 3 months.
  • If a person is going to be abroad for more than three months then all that the patient is entitled to at NHS expense is a sufficient supply of his/her regular medication in order to get to their destination, where they should then find an alternative supply of that medication.

As GPs you do need to be aware of your responsibilities in signing FP10’s for patients’ travelling abroad, i.e., the resultant monitoring and treatment of the patient’s condition and any adverse effects of doing so.

You may be committing fraud in prescribing to patients that are leaving the UK – please note this information carefully.

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Travelling with Prescribed and Controlled Drugs

The rules concerning travellers who are carrying prescribed drugs controlled under Schedules 1, 2, 3 and 4 Part 1 of The Misuse of Drugs Regulations 2001 changed.

Historically until December 2007, those travelling for a period of up to 28 days were automatically covered under the provisions of a Home Office general, or blanket, licence – irrespective of the amount of drug they had been prescribed to cover such a period.

For periods longer than 28 days the patient needed to apply for and be in possession of an individual licence.

As from January 2008 the validity of this Home Office general licence was extended to a period of up to three months.

Any person whose absence from the UK is likely to be longer than three months will, in normal circumstances, be expected to make arrangements to have their medication prescribed by a practitioner in the country they are visiting.

Travellers in possession of prescribed controlled drugs are strongly advised to carry a letter of confirmation from their doctor or drug worker. The letter should include:

  • the patient’s personal details
  • dates of their departure and return and
  • the drug and amount to be carried

Further information is available on drugs

GOV.UK Controlled drugs list

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Advice for Patients Whilst Abroad

Patients travelling abroad may contact their practice for a variety of reasons. This may include:

  • Urgent request for medical records/history due to emergency
  • Illness while abroad
  • Admin reasons (e.g., request for appointment or repeat prescription for when they return)

Any requests for information from the medical records should be handled in accordance with GDPR.

If a patient cannot consent, then the GP may have to decide if they feel that the transfer of information is in the persons best interest. BMA

There is no reason why a practice cannot deal with administrative requests such as repeat prescription ordering or appointment booking pending the patients return home.

Where a patient is requesting medical advice while abroad it is very important that clinicians are aware of the risks associated with giving such advice. MDU GMC

As well as the difficulties of adequately assessing the patient to make a proper diagnosis, it is likely that the clinician would not be covered in terms of medical indemnity if actions were taken against them in another country where harm had arisen because of their provision of advice. Please check with your indemnifiers for further clarification. BMA

Because of this, we would advise clinicians not to offer any medical advice to a patient who is overseas. They should instead be encouraged to seek local medical advice in the country in which they are travelling.

Changes to Funding Routes for Planned Treatment Abroad

The ways in which patients can access planned treatment abroad have changed following the UK leaving the EU on 31 December 2020. Pre-authorised planned treatment at state-run facilities continues to operate under the S2 funding route but the EU directive rote is no longer available for patients starting treatment after 31 December 2020.

Practitioners should direct patients considering receiving planned treatment abroad to the official S2 funding route. This will not require patients to pay their treatment costs up-front. Patients should be wary of using third party services which organise planned treatment abroad on their behalf, as these services often rely on the EU directive route and may not be able to refund the treatment costs. There have been several cases of patients being out of pocket due to using these services. Information on the EU directive is available here.

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