Mission Impossible.....my NHS number

NHS Number: information for patients
Your NHS Number is unique to you and is the only National Unique Patient Identifier, used to help health care staff and service providers match you to your health records. It is an important step towards providing you with safer patient care. Everyone registered with the NHS in England and Wales has their own NHS Number.


(NHS Website)



Family, Friends, Countrymen,





I ran out of my GP's (primary care physicians) office this morning clutching the folded piece of paper in my hand like a lucrative lotto ticket. It has taken 3 months of Sherlock and Watson to get to this precious moment. My degree is in Nursing......once a nurse always a nurse. Hence a major priority for me after moving to the UK with Mr. Jeopardy has been identifying appropriate health care for us both. Mr Jeopardy although extremely smart is a typical man when it comes to health care which means "let's not worry until something deadly happens". When we first got married he had issues with paying two insurance premiums. "Why do we need two insurances? We have mine." Oh the young, the well intentioned and the very naive. Mr. Jeopardy had never been sick let alone developed a chronic illness. He had never seen the victim of a motorcycle accident or a brain aneurysm or cancer in their 20's or 30's who received good care until their primary insurance ran out. The term "exhausted all medical benefits" never meant anything to him before. Of course we as nurses know that cancer, diabetes, a neuro-degenerative disease never waits until you are ready for it at the ripe old age of 101. All of this means that when I asked my beloved about health care in England he replied...."Honey, we have insurance." Mr Jeopardy is part of the naive few who have never been impacted by a health crisis and does not work in health care. Hence, he believes that if needed your insurance company will be there for you willing and able to pay for all necessary tests and treatments. The key word in the aforementioned was necessary and that is the word the insurance companies love to debate. But I digress.....





When I arrived I spent some time speaking with our "EXPAT Relocation Specialists". I was told that we are eligible to receive care under our private health care and to call around to find a physician that is accepting new patients. I was also urged to wait until our yearly trip back to the states to see a physician for check-ups, maintenance visits, medication and dentistry. Wow! How realistic is that? Apparently the folks at Relo Services feel you can optimistically schedule in disease and affliction when it fits your schedule as well! I phoned two practices in our town of Maidenhead and informed them that we were covered by BCBS of Illinois and were the accepting new patients? I will not belabour you with the conversations that followed. Suffice it to say they had not heard of BCBS of Illinois and asked if we had NHS numbers? No,they did not take private insurance and could not refer me to anyone who could.





Luckily for me I ran in to a GP at our gym who told me her practice was accepting new patients but did not believe they accepted patients with private insurance. When I asked her how we as expats went about obtaining a NHS number she confessed did not know. She advised calling the NHS direct line and inquiring with them.





Hah! Has anyone ever tried calling the NHS direct line? Well, in the event that you have not I would liken it to attempting to reach your local cable provider on a Saturday when you are in need of service. Good luck with that! I was not successful with the highly touted but little spoken to NHS Direct Line despite numerous attempts.





I decided to call our Expat Relocation Services again to explain that there were no local practices accepting private insurance patients. How did my husband and I go about obtaining an NHS number? They told me that they would call me back after doing some research. They then called back the next day and told me that according to their research I only needed to register with a local GP. Hmmmm.... ok. Well the next day I went down to the local practice which was accepting new patients. In the midst of all this I had found employment in the UK which meant that we now had two private insurance companies for medical cover but no NHS numbers. I explained to the receptionist that we had two private medical insurances (primo clientel in the United States) and that we would like to register with the practice and obtain NHS numbers as well since apparently that was the key to obtaining care. The receptionist was completely confused and stated that they did not take private medical insurance and an NHS number was needed but she had no idea how to get one for us. She advised calling the NHS direct number or going to their website. Arrrgh!

