Pregnancy
Maternity care is delivered mainly by midwives and is free on the NHS. Around ten antenatal appointments are offered for a first pregnancy, with two routine scans. Maternity leave is among the longest anywhere at fifty-two weeks, but Statutory Maternity Pay covers only thirty-nine of them, and at a low flat rate after the first six weeks. Shared Parental Leave allows the balance to be split between parents.
NHS maternity care is free and midwife-led: you book with a midwife rather than an obstetrician, and only see a consultant if there is a reason. Leave is generous in length and thin in pay — up to fifty-two weeks, of which thirty-nine are paid, the first six at ninety per cent of earnings and the rest at a flat statutory rate. Shared parental leave allows most of it to be transferred between partners, though take-up remains low.
Key points
| Care model | Midwife-led, with obstetric input where needed |
|---|---|
| Appointments | Around ten for a first pregnancy, fewer for later ones |
| Cost | Free on the NHS; care must never be refused or delayed, whatever the charging status |
| Maternity leave | Fifty-two weeks, of which thirty-nine are paid |
| Pay | Ninety per cent of earnings for six weeks, then a low flat rate |
| Paternity leave | Two weeks, with Shared Parental Leave available |
| Place of birth | Hospital, midwife-led unit or home, according to risk and choice |
In practice
- Book with a midwife by around eight weeks: the first appointment sets up screening and care.
- Tell your employer at least fifteen weeks before the due date to secure your leave rights.
- Maternity care must not be withheld from anyone, whatever their immigration status — say so if you are turned away.
- Consider Shared Parental Leave early: it must be notified in advance.
Cost and coverage
Care is free on the NHS; maternity pay is capped at a flat rate after the first six weeks.
Recent changes
Protection from redundancy has been extended to cover pregnancy and a period after returning from maternity leave, and neonatal care leave and pay were introduced for parents whose babies need hospital care after birth.
Where to go
- NHS maternity services, bookable directly without a GP referral in most areas.
- Health visitors for care after birth.
- Maternity Action for advice on rights at work.
Worth knowing
Maternity care is chargeable for some overseas visitors, but it is classed as immediately necessary: it must be provided first and billed later. Nobody should delay care over cost.
Frequently asked questions
How much maternity pay do you actually get?
Six weeks at ninety per cent of your average weekly earnings, then thirty-three weeks at the flat statutory rate or ninety per cent of earnings if that is lower, then thirteen weeks unpaid. Many employers top this up; check your contract, because the difference is substantial.
The general article: Pregnancy · Compare with another country
Periods and period products
The United Kingdom abolished the “tampon tax” on 1 January 2021, once EU rules no longer applied: VAT on sanitary products fell from the 5 % reduced rate set in 2000 to zero, and period pants joined the zero rate in January 2024. Free provision is organised nation by nation. Scotland went furthest with the Period Products (Free Provision) (Scotland) Act 2021, in force since August 2022, which obliges councils and education providers to make products available free to anyone who needs them; Northern Ireland passed a similar act in 2022. England has funded free products in state schools and colleges since January 2020, and Wales through its Period Dignity programme.
There is no statutory menstrual leave. Absence for disabling periods is ordinary sick leave, with statutory sick pay from the fourth day unless the employer pays more; some employers have adopted menstrual or menopause policies voluntarily.
Endometriosis is treated on the NHS under the NICE guideline of 2017, updated in 2024, through GP referral to gynaecology and, for complex disease, to accredited specialist centres; waiting times for diagnosis and surgery are long, and the average delay to diagnosis remains close to eight years. Endometriosis UK runs support groups and a helpline.
Reusable products carry the same zero rate; nothing is reimbursed by the NHS.
Key points
| VAT | 0 % since 1 January 2021 (5 % from 2000); period pants at 0 % since January 2024 |
|---|---|
 Scotland | Period Products (Free Provision) Act 2021: free products for anyone who needs them, since August 2022 |
 England | Free products in state schools and colleges since January 2020 |
| Wales and Northern Ireland | Period Dignity programme; Northern Ireland Act 2022 |
| Menstrual leave | None; ordinary sick leave |
| Endometriosis | NICE guideline 2017, updated 2024; specialist centres by referral |
In practice
- In Scotland, councils publish where free products are available; the PickupMyPeriod app lists collection points.
