NHS primary care

Primary care is mostly provided by independent general practitioners (GPs) employed by the NHS to provide a service to the local population. GPs usually work with other health professionals such as practice nurses. Some appointments may be with one of these other professionals.

GP practices are the first place to go for advice on health problems unrelated to HIV. They will offer examinations and treatment for a range of common medical conditions including infections, pain, depression and provision of vaccines, but will refer to secondary care for more specialised medical care.

Dentists may provide care for NHS patients, private patients or both. People with HIV have often had problems finding dentists to treat them, privately or as an NHS patient. Nonetheless,  people with HIV should be treated in the same manner as other patients, with standard infection-control procedures. Dentists are not allowed to refuse treatment because a patient has HIV, though they might not give that as a reason.

In England, primary care trusts (PCTs) are the NHS organisations that are responsible for funding (commissioning) local services, including GPs, NHS dentistry, the free optical services and some aspects of pharmacy care. There is a primary care trust for each local area, often with a name like NHS Sheffield or NHS Surrey. The Conservative/Liberal Government plans to transfer these commissioning responsibilities to a national NHS Commissioning Board.

In Scotland and Wales the funding comes from Health Boards, and in Northern Ireland from the Health and Social Care Board.

No. You can ask to register with any GP as long as you live within the catchment area of their practice.  Practices are not obliged to accept you. You can leave one practice and move to another without giving a reason, and a practice can remove you from their books without giving a reason, although this is rare. Patients who are having difficulty registering should ask for help from their local primary care trust, health board or health and social care board.

No referral is needed for a dentist, optician or pharmacist.

For GP services, yes - they are usually only provided to people living near the GP surgery. However, catchment areas are due to be abolished in England in 2012.

There is no charge for being seen by a GP. However, there is a prescription charge for medicines which varies in price between England, Scotland and Northern Ireland. They have been abolished in Wales and are due to be abolished in 2010 in Northern Ireland and 2011 in Scotland.

There are charges for NHS dental care (which vary between England, Scotland, Wales and Northern Ireland). Moreover, the care provided is limited to specific examinations and interventions. Many people, regardless of HIV status, struggle to find a dentist that will take them on as an NHS patient, and so pay for private dental care.

There are charges for eye tests and supplying glasses or contact lenses. In Scotland, all eye tests are free of charge.

However, prescriptions, dental care and eye tests are free for those under 18, pregnant women up to one year after the birth, and those on means-tested benefits or those on a low income. Those entitled to free eye tests can also receive a voucher toward the cost of glasses or contact lenses.

For people who are not entitled to free prescriptions, but who need lots of prescriptions, a Prescription Pre-Payment Certificate may be more economical. A three-month certificate works out cheaper if a person has three or more prescriptions in that time; a twelve-month certificate is cheaper if the person will have 14 or more prescriptions in a year.

GP practices are free to decide whether to accept any patient onto their books regardless of immigration status. However, many ask for proof of address or identification documents that undocumented migrants and others would have difficulty providing. Moreover, some ask about immigration status, perhaps because of confusion between the rules on secondary care and primary care. See Access to health care for more information.

Similarly, NHS dentists and opticians have the discretion to accept patients regardless of their immigration status. Although the charges for dental and optical treatment discourage many migrants from accessing these services, people on a low income may be entitled to free dental care, eye tests and NHS prescriptions. Entitlement to this support does not depend on immigration status.

Under the NHS Act 2006, the Secretary of State for Health has a duty to provide a comprehensive health service, but this involves making ‘reasonable’ decisions about the best use of limited resources. Similar legislation exists for the other countries of the UK.

Residents of the UK are entitled to a GP, and if they cannot find one can contact their local PCT or Health Board to be allocated to one. The situation is more complex with dentists, but availability is improving.

Some GP practices have their own patient groups, but other methods of patient involvement and complaints are the same as for HIV medical care (see above).