Deal or no deal?

Source: NHE Sept/Oct 2018

Dr Andrew Dearden, BMA treasurer and Brexit lead, takes a look at what different Brexit scenarios could means for both patients and healthcare professionals alike.

Since the EU Referendum, the BMA has extensively explored the impact of Brexit on health services across the UK and Europe. We have produced a series of briefing papers which have highlighted the many ways in which the UK’s membership of the EU has benefitted patients, the health workforce and health services, as well as the risks of leaving the EU without a deal.

The situation has become so grave that, at our annual representative meeting in June this year, doctors made it clear that they believe Brexit poses a major threat to the NHS and the nation’s health. With less than eight months to go until the UK leaves the EU, there is still far too much uncertainty and confusion around the implications of Brexit for patients, doctors and wider health services.

The government has yet to provide detailed, tangible solutions to many issues facing the profession. How will the UK continue to secure a consistent supply of medical radioisotopes for cancer treatment once we leave the EU? What immigration system will be put in place to enable highly skilled EU nationals, that we so need, to come and work in the NHS? Could the introduction of a separate regulatory system for medicines in the UK lead to patients facing delays of up to 24 months to access lifesaving drugs as feared?

One of the key issues for the health sector that is still very much up in the air is what will happen to the Mutual Recognition of Professional Qualifications (MRPQ). This plays a fundamental role in helping doctors deliver high-quality healthcare, both here in the UK and across Europe. Once qualified, medical students from across the UK and Europe can, upon qualification, practise anywhere in Europe. There are also many European doctors who work not only in the NHS, but also in their home nation. This allows them to develop their expertise and to then share it – an arrangement which benefits the health of the continent, and it means our over-stretched NHS can fill gaps quickly in its workforce. More than 12,000 doctors in our health service – that’s around 8% of the NHS workforce in England – gained their primary medical qualification in the EEA. Without EEA-qualified doctors, our health system would collapse.

The Draft Withdrawal Agreement says that any qualifications obtained before the end of the transition period in December 2020 will continue to be recognised. While this provides some reassurance for doctors who will have qualified by then, the same cannot be said for medical students who are set to graduate after December 2020. This means our future medical workforce faces extreme uncertainty. We know there are more than 4,400 EEA students currently at UK medical schools, and that more than 3,400 will not have completed their medical degrees by the end of December 2020. If UK and EU negotiators are unable to reach an agreement on MRPQ, an EU student gaining their medical qualification at a UK medical school could find themselves having to overcome a number of administrative barriers before they can practise in their home country. Similarly, UK graduates aspiring to work in Europe, or those at English-speaking medical schools in Germany or the Czech Republic, for example, could see their career options affected.

Given what is at stake, it is vital we find the right solution to this issue, and all the others that Brexit has left the profession scrambling for answers on.

The UK Government has finally started planning to ensure the health sector and industry are prepared in the short term for a no-deal Brexit, including (astonishingly) stockpiling medicines and equipment and reviewing supply chains. We believe this is too little, too late and, quite frankly, proof that the impact on the NHS has not received the attention it deserves in the Brexit negotiations.

The government recently published its guidance on what to do if we end up with a no-deal Brexit, which could have wide-ranging and potentially damaging consequences for health services across the UK and Europe, including on workforce and immigration, Northern Ireland, access to medicines, reciprocal healthcare, professional qualifications and patient safety, access to medical radioisotopes, medical research and rare diseases.

Despite raising concerns before the referendum, nobody could have predicted the chaos that Brexit would cause. Now that more is known regarding its potential impact, the BMA is calling for the public to have a final, informed say on the Brexit deal, including the option to reject the notion of a ‘no-deal’ given the serious risks such an outcome carries.

Top image: vchal


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