- In England, ask the school or college office: the scheme covers all state schools and 16–19 colleges.
- For periods that stop you working or studying, see a GP and ask about endometriosis rather than losing days quietly.
- Check the retail price rather than trusting the zero rate: the saving was not always passed on.
What it costs
A cycle costs roughly £3 to £10 in disposables at zero VAT; a cup £15 to £30 for several years. Nothing is reimbursed; free provision is through schools, councils and charities.
What has changed recently
Period pants were added to the zero rate on 1 January 2024 after a campaign; the NICE endometriosis guideline was updated in 2024.
Where to find help
- GOV.UK and the Department for Education: period products scheme for schools and colleges.
- Scottish councils and PickupMyPeriod: free product collection points.
- Endometriosis UK: helpline and support groups.
- Bloody Good Period and other charities: products for people in poverty.
Worth knowing
Free provision is a right in Scotland and Northern Ireland; in England and Wales it depends on the scheme and the institution. If the school has no products, ask — the funding exists.
Frequently asked questions
Is there VAT on tampons in the UK?
No, not since 1 January 2021; period pants have been zero-rated since January 2024.
Where can I get free period products?
In Scotland, from councils and education providers by law; in England, in state schools and colleges; in Wales and Northern Ireland through their programmes.
Is there menstrual leave in the UK?
No. Ordinary sick leave applies; some employers have their own policies.
Sources
- GOV.UK — period products scheme — free period products in schools and colleges in England
- Scottish Government — free period products — Period Products (Free Provision) (Scotland) Act 2021
- Endometriosis UK — helpline and support groups
The general article: Periods and period products · Compare with another country
Sex therapy
“Sex therapist” is not a protected title; COSRT's register and the Institute of Psychosexual Medicine are the benchmarks, and NHS psychosexual services exist but are patchy.
In the United Kingdom anyone may call themselves a sex therapist, psychosexual therapist or sexologist: none of these titles is protected, and neither are “counsellor” or “psychotherapist”. What is protected are the titles around them — doctor (General Medical Council), nurse (Nursing and Midwifery Council) and practitioner psychologist, clinical psychologist and counselling psychologist (Health and Care Professions Council). Successive governments have relied on voluntary registers accredited by the Professional Standards Authority rather than statutory regulation of talking therapies.
The reference body is the College of Sexual and Relationship Therapists (COSRT), which accredits postgraduate training courses in psychosexual and relationship therapy — typically two years, with supervised clinical hours — and keeps a public register of therapists who meet its standards. For doctors and nurses, the Institute of Psychosexual Medicine has trained clinicians in brief psychosexual medicine since the 1970s; sexual-medicine specialists in urology, gynaecology and genitourinary medicine may also hold the European FECSM certification.
The NHS does provide psychosexual therapy, but unevenly. In many areas it sits within sexual health services and is reached by GP referral — sometimes by self-referral through the sexual health clinic — with an assessment followed by a limited course, often six sessions. Waiting lists of several months are common and some areas have no service at all. Erectile dysfunction, pain and hormonal problems are seen by GPs, urology, gynaecology or endocrinology on the usual NHS pathways.
Privately, a session with a COSRT-registered therapist costs roughly £60 to £120, more in London; the charity Relate offers sex therapy with fees adjusted to income. Private medical insurance rarely covers psychosexual therapy unless it is delivered by a psychologist or psychiatrist for a recognised mental-health diagnosis.
Key points
| Title | Not protected; nor are counsellor or psychotherapist |
|---|---|
| Protected titles nearby | Doctor, nurse, practitioner / clinical / counselling psychologist |
| Reference register | COSRT register of psychosexual and relationship therapists |
| Training for doctors and nurses | Institute of Psychosexual Medicine; FECSM for sexual-medicine specialists |
| NHS | Psychosexual therapy in some sexual health services, GP or self-referral, often limited to six sessions |
| Private cost | About £60–£120 a session; Relate charges according to income |
| Private insurance | Rarely covers psychosexual therapy as such |
In practice
- Check the COSRT register, which shows training and accreditation status; ask any therapist which accredited course they completed.
- Ask your GP or local sexual health clinic whether a psychosexual service exists in your area and how to be referred.
- For a physical symptom — erection, pain, bleeding, low desire with fatigue — start with the GP: investigations and treatment stay free on the NHS.