The following week I was at our company headquarters for a Human Resources Welcome and Review of Policies and Procedures (always a fun filled day). In my new employee class was a gentleman who was a physiologist and who worked for the NHS prior to coming on board. I was elated. Here I had a bona fide ex-NHS employee. Surely he would be able to help me. I explained my predicament and asked how we as American Expats received NHS numbers. He offered the following advice- "I don't know really. Everyone here is just born with one. I suppose if you get into a car accident and are rushed to the Accident and Emergency Room at your local hospital they will give you one. No one is refused care." Ok..... so all I needed to do was have a near fatal injury and taken to the A&E. This chap thinks along the same lines as my husband- let's not worry until something tragic happens. I prefer to plan ahead when it concerns my health and wellness...silly me. I also consulted with my human resources consultant at my company but she had been born in the UK and was not familiar with an American Expat obtaining a National Health Service number. "Have you tried calling the NHS or going to their website?" Yes, I had. "Maybe when you receive your private medical cover you can contact them and they may be able to help you."

National Health Service - Definition
The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. The organisation provides the majority of healthcare in the UK, from general practitioners to Accident and Emergency Departments, long-term healthcare and dentistry.
A particularity of the NHS compared to other public healthcare systems in Continental Europe is that not only does it pay for the health expenses, it also employs the doctors and nurses that provide them, and runs hospitals and clinics.

Feeling very frustrated I decided to share my concerns with my beloved. Normally, I try to protect him from any undue stress but felt that lack of access to health care was a big enough issue to bring to his attention. He listened, I think, it is difficult to tell at times. He asked if I had called our Expat Relo Specialists. Yes, I did twice. He remarked that it was unusual that the local practices did not accept private health care insurance but was confident that all would be well and that I would work it out. Sigh...

Fortunately, I ran into the GP at the gym again who explained a little more in depth about how the NHS and private insurance works. Apparently there are not allot of GP practices that accept private insurance only NHS patients. What makes this more difficult is that you must go to a GP in your "catchment area" or UK zip code. In addition most UK private insurances like my own will not accept consultant or specialist fees unless you were referred by a GP. The vicious circle continues as the GP's in my catchment area require an NHS number. Arrrgh! The good news was that if I ever do obtain the elusive NHS number I would be eligible with my private insurance to see a consultant immediately and not put on a waiting list. I would also have access to a private hospital and perhaps a larger range of treatment options. Everyone in the UK has access to health care through the NHS but access to specialists and treatment options often require a wait. "Perhaps you should speak with Stella our office manager. If anyone knows she would know."

Ahah! A lead! The very next Monday I was down at her local practice and requesting to see Stella. I gave her my most succinct version of events in a now well rehearsed speech and braced for the worst. "Yes, now what you will need to do is register by filling out these forms and we should have your numbers for you in the next week or two. Just check back with us." Eureka! Thank God for Stella keeper of the NHS numbers. As long as we were on an active work visa and gainfully employed at the time of treatment we would be covered and not responsible for health care fees.

I booked an appt for a Hepatitis B booster the following week which is recommended for health care workers or those in close contact with patients. This would be chargeable they explained since it was not medically necessary under the NHS system. No worries as my employer would cover it. I skipped home excited that progress had finally been made.

Finally, today the day of my appointment had arrived. I arrived at the office and was given a number and told to watch the call board for when my number came up. Hmmm.... was this a clue as to how things were going to go? The waiting room was full of patients with their eyes glued to the buzzing light board. My number buzzed and I was off to meet with the nurse after only a 10 minute wait. The nurse shook my hand introduced herself and proceeded to get my background and my reason for wanting a vaccination booster. She went over the pros and cons and advised a blood titer first to avoid an unnecessary allergic reaction. I decided to move ahead with the booster since it had been 15 years and I had previously no allergic reactions. She gave me the booster and asked if I wanted to make an appt to get started with a GP now that I was in the UK. She immediately made me an appointment, told me to come back in two months for a blood titer and to call right away if I had any adverse reactions. She was thorough, professional and did not rush me in the least. I was impressed. I asked her what medications were covered by the NHS. She advised me to check with my local chemist to determine what was covered on the formulary through the NHS. All medications through the NHS cost 6£ or the equivalent of 10$ in the States. Stay tuned for what is approved medication on a Universal Health Care plan. On my way out the receptionist was able to provide me with our NHS numbers to take with me. We were in! We had made it into the system! Whether this was good news or bad news I was not sure but it is what it is for the moment.

Later I proudly gave Mr. Jeopardy his NHS number. He said that he knew I would figure it out and that I worry too much.