Almost everyone who moves abroad worries about the ambulance. Almost nobody who moves abroad needs one. What actually goes wrong in the first months is duller and far more common: a prescription that runs out, a rash that will not settle, a check-up that was due anyway — and no way to see anyone about it, because seeing someone routinely is a thing you have to be registered for.
This article is about that registration: the two separate doors you have to walk through, what each one is conditional on, why your first appointment may not be about your health at all, and what to take out of your old system before it stops answering.
Key takeaways
- Emergency care is the easy part — it is routine care that is gated behind paperwork.
- Being insured and having a doctor are two acts, in that order, and one does not produce the other.
- Entitlement follows your status, not your nationality — working, residing and studying open different doors.
- Nothing transfers automatically: not your records, not your repeat prescription, not your visitor cover.
Emergency Care Is Rarely the Problem
Most health systems treat an emergency first and ask questions later, and several say so in writing. The UK government's migrant health guide states plainly that accident and emergency services, walk-in centres, minor injuries units and urgent care centres are free of charge to everyone, as are GP and nurse consultations in primary care, whatever your immigration status.
The same guidance is equally plain about everything else. For hospital treatment, it says, "the UK's healthcare system is residence-based. This means that you must be living lawfully in the UK on a properly settled basis to be entitled to free healthcare." That is the shape almost everywhere: the door marked urgent is open, and the one marked planned has a form in front of it.
Which makes routine care the thing to sort out on arrival, and routine care is booked rather than walked into — through a portal, an app or a phone queue, usually before your local number exists. It is worth landing with a working data connection already on your phone rather than hunting for a café with Wi-Fi on the morning you need to make the call.
The Fund and the Practice Are Separate Doors
Two things have to happen, and people routinely believe the first one did the second. You have to be insured — enrolled with whatever body pays, a statutory fund, a national scheme, a private insurer required by law. And you have to be on a list — accepted by a named practice or doctor who will actually see you.
They are not the same act, they usually happen weeks apart, and they have different conditions. In England the second door is startlingly low: the NHS says "you do not need ID, proof of address or proof of immigration status" to register with a GP surgery, and you do not need an NHS number either. In Germany the first door is the hard one, because you must choose and join a fund before anyone bills anything to it.
| Door | Opens | Needs |
|---|---|---|
| The fund or insurer | Someone to pay the bill | Proof of your status |
| The practice list | Appointments at all | Sometimes only an address |
| The referral | A specialist | A first appointment |
What Your Entitlement Hangs On
Nationality decides very little here. Status decides almost everything, and the same country can give two neighbours completely different answers.
France is the clearest worked example. Service-Public.fr, the French administration's own information service, sets out two cumulative conditions for joining the universal health cover, PUMa: lawful residence, and stable residence. If you are working, cover opens on approval. If you are not, the site states that "vous devez attendre 3 mois avant de voir vos droits ouverts" — you wait three months before your rights open. Same country, same street, different door.
Germany runs the other pattern. Under § 193 of the Insurance Contract Act, published by the federal justice ministry at gesetze-im-internet.de, "Jede Person mit Wohnsitz im Inland ist verpflichtet" — every person resident in the country is obliged to hold and maintain health cover. The trigger is residence itself, not a job, which is why the obligation can begin before you feel remotely settled.
The UK adds a third pattern, worth understanding because it inverts the usual order. Its migrant health guide explains that people subject to immigration control generally have to hold indefinite leave to remain to count as ordinarily resident — but that most visa applicants pay an immigration health surcharge with the application itself, and can then use the NHS much as a resident would while the visa is valid. Your access arrives with your permission, months before you feel local.
The First Appointment Is Not About Your Health
In a referral system, the first appointment is an administrative act wearing a stethoscope. You are being taken onto a list, given a record, and told what the route to a specialist looks like. Bring the complaint you actually have, by all means — but the appointment's real product is that you now have a doctor.
That doctor is then the gate. In France you formally declare a médecin traitant, and Service-Public.fr is blunt about consulting outside that pathway: "vous êtes moins bien remboursé" — you get back less. It also lists the exceptions, which are worth knowing before you panic: being under 16, being away from home, an emergency, and several specialities including gynaecology, ophthalmology and psychiatry, which can be consulted "sans passer par votre médecin traitant".