- If the wait is long, Relate and some university training clinics offer reduced-fee therapy.
Cost and reimbursement
NHS: free, where a service exists, after a wait. Private: £60–£120 a session, usually six to fifteen sessions. Relate: sliding scale. Most private insurers exclude psychosexual therapy.
What has changed recently
COSRT has announced its intention to seek regulatory status, which could one day make “psychosexual therapist” a protected title; nothing has changed in law so far. Several NHS psychosexual services have been cut or absorbed into sexual health contracts since 2020.
Where to go
- COSRT — College of Sexual and Relationship Therapists: public register and complaints.
- Institute of Psychosexual Medicine: doctors and nurses trained in psychosexual medicine.
- Your GP or local sexual health clinic: referral to NHS psychosexual therapy.
- Relate: sex therapy with fees adjusted to income.
- HCPC register: psychologists' protected titles.
Worth knowing
Because no title is protected, the register matters more than the name on the door. A “sex coach” or “intimacy therapist” with an online certificate answers to nobody; a COSRT-registered therapist answers to a complaints procedure.
Frequently asked questions
Do I need a GP referral?
Not to see a private therapist. For most NHS psychosexual services, yes, though some sexual health clinics accept self-referral.
Does the NHS offer sex therapy?
In some areas, within sexual health services, usually for a limited number of sessions after assessment. Availability and waiting times vary widely.
How do I check a therapist?
Look them up on the COSRT register, and ask which accredited course they completed and whether they are supervised. A doctor or psychologist should also appear on the GMC or HCPC register.
Sources
- COSRT — College of Sexual and Relationship Therapists — public register, accredited courses, complaints
- Institute of Psychosexual Medicine — doctors and nurses trained in psychosexual medicine
- NHS — sexual health services — find local services and psychosexual therapy pathways
The general article: Sex therapy · Compare with another country
Mental health
You can refer yourself to NHS talking therapies without seeing a GP first - and the waiting list is the real obstacle.
NHS talking therapies accept self-referral: you fill in an online form or call the local service directly, with no need to see a GP first. Treatment is free. The difficulty is the wait, which varies enormously between areas, and the fact that the service is designed for common anxiety and depression rather than complex needs. For a crisis, every area has a round-the-clock mental health line reachable through NHS 111.
Key points
| Self-referral | Accepted for NHS talking therapies, with no GP appointment needed |
|---|---|
| Cost | Free at the point of use |
| Waiting times | Vary enormously by area, from weeks to many months |
| Crisis line | Round-the-clock mental health line in every area, via NHS 111 |
| Detention | Governed by the Mental Health Act, with a tribunal right of appeal |
| Scope | Designed for common anxiety and depression; complex needs go to secondary care |
| Private | Widely used to bypass the wait, at full cost |
In practice
- Refer yourself online rather than waiting for a GP appointment: it is the same service, reached faster.
- Ask the service directly what its current wait is, and whether a different nearby service is quicker.
- In a crisis, the round-the-clock line is reached through NHS 111 and can arrange an urgent assessment.
- If you are detained, you have a right to a free legal representative at the tribunal.
Cost and coverage
NHS treatment is free at the point of use; private therapy is charged in full.
Recent changes
Round-the-clock local crisis lines, reachable through NHS 111, now cover the whole country.
Where to go
- NHS talking therapies self-referral portals.
- Round-the-clock local crisis lines, via NHS 111.
- Charity helplines offering free listening support at any hour.
Worth knowing
Self-referral is the single most useful thing to know here, and it is badly publicised. Many people wait weeks for a GP appointment only to be told to refer themselves.
The general article: Mental health · Compare with another country
Dental care
NHS dentistry exists in law and is increasingly hard to find in practice; three price bands and a private market that has taken over.
NHS dental charges in England are set in three bands: band 1 for an examination, diagnosis and scaling, band 2 for fillings, root treatment and extractions, band 3 for crowns, dentures and bridges. Treatment is free for under-18s, for those under 19 in full-time education, during pregnancy and for twelve months after giving birth, and for people on certain benefits. Wales, Scotland and Northern Ireland run their own charging systems, and NHS examinations are free in Scotland.
The practical problem is access: many practices closed their NHS lists, and finding a dentist taking new NHS patients has become the central difficulty rather than the charge itself.
