The Healthcare System in Guernsey: Paid GP, Public Hospital and Specialist Benefits Scheme

The Government of Guernsey's settling-in guide states that the island is not attached to the NHS and runs its own health service, backed by a social security system funded by contributions. Three tiers coexist. General practitioners work in private surgeries, separate from the public Health & Social Care committee; they refer patients to consultants, accessible through a specialist benefits scheme. The public hospital handles inpatient stays, outpatient consultations and emergencies. Finally, private medical insurance exists on the island for those who want private care or a complement to the local scheme.

Dentists, opticians, podiatrists and physiotherapists outside the scheme remain at the patient's expense according to the same guide. For an overview of an expatriate's cover, see expat health insurance and the page on Guernsey.

Access to benefits follows residence and registration for contributions. Anyone who arrives in Guernsey registers with the Revenue Service, which produces a tax number and a social security number. According to the settling-in guide, new residents benefit from immediate cover under the specialist scheme, and registration for contributions gives entitlement to subsidies for consultations and a reduction in the cost of prescriptions. Contributions are proportional to income: 7.5% of pay for the employee and 7.1% for the employer, 12.4% for the self-employed and 11.8% of income for a non-employed person before pension age (3.8% after).

The specialist benefits scheme covers consultations, procedures and treatments provided by consultants, hospitalisation and certain physiotherapy referred by these specialists, with no payment at the point of service for covered people. Income support and a medical expenses aid scheme exist for low-income households. For a French national, local entitlements come through residence and contributions, the 1965 convention targeting employees (see who reimburses what in Guernsey).

The GP is the first point of contact. To register, simply contact a surgery: if it does not yet have the patient, it adds them to its list. Consultations, prescriptions and tests are paid directly at the surgery, whose fees are set freely. The States of Guernsey subsidise residents' consultations: the “Health Benefit” payment amounts to £12 (about €14) for a consultation with an approved doctor at the surgery, at a primary care centre, in the emergency department or at home, and to £6 for a nurse or health assistant. How this subsidy is paid is to be confirmed with local social security.

Children up to 18 benefit from reduced rates: £25 for a doctor and £15 for a nurse. Outside opening hours, an out-of-hours doctor answers on weekdays from 6 p.m. to 8 a.m., from Saturday noon to Monday 8 a.m. and on public holidays; each surgery publishes its arrangements. The social security service (01481 732500) provides information on subsidies.

The Princess Elizabeth Hospital is Guernsey's public hospital: the settling-in guide states that treatment and accommodation there are in principle not billed, unless the patient chooses to be treated privately. Its emergency department is open 24 hours a day, all year round, and sees about 24,000 patients a year from Guernsey, Alderney, Sark and Herm. In Alderney, emergencies are handled by the Mignot Memorial Hospital. For a life-threatening emergency, dial 999 or 112: the ambulance takes you to the hospital's emergency department.

• Emergency billing: an arrival charge depending on the time, plus a consultation graded from minor to critical. The published scale set, for example, arrival at £70 (about €83) on weekdays from 8 a.m. to 6 p.m. and the minor consultation at £50; the scale in force is on the emergency department page and is to be confirmed with the department. Children up to 18 pay £25 whatever the treatment.
• Payment: payment is made on leaving by card (excluding American Express), with no cash or cheques. With private insurance, the emergency department may bill the insurer if the patient completes a form at reception; in case of refusal, partial reimbursement or a file not processed within 90 days, the balance falls to the patient.
• Ambulance: the St John rescue service bills its call-outs, with an annual subscription that makes trips free for its members.

When a patient is referred for treatment off the island, they contact the doctor who referred them if their condition changes.

The social security pharmaceutical service covers the cost of prescribed medicines and medical appliances, except for a charge per item of £5.40 (about €6.40), for up to 28 days of treatment. This charge, paid to the pharmacy or the dispensing doctor, does not include the fee for writing the prescription. Exempt are holders of an old-age pension, recipients of income support or medical expenses aid and their dependants, holders of the severe disability benefit and holders of an exemption certificate.

For travelling with a treatment, France Diplomatie advises, in its United Kingdom page, keeping the prescription and a letter from the doctor covering three months of treatment.

The Government of Guernsey states that the island is independent of the NHS and of European health insurance card holders, and that visitors from countries without a bilateral agreement pay for general practice care, hospital, prescriptions, dental care, prescribed physiotherapy and ambulance trips. The eight countries cited are Australia, Austria, Iceland, Jersey, New Zealand, Portugal, Sweden and the United Kingdom; France is not among them.

The reciprocal agreement signed with the United Kingdom, in force since 1 January 2023, covers necessary care, urgent or that cannot wait until return, received from recognised providers by visitors from the United Kingdom and by Bailiwick residents in the United Kingdom; it is based on residence, the page not mentioning nationality. Repatriation is not included. A French resident of France is therefore not concerned. A travel insurance with repatriation or an assistance contract therefore complements the arrangements. The same government notes that the repatriation of a deceased visitor is at the expense of the visitor or their insurer.

France Diplomatie presents no separate health page for Guernsey; its United Kingdom page, for which the London consulate is responsible for the island, recommends being up to date with the French vaccination schedule (diphtheria, tetanus, poliomyelitis, whooping cough, measles) and mentions that vaccination against tick-borne encephalitis may be useful depending on the conditions of the stay. The family doctor or an international vaccination centre, consulted early enough before departure, adapts this advice.

On the island, prevention goes through a registered GP, the out-of-hours service and the emergency department. Non-emergency dental care and optical care, outside the scheme, are paid for directly; a supplementary contract or the CFE (see the CFE guide) helps limit the out-of-pocket cost.