A first appointment for a healthy adult is often weeks out, because nothing is wrong. Book it anyway, early, and treat the wait as the registration period it really is.
So the practical order is inverted from what feels natural. You do not find a doctor when you are ill. You find one while you are well, because the version of that search you run with a fever is the expensive one.
A Repeat Prescription Does Not Travel
This is the trap that catches people who did everything else right. A repeat prescription is not a document. It is a standing arrangement inside one system, between one prescriber, one pharmacy and one record — and arrangements do not emigrate.
The paper itself travels further than most people expect. The European Commission's Your Europe portal states that "a prescription delivered by a doctor in one EU country is valid in all other EU countries", provided it carries the prescribed details, including the medicine's common name rather than a brand. Two limits sit right beside that. Some medicines "may not be authorised for sale" or simply are not available in the other country. And dispensing is "subject to the rules of the country where they are dispensed", so the pharmacist applies local rules, not the ones you are used to.
Work out the date your current supply runs out, then work backwards past the wait for a first appointment. That gap, not the medicine, is what people run into.
Ask your current prescriber for a list of what you take written with international non-proprietary names, the doses, and why. A brand name that means nothing abroad turns a two-minute conversation into a diagnostic one.
The Cover That Stops When You Become a Resident
Visitor cover and resident cover are different products, and the moment they swap is defined by something you may not notice happening.
The European Health Insurance Card is the classic misreading, and the pillar article on your first month after moving abroad covers where that gap opens. The mechanism worth adding here is the other side of it: the new country's rules can switch on by themselves. Germany's obligation, again, attaches to Wohnsitz — residence — so the day you become resident is the day you are required to be covered locally, whether or not anything has been arranged.
Travel and expatriate policies define residence in their own wording and generally stop where it begins. Read that clause before you fly, not after, and note the order many permits impose: proof of cover is often required before residence is granted, while the state scheme only becomes available after it is. Private cover for the overlap is the normal answer, not a luxury.
What to Carry Out of Your Old System
Your old system will not send anything on, and it becomes markedly harder to reach once you are no longer registered with anybody in it. Ask while you are still a patient.
You have a right to the file. Under EU data protection rules, summarised by the Commission's Your Europe portal, you can ask any organisation for a copy of the personal data it holds on you "free of charge, in an accessible format", and it "should reply to you within 1 month". A medical record is personal data like any other.
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Request a copy of your record
In writing, before you deregister. Ask for the summary a doctor would actually read, not only the raw file.
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Get a medicines list in generic names
Doses, frequency and the reason for each. Add anything you have reacted badly to.
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Take your vaccination history
Schools, employers and some permits ask for it, and reconstructing it from memory is not accepted.
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Note devices, implants and allergies
Model numbers and dates. This is the part nobody can look up for you in a hurry.
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Keep your old number reachable
Old health portals, insurers and pharmacies send codes to it long after you have gone. Running a second profile alongside your old SIM keeps it alive while your new local line does the daily work.
Common Questions
Can I Register Before My Permit Arrives?
Sometimes, and it is worth trying. Registering with a practice and being insured are separate, and the practice door can be the lower one — England asks for no proof of status at all. The fund almost always waits for the permit.
What if I Am Only Staying for a Year?
Then you are the case the rules handle worst. Study, secondment and working-holiday routes each carry their own cover arrangements, and the conditions attached to a student's place are a good illustration of how specific those get. A year is long enough to lose visitor cover and short enough to sit outside residence-based schemes.
Does My Old Country Still Cover Me?
Usually only for unplanned treatment during a temporary stay, which a move is not. Certain groups — posted workers, some pensioners — stay insured where they came from and carry paperwork proving it. That is a status question, and the wrong assumption is expensive.
Should I Keep My Old Doctor for Now?
Keep the relationship, not the dependency. A former prescriber can answer a question about your history for years; they cannot legally keep prescribing to somebody who lives elsewhere, and planning around it delays the registration that fixes the problem properly.
Before Your First Appointment
Ask for your record and your medicines list while you are still registered at home. Arrange cover for the overlap before you fly. On arrival, join the fund your status points you to, then get onto a practice list — separately, and without waiting for the first to finish. Book the first appointment while you are well, and take the record with you.
None of it is difficult. It is only sequential, and the sequence is unforgiving to anyone who assumes their old system is still behind them.