Band 3 covers crowns, bridges and dentures at a fixed charge whatever the number of items, which makes NHS prosthetic work far cheaper than private work — when you can get it.
Implants are not routinely available on the NHS; they are provided only in restricted clinical circumstances, such as after cancer surgery or trauma.
Orthodontics is free on the NHS for under-18s who meet a clinical need threshold assessed on an index; cosmetic cases and adults are private.
Whitening is never available on the NHS, and in the United Kingdom it may lawfully be carried out only by a registered dental professional.
Key points
| NHS bands (England) | Band 1 examination and scaling; band 2 fillings and extractions; band 3 crowns and dentures |
|---|---|
| Free treatment | Under 18, under 19 in education, pregnancy and 12 months after birth, certain benefits |
| Scotland | NHS examinations free for all |
| Implants | Not routinely available on the NHS |
| Orthodontics | Free under 18 where clinical need is met |
| Whitening | Registered dental professionals only; never NHS |
In practice
- Use the NHS website's find-a-dentist tool and call several practices: lists open and close without notice.
- An urgent dental appointment is available through NHS 111 even without a regular dentist.
- Ask whether a treatment plan is NHS or private before it starts: mixed plans are lawful but must be set out clearly in writing.
- Dental schools in the large cities treat patients at reduced cost, with longer appointments.
Cost and coverage
NHS band charges are fixed nationally and revised annually. Private prices: examination £30–£70, crown £500–£1,000, implant £2,000–£3,000, clear aligners £2,500–£5,000.
Recent changes
Access to NHS dentistry has remained the main political issue in the sector, with recovery plans and incentives for practices to take new patients.
Where to go
- NHS find-a-dentist service and NHS 111 for urgent care.
- Dental hospitals and dental schools in the large cities.
- General Dental Council register, to check a practitioner.
- Healthwatch, for complaints about access.
Worth knowing
Beauty salons offering whitening are acting unlawfully: only registered dental professionals may carry it out. The gum burns reported come mainly from that sector and from online kits.
Frequently asked questions
Is NHS dental treatment free?
Not generally, but it is free for under-18s, in pregnancy and for twelve months after birth, and for people on certain benefits.
Are implants available on the NHS?
Only in restricted clinical circumstances, not as a routine option.
Can a beautician whiten my teeth?
No. Only registered dental professionals may carry out tooth whitening.
The general article: Dental care · Compare with another country
HIV and AIDS
Free testing and treatment regardless of immigration status, PrEP available on the NHS, and opt-out testing in emergency departments.
HIV care is free to everyone in the United Kingdom, including people with no immigration status — an explicit exception to the charging rules for overseas visitors. Sexual health clinics are open access and confidential, postal self-sampling is widely available, and PrEP has been routinely commissioned since 2020. Emergency departments in high-prevalence areas now test everyone having blood taken unless they decline.
Key points
| Cost | Testing, treatment and PrEP are free, including for people without immigration status |
|---|---|
| Sexual health clinics | Open access, confidential, no GP referral needed |
| Postal testing | Free self-sampling kits ordered online in most areas |
| PrEP | Routinely commissioned through sexual health services |
| PEP | From sexual health clinics or emergency departments |
| Opt-out testing | Emergency departments in high-prevalence areas test everyone having bloods taken |
| Criminal law | No specific offence; reckless transmission has been prosecuted as grievous bodily harm |
In practice
- Order a free postal test rather than booking an appointment if you have no symptoms.
- Ask for PrEP at a sexual health clinic; it is not usually prescribed by GPs.
- For PEP out of hours, go to the emergency department rather than waiting for a clinic to open.
- Tell the clinic if you have no immigration status: HIV care is exempt from charging.
Cost and coverage
Testing, treatment and PrEP are provided free of charge.
Recent changes
Opt-out testing in emergency departments has been expanded well beyond London and has identified large numbers of previously undiagnosed infections, including among people who would never have attended a sexual health clinic.
Where to go
- NHS sexual health clinics, findable online by postcode.
- Terrence Higgins Trust and National AIDS Trust.
- Your GP, who can test but not usually prescribe PrEP.
Worth knowing
HIV treatment is exempt from NHS charging for overseas visitors. Nobody should be deterred from testing or treatment because of immigration status.
