Cross-border arrangements 

The Department of Health and Social Care, NHS England, the Welsh Government and NHS Wales are responsible for implementing and managing cross-border arrangements for patients.

NHS patients living on the border between England and Wales may access healthcare across the border for many reasons, including a lack of provision in the patient’s locality, or choosing to access services that are closer to their home, despite not being in their country of residence.

There are differences in the type of provision that patients have, depending on whether they are registered with an English or Welsh GP:

  • Patients registered with an English GP have the right to choose which hospital their GP refers them to. Patients registered with a Welsh GP do not have this right, but the Welsh NHS aims to provide treatment close to the patient’s home, where possible.
  • All patients registered with a Welsh GP, including English residents, are entitled to free prescriptions. However, prescriptions must be dispensed in Wales, otherwise English prescription charges apply. Welsh patients with an English GP can obtain free prescriptions via an entitlement card.
  • Emergency and primary care across the England–Wales border operates on a local basis, with each side covering patients in its area and no money exchanged for routine services. Funding for secondary care is subject to a more complex arrangement.

English residents with Welsh GPs can now choose to be referred into either the Welsh or English system.

The Welsh Affairs Committee held a one-off session on cross-border healthcare, and took oral and written evidence between January and March 2025. Evidence submissions to the session noted concerns about:

A statement of values and principles on England / Wales cross-border healthcare services (PDF), first published in 2018, sets out how the NHS in Wales and England will ensure “smooth and efficient interaction between both bodies for patients along the England-Wales border, in the interests of supporting better patient outcomes and avoiding the fragmentation of care”.

During the September 2024 Labour party conference, Jo Stevens, Secretary of State for Wales, announced a new partnership between the UK and Welsh Labour governments, to “drive down NHS waiting lists on both sides of the border”. The UK and Welsh Governments were to share best practice, on Wales’ dental reforms releasing 400,000 appointments and England introducing new systems to add 40,000 more each week.

In response to a June 2025 Parliamentary Question on cross-border healthcare, Jo Stevens, Secretary of State for Wales, highlighted how UK Government funding will support the delivery of health services in Wales:

I welcome the news that waiting lists, including long waits, have fallen in recent months. These improvements come after we provided the Welsh Government with an additional £1.7 billion to invest in public services like the NHS at the Autumn Budget. An extra £600 million in funding has now been announced by the Welsh Government for health and social care in their Budget for 2025/26. Furthermore at the Spending Review last week, we announced a record £22.4 billion per year on average for the Welsh Government between 2026-27 and 2028-29, to invest in public services and drive down waiting lists. This is the largest budget settlement in the history of devolution.

Jo Stevens also highlighted the work of the Interministerial Group for Health and Social Care. The group brings together ministers from the respective health and social care departments of the four UK nations.

Further reading

Related posts