NHS and UK Emigration 2026: GHIC Card, S1 Form and Private Health Insurance

What changes in 2026: GHIC fully replaces EHIC, S1 still works for state pensioners

By 2026, the post-Brexit transition for UK healthcare abroad is complete. The European Health Insurance Card (EHIC) issued before Brexit has expired for nearly all UK residents (last expiries during 2024-2025), and the Global Health Insurance Card (GHIC) is the standard replacement for visiting EU/EEA countries plus Switzerland (added under bilateral agreement in 2021), Australia and New Zealand (under reciprocal healthcare agreements). The GHIC is free from the NHS Business Services Authority — never pay third-party sites that charge fees.

The GHIC is for temporary stays only — holidays, study trips, short business visits. It is not health insurance and does not cover ongoing residence abroad. For emigrants, the relevant document is either: (a) the S1 form (DWP, formerly E121), if you are a UK State Pensioner moving to an EU/EEA country or Switzerland; or (b) private comprehensive health insurance plus enrolment in the destination’s national system. The GHIC may help bridge the first weeks before destination-country registration, but is not a long-term solution.

GP deregistration: when and how

Once you leave the UK with intent to live abroad, NHS England policy under the GMS Contract requires your GP to remove you from the patient list within 3 months of departure. In practice, you should formally notify your GP practice of your departure date and provide a forwarding address. Some practices process this immediately; others wait the 3 months. Either way, your NHS number remains assigned to you for life — re-registration on return is administrative, not a fresh application.

Before deregistering, request: (1) a printed copy of your Summary Care Record (SCR) via the NHS App or your GP practice, (2) a copy of your full medical record under UK GDPR subject access (free, must be provided within 1 month), (3) any specialist letters and recent test results, and (4) prescription history with active repeat prescriptions clearly listed. Many destination GPs will accept a translated summary; full records are useful for chronic conditions.

S1 form: who qualifies and how to apply

Under the EU-UK Trade and Cooperation Agreement and the Withdrawal Agreement, the UK still issues S1 forms for: UK State Pensioners moving to EU/EEA/Switzerland, posted workers sent to another country temporarily by a UK employer (max 2 years, extendable to 5 with PD A1), and frontier workers who work in one country and live in another. The S1 entitles you to register with the destination’s national health system and receive treatment as if you were a local resident, with the UK reimbursing the destination for the actual cost.

Apply via the DWP’s International Pension Centre (IPC). The S1 issues within 4-8 weeks. Once received, register the S1 with the destination’s social security or health authority — for example, INSS in Spain, Caisse Primaire d’Assurance Maladie (CPAM) in France, ASL in Italy, AOK or TK in Germany. The destination then issues a local health card that gives access on the same basis as nationals. Your spouse and dependants under 18 are usually included as derivatives of your S1, with separate registration.

Post-Brexit healthcare comparison for popular emigrant destinations

Prescriptions and ongoing medication

Your UK GP can issue a maximum 3-month supply of repeat prescriptions before departure (some practices limit to 1-2 months). For controlled drugs (e.g. ADHD stimulants, opioids), the limit is typically 30 days under the Misuse of Drugs Regulations 2001 and you may need a personal licence to carry more across borders. For long-term conditions, schedule a review appointment 60-90 days pre-departure to optimise the medication list and obtain generic-equivalent international names (INN).

In the destination, register with a GP within the first 4 weeks where possible. Some EU countries have waiting periods for non-urgent prescriptions; bring 2-3 months supply. Insulin and other temperature-sensitive medications need cold-chain transit — coordinate with your moving company or carry as hand baggage with airline notification.

Children and CAMHS continuity

For children with ongoing CAMHS or specialist-paediatric care, request full referral letters and treatment plans 90 days pre-departure. The destination paediatric system may not accept UK NICE-guideline pathways without locally-validated diagnostics. Allow 3-6 months for re-establishment of specialist care abroad. For ASD, ADHD and similar diagnoses, retain the original UK assessment reports — most countries accept them as evidence even if local re-assessment is required for school accommodation.

Coming back: re-registering with the NHS

If you return to the UK to live, you can re-register with any NHS GP in your area immediately on return. Bring evidence of UK residence (tenancy, mortgage, council tax). Your NHS number is permanent; the GP practice retrieves your historical record from the NHS Spine. There is no ”reactivation fee” or waiting period for ordinary residents — but be aware of the NHS surcharge for visa-holders (£1,035/year adult in 2026), which does not apply to returning British citizens.

For tax-residence interaction, see our UK tax residency guide. For the administrative HMRC P85 step, see our P85 guide. For State Pensioners, the S1 process integrates with the broader pension picture — see our UK pension abroad guide.