Sources
- NHS — sexual health — free testing and treatment, self-referral to clinics
- Terrence Higgins Trust — HIV and sexual health charity, free advice
- BHIVA — national clinical guidelines
Hepatitis B
Universal infant vaccination only since 2017, after decades of targeting only those thought to be at risk.
The United Kingdom was a late adopter of universal infant hepatitis B vaccination, introducing it in the routine schedule in 2017. Before that, vaccination was offered selectively, which left large parts of the adult population unprotected. Antenatal screening has long been universal, and treatment is free on the health service.
The UK added hepatitis B to the routine infant schedule in 2017, as part of the six-in-one vaccine, so anyone born before that year was not routinely vaccinated unless they were in a risk group. Screening in pregnancy is universal, and babies born to positive mothers receive a birth dose and a tailored schedule with follow-up testing at one year.
Key points
| Infant vaccination | Universal since 2017, in the combined six-in-one vaccine |
|---|---|
| Before 2017 | Selective vaccination only, leaving most adults unvaccinated |
| Antenatal screening | Universal and long established |
| Babies of carriers | Vaccine from birth, with immunoglobulin where indicated |
| Testing | Free at sexual health clinics and through GP practices |
| Treatment | Free on the health service |
| Higher prevalence groups | People born in countries of higher endemicity |
In practice
- If you were born before 2017, assume you were not vaccinated unless you know otherwise.
- Ask for the full serology — surface antigen, core antibody and surface antibody — not a single marker.
- If you were born in a country of higher prevalence, ask for testing even without symptoms.
- After an exposure, seek vaccine and immunoglobulin within 48 hours.
Cost and coverage
Testing, vaccination for those at risk, and treatment are free on the health service.
Where to go
- Sexual health clinics for free testing and vaccination.
- GP practices and occupational health services.
- British Liver Trust for information and support.
Worth knowing
Most adults in the United Kingdom are not vaccinated, because universal infant vaccination started only in 2017. If you are at any risk, do not assume childhood protection.
Frequently asked questions
Was I vaccinated as a child in the UK?
Only if you were born in 2017 or later, when hepatitis B entered the routine infant schedule, or if you were in a defined risk group. Everyone else was not routinely vaccinated. A blood test settles it, and catch-up vaccination is free for those at higher risk.
Sources
- NHS — sexual health — free testing and treatment, self-referral to clinics
- Terrence Higgins Trust — HIV and sexual health charity, free advice
- BHIVA — national clinical guidelines
HPV
A single-dose school programme since 2023, HPV primary screening, and a national target to eliminate cervical cancer.
The United Kingdom vaccinates in schools, has offered the vaccine to boys as well as girls since 2019, and moved to a single dose for young people in 2023. Cervical screening uses the HPV test as the primary test, with cytology only where HPV is found. The health service has set a target of eliminating cervical cancer as a public health problem by 2040.
Key points
| School programme | Offered in year 8; girls since 2008, boys since 2019 |
|---|---|
| Doses | A single dose for young people since 2023 |
| Catch-up | Available up to 25 through the school programme route |
| Men who have sex with men | Offered through sexual health clinics up to age 45 |
| Screening | HPV primary testing, ages 25 to 64 |
| Self-sampling | Being introduced for people who do not attend screening |
| Cost | Vaccination and screening are free on the health service |
In practice
- If your child missed the school session, contact the school immunisation team: catch-up is free.
- Attend when invited for screening — intervals have lengthened because HPV testing is more sensitive, not less.
- Men who have sex with men can ask for the vaccine at a sexual health clinic up to 45.
Cost and coverage
Vaccination and screening are free.
Recent changes
The move to a single dose in 2023 followed evidence that one dose gives protection comparable to two in young people.
Where to go
- School immunisation teams and GP practices.
- NHS cervical screening programme.
- Sexual health clinics for eligible adults.
Worth knowing
A longer screening interval is not a reduction in care. HPV testing detects risk earlier and more reliably than the old smear, which is why five years between tests is safe for those who test negative.
Sources
- NHS — sexual health — free testing and treatment, self-referral to clinics
- Terrence Higgins Trust — HIV and sexual health charity, free advice
- BHIVA — national clinical guidelines
General sources
- GOV.UK — official portal for public services and rights
- legislation.gov.uk — the statute book as enacted and revised