Let’s be honest, Brexit is the topic on everyone’s lips these days, to the point where everyone seems to have a Brexit hangover before the UK has even left. However, the true nature of Brexit and the impact it may have on the European Union (EU) and the UK have yet to unfold. 

Why should you care?

Brexit is likely to have major implications for the health sector, particularly in the UK.  Chances are that you’ll be asked to share your understanding and opinion on the effect of Brexit on UK healthcare at your medical school interviews. That’s why Brexit is something all medical school applicants should get their head around. This blog post cannot capture the full issue, but will give you some food for thought as you prepare for your interviews.

Setting the scene

When they voted on 23 June 2016, the British electorate chose to leave the EU, taking part in a referendum called by the former Prime Minister, David Cameron. Negotiations on the UK’s exit started in June 2017. As per the laws governing such negotiations, the time limit to reach an agreement is two years and the talks are currently scheduled to finish by March 2019.

Healthcare policies in the UK are set by the devolved nation governments in Scotland, Wales and Northern Ireland and by the British government in England. All must incorporate EU legislation that covers health policy, whether it concerns the length of a doctor’s training before and after university, healthcare workers’ working hours or university fees for European medical students.

 

    1. 1.       Healthcare Professionals

Let’s start with looking at the consequences of Brexit for healthcare professionals.

UK health and social care systems are facing a significant shortage of staff.  Brexit is likely to make it more difficult for EU staff to apply to the UK if their qualifications are recognised differently, and as immigration rules tighten. As a result, Brexit could make it harder to recruit as many EU healthcare staff in the future.

1.a. Staff shortage

In 2017, 150,000 EU citizens were working in England’s National Health Service and social care. The UK is already not recruiting enough nurses and doctors. There are severe shortages in medical specialties such as General Practice and Psychiatry. For nursing, the combination of the Brexit vote, stronger rules defining English language ability, as well as changes to funding of nursing training has reduced the numbers from 1,304 EU nurses arriving in July 2016 to the UK, to only 46 in April 2017* (*NMC statistics).

1.b Mutual Recognition of Professional qualifications

The European Directive on Mutual Recognition of Professional Qualifications (MRPQ) is a piece of legislation that standardises certain elements of healthcare training across Europe. This includes nurse training, but also medical training. This legislation allows healthcare professionals to move very easily between countries, but with Brexit talks, we do not know if the agreements in this legislation will continue to be respected post- Brexit. If they are not, , then EU nationals will find it much harder to work in the UK and vice-versa for UK nationals in Europe. 

 

  1. 2.       Medical Students

What about Medical Students?

Brexit already had an effect on the number of medical school places authorised by the UK government. It could impact medical student exchange programmes, as well as research and science cooperation.

2.a. Medical School places

In October 2016, the UK government announced plans for an extra 1,500 medical school places in England to start in 2018. It is part of a plan to train more British doctors to ease NHS staffing pressures, and is a response to concerns about Brexit. The British Medical Association has warned that the plan will not address the immediate shortage of medics. Brexit could however, benefit UK and non-EU international students by lowering the competition for university places from EU citizens. EU membership had largely benefited European students wanting to pursue medical studies in the UK, at the expense of those from non-EU countries.  

Currently, UK membership of the EU enables students from across the EU to come to Medical Schools in the UK. For now, EU students beginning their medical studies at a UK university in 2018/19 will continue to be charged the same rate as UK students for tuition fees for all years of their programme. Uncertainty remains however on the future of this relationship and exchanges such as the Erasmus programme.

2.b Medical student exchange programmes

More than 200,000 British students have been directly funded by the EU Erasmus exchange programme since it was established, allowing them to study in EU countries.  The British government is legally obliged to support EU exchange programmes until the UK's final withdrawal from the EU, so little will change on this front for the next two years at least. However, should these exchange programmes fail to be maintained post-Brexit, academics warn that the social mobility could be impacted for those students wanting to study abroad. 

2.c Research and science cooperation

Science co-operation between the UK and EU countries has always been extremely strong. Membership of the EU has, for example, enabled the University of Oxford's participation in pan-European research, and has guaranteed the opportunity to access EU research funding (£74m in 2015/16). There are doubts on what is going to happen to joint research programmes, some heavily financed by the EU, but these schemes are likely to continue. Both the EU and the UK have expressed publicly on different occasions that their respective desire was to find ways to pursue that cooperation post Brexit.

 

    1. 3.       Patients

Strong uncertainties remain on whether Brexit will help improve UK patient’s safety and experience. From the approval of medicines at the EU level to the European health insurance card, it is yet to be seen how it will work in practice.

 

3a. The European Medicines Agency

Patient groups fear that Brexit would cut the UK off from Europe’s side-effect detection system, which is managed by the European Medicines Agency (EMA) and can immediately suspend product licenses if a drug is deemed unsafe. The EMA based in London will be relocated to an EU member state.

3b. The European Health Insurance Card

The fate of the European Health Insurance Card (EHIC) allowing EU citizens, including UK citizens for now, to be treated while travelling in the EU remains uncertain. Among the good news, British and EU negotiators agreed in August 2017 that British pensioners who have retired to other EU countries will continue to have their healthcare paid for by the NHS post-Brexit.

3c. EURATOM

The European Atomic Energy Community (EURATOM) is a de facto regulator of radioactive materials and covers all usage of these materials in EU countries including radioactive isotopes used for medical treatments, including cancer treatments, but also as tracers for identifying particular areas of the body or abnormal functions. If the UK were to leave this particular market, it will be harder to obtain these vital substances for their medical value, which could have a substantial impact on patients suffering from a variety of complex conditions.

  • 4.       What about Northern Ireland?

Bernie McCrory* believes that Brexit poses risks to the health and social-care cross-border co-operation in both Northern Ireland and the Republic of Ireland. Many citizens cross the border daily, both to provide services as health and social care staff and to receive services as patients. The continuation of this unrestricted travel in both directions will be important in enabling the maintenance