Is it a requirement to register with GP

You don't have to register if you have private medical insurance and you can go and visit a GP of your choice whenever you want to (find one near to you on Superdoc). If your insurance doesn't cover GP visits you pay a pretty small fee to the GP.  If you're a pensioner you can get an S1 from whichever country is paying you a pension and then register with NHIF, which entitles you to the same treatment as a Bulgarian pensioner (which frankly is nothing to write home about). You'd be wise to either retain your insurance or keep a decent-sized "rainy-day fund" handy, to give you the flexibility to make any necessary but optional medical choices that cost extra (there's no shortage of Lancelot Spratts that you'll be happy to pay to avoid here).

It would be worth considering paying into the public system - I certainly do.  Reason being, not only will you get treated at public hospitals, but you can often get treated at private ones too, depending on your condition and where you live.

If the area you live doesn't have a relevant treatment available to you, then you can ask to go to a private hospital. Inouve in Varna and in 2023, I was seriously ill, with a gastroenterologist problem. The consultant in Varna said she didn't recommend getting treated in Varna and refered me to the Heart and Brain Hospital in Burgas, that has a gastrointestinal unit.  It was an amazing hospital - absolutely brand new and spotlessly clean, you could eat your dinner off the floor. All I paid for was the room - at the time, 75 leva for three nights. I had an endoscopy, ultrasound and MRI.

To register on the public system, you have to first register with a public GP, who will give you documents to take to the NRA office to get registered. You can pay monthly, or in one hit, for the whole year, by card or cash.

As for public hospitals, they're generally pretty run down, but in the bigger cities, usually well equipped with modern diagnostics. I've used the Military Hospital in Varna, very close to where I live and I was certainly happy with my treatment - the doctors, nurses and staff were all great, although, of course, some don't speak English, so Google Translate was very useful.

@jeanmandredeix

The short answer is no. There's no requirement to be part of the public health system just because you're a resident. However, depending on your residence status, you might need proof of health insurance when you renew, and this can be either NHIF coverage, or a private health insurance policy, or the immigration-oriented Health Insurance for Foreigners policy.

On insurance policies, I'd point out that the above mentioned Health Insurance for Foreigners is cheap (100 euros ish) and purchased just to meet the immigration requirements. It can't be relied on as a true private health insurance policy, these are significantly more expensive, especially if you're older and/or have pre-existing conditions.

If you can afford private medical insurance, then that's probably the luxury option.

However, I'd say public health coverage (in NHIF) is a fantastic deal, and I recommend it highly. You can have both public coverage and a private policy, or just one (or the other). I pay into NHIF as a voluntary contribution (unemployed/economically inactive) and it's around 30 euros per month. I'd say the only disadvantage is that once you opt in, it seems quite difficult to opt out and they'll expect you to maintain your payments indefinitely. On the other hand, that 30 pm is far cheaper than a true private health insurance policy.

Once you're in the system, you will need to choose a GP, just like in the UK. I wouldn't surprised if, supposedly, GPs are supposed to examine new patients, but I doubt it's enforced, or taken particularly seriously. The only requirement is that you choose a GP and there are some rules over when/how you can change him/her. But once you have a GP, it's entirely up to you when (or if) you ever go see him/her.

Full coverage (i.e. from up to date contributions) entitles you to free or nearly-free treatment from your GP and public hospitals. Just like most national health systems, typically your GP is the gatekeeper, so if you want the cheap x-ray or cheap cardiologist consultation you need a referral.

With or without a GP, you can go direct to other GPs or specialists (I recommend SuperDoc as the way to find these docs online, check their reviews, and book appointments). However, you'll then have to pay whatever their full rate is (unless you have private health insurance).

Finally, there's an unusual feature of the Bulgarian public health system which I have not seen anywhere else, and this is what makes the NHIF monthly contribution such a great bargain (IMHO). In the Bulgarian system, many (most?) private clinics/hospitals are affiliated with the public system and get reimbursed by it. This means you can get private hospital treatment (from a GP or specialist), pretty much whenever you want/need it, and the cost will be heavily subsidized by the public system (i.e. you get VIP private treatment for a fairly minimal private hospital surcharge).

If you're familiar with the NHS, for example, you know that many folks with aching hips/knees find it quite time-consuming to get through their GP to get appointments in hospitals firstly for scans, and then secondly for a specialist to review the scans. Even IF the specialist agrees your aching hip needs fixing (and there's a high chance he won't), you can spend months (years?) on the NHS waiting list for the relevant operation. It will be free, when you get it, but you might wait a long time. If that frustrates you, you can go private and get your new hip next week... but you will pay FULL PRIVATE PRICE (e.g. 15k-20k I'd guess in a good UK private hospital).

Here in Bulgaria, you can go directly to an orthopedic surgeon in a private hospital and get a consultation and relevant scans in days. If he agrees you need the new hip (and he'll largely be guided by how much pain you have, and how much YOU want to have the op) then you can schedule the op whenever you want. I saw orthopedic surgeons in large private hospitals in Sofia (one was Tokuda) and all agreed I could have a THR whenever I wanted. The only thing I checked was whether they were affiliated with NHIF (otherwise you pay full price). I asked them to quote me 2 prices: the price for a standard THR as recommended by NHIF, and the price for their top-rated prosthesis with private room and a week of physiotherapy. The former was like 500 euros, and the latter maybe 1,500 euros. This is a few years ago, so the price is higher now, but you get the idea. The same thing happened when I went to the specialist (private) hernia clinic in Sofia. They checked online for my NHIF coverage, and then confirmed that my VIP private surcharge would be 500 euros. I didn't go ahead with either op, but both hospitals looked clean and modern and the surgeons seemed very credible and competent.

You should note that if you have this NHIF coverage, then any private health insurance policy that you buy should cost less (as they'll know that they'll pay less for your treatment).

My GP is wonderful, he's based in one of local private hospitals (Medline in Plovdiv). He's very low touch (i.e. he doesn't bother to chase me on anything), but he's super helpful when I do decide I need something. He has clinic hours every weekday, and unlike the UK, there's usually a very small line (3-4 people tops, and I can be first in line if I arrive 15 mins before clinic opens). He doesn't clock watch or have designated 10 minute appointments, he spends as long as needed to figure out the problem and deal with it). If I need a scan/test or specialist consultation, he does the referral straight away, and usually I've done it at Medline during the same visit (occasionally a couple of hours later, or next day).

I have been to public hospitals here (e.g. St George in Plovdiv) and, just like the UK, they are extremely crowded and you can hang around for hours. Pretty much I just go to private hospitals (Medline, Kaspela, Pulmed in Plovdiv or Tokuda and Vita in Sofia) so I've pretty much had the VIP treatment almost exclusively.

I should note that consultations/scans/tests are really pretty cheap here anyway, so I find it's hardly worth the aggravation of bothering my GP in order to get a referral. e.g. full blood tests at Ramus Labs are like 35 euros (+ a bit more for your extras), an x-ray is around 50 euros, an MRI maybe 200-300 euros (depending on what you want to scan), and a specialist consultation is typically 50-100 euros (but some might be higher, of course).

Overall, I find my medical treatment (including GP access) is far easier/quicker/better here than in the UK. I know others disagree, but my experience here has been excellent.

By registering with a GP and opting into the public health system here does that affect your NHS entitlements in the UK if not been of UK state pension age.

Not at that age yet where S1 form is relevant.

@mickg

It doesn't make any difference to your NHS entitlement if you aren't a pensioner. If you are below pension age but aren't habitually resident in the UK you don't have any entitlement to NHS treatment, apart from the universal emergency component. If you are a resident in another country you can get an EHIC/GHIC to access medically necessary emergency care while visiting the UK, paid for by your country of residence.

NHS treatment is based on residence, not nationality or how much you may, or may not, have paid into the system...unless you hold a UK S1.

Jim, can I clarify? Are you saying that pensioner S1 holders normally resident in a different country remain entitled to UK NHS care?

Okay, I did some online searching on this and it seems the answer is yes, provided the S1 has been registered with the health system in your country of residence. So this is probably a good reason to register with the local system even if you don't intend to use it.

"UK state pensioners who live elsewhere in the EEA have the same rights to NHS care as people who live in England. This applies to all pensioners who receive a UK state retirement pension and registered for healthcare in Europe with an S1 form."