05 February 2020
So Brexit has happened?
Yes. The UK officially left the European Union at 11pm on Friday 31 January 2020. However, as the UK and EU confirmed the withdrawal agreement in advance of this date, we are currently in a ‘transition period’. During this time (currently scheduled to last until December 31 2020), the UK will continue to follow the vast majority of EU rules, and people and organisations within the UK will continue to have access to EU services and processes.
What will the impact be on the health service?
For now, very little. We can expect to see some workforce pressures as the negotiations progress, but the long-term impacts won’t be clear until final agreements are in place. We should know more by the middle of the year.
Does the withdrawal agreement meant that we've avoided the risk of a no-deal Brexit?
No. If no agreements are concluded on the future relationship between the UK and the EU by the end of the transition period, and the transition period is not extended, then all agreements will cease on that date, and there will effectively be a no-deal Brexit.
Nobody knows for certain what impact that would have. Possibilities range from a minimal impact on day-to-day life, to pretty major disruption across a number of sectors. Under a no-deal Brexit, very few existing international agreements that the UK has been party to previously will still have effect. Only a handful of the most vital exceptions have been agreed (the EU has agreed, for example, to allow UK air traffic to continue to operate more-or-less as usual in the event of no-deal).
In most instances, however, immediate resilience against any potential disruption will rely chiefly on contingencies being put in place by individual organisations. Within healthcare, this could be very difficult. Government documents have previously warned that medicines and medical products could be particularly vulnerable to severe extended delays caused by customs issues. Although stockpiling can help in some cases, certain products have short shelf lives, and the government warns that even stockpiling would not be able to cover delays forecast to last up to six months.
Is there anything I can do?
The Department for Health and Social Care is acting to try to mitigate any possible problems. The government has issued several pieces of guidance, including on recognition of professional qualifications, and on clinical trials for medicine.
These resources will be added to and updated over the course of the year, as negotiations progress.
Below is a summary of some of the most common areas for concern, for ease of reference. For more specific queries, your first port of call should be your Trust's clinical director or other senior management. Our policy team is here to help members with further questions.
How easy will it be to access medicines?
The government had previously asked all pharmaceutical companies to ensure they have a minimum of six weeks’ additional supply in the UK, in preparation for exit day. This request was originally made in readiness for a March 2019 departure from the EU, and it is unclear whether similar precautions will be put in place towards the end of the transition period. Companies were also asked to make arrangements to air freight medicines with a short shelf life, such as medical radioisotopes.
To support this, the government have also made funding available for additional storage space, and will seek to prioritise available transport capacity for medical supplies if needed. Understandably, some patients are nervous about being able to access medicines they rely on. Official advice urges against encouraging individuals to stockpile medicines themselves as a precaution.
This is, perhaps, the area of greatest concern among the medical community, and further clarity is being sought from the government about supply chains and contingency plans. For the time being, we recommend following government advice about stockpiling, but we'll keep members updated with any significant developments.
What about workforce issues? Will EU nationals be forced to leave the UK?
The government have put in place a Settlement Scheme, to allow all EU national UK residents to apply for settled status in advance of the UK leaving the EU. No EU nationals currently residing and working within the UK should have to leave because of Brexit. We understand, however, that individuals may be facing problems with the application process. Unfortunately, we are not able to offer individual assistance with this, but members of the BMA may find their support useful.
The impact of Brexit on recruitment of new staff is less clear. The government have announced that they plan to end Freedom of Movement for EU citizens within the UK, and instead move to a points-based immigration system from January 2021. How this will function in practice is still unclear, and it is likely that the new system will not be fully in place in time for exit day. No interim arrangements have been announced, although it may be anticipated that they will be closer to the time.
We believe that many services within the NHS will face severe workforce pressures following Brexit. This document will be updated as and when further information becomes available, but in the meantime please do keep us informed of any issues your department encounters.
Will patients still be able to access healthcare abroad? Can EU citizens access healthcare here?
For now, yes. If there is no agreement on a future relationship by the end of the transition period, UK nationals resident in the EU and Switzerland may face barriers to accessing healthcare, as international treaties will expire. The Government has announced that they are seeking to protect current reciprocal healthcare rights through temporary agreements with other countries, but details are yet to be announced.
The government has not commented on the impact of this on EU national UK residents. There is also no confirmation of whether UK nationals resident in European countries, but who access prescriptions on the NHS, will have their status changed.
I collaborate with colleagues abroad through a European Research Network. Will this be affected?
Possibly. The government has previously said that in a no-deal Brexit, UK clinicians would be required to leave European Reference Networks. The detail of the future relationship may contain details on these networks, so watch this space.
I’m involved in a clinical trial. Will this be impacted?
Probably. Detailed information is available in the government’s operational readiness guide, but their first advice is to contact your trial sponsor for confirmation of plans.
What happens once the UK and EU have agreed a deal on a future relationship?
If a deal is agreed, then healthcare issues are likely to be a central part – with many existing arrangements carried over to some extent. Under any kind of agreement, it is highly unlikely that there will be major disruption to medicines or medical supplies, and we can expect that access to healthcare for UK citizens abroad and EU citizens in the UK will be maintained as at present. Research agreements are more of a question, but these too would likely be maintained, at least temporarily. Costs of medicines, however, is an area where we are still awaiting more clarity.
The biggest question mark under an agreed deal exit is over workforce. While freedom of movement is being maintained during transition, we don’t know how this will effect recruitment, particularly as we near the end of the transition period. The government will be consulting on a new immigration framework this year, and we’ll have a clearer picture after that. Trusts, Health Boards and individual departments would be best advised to prepare for some disruption, however.
What if I have another question not answered here?
Email policy@rheumatology.org.uk and we’ll do our best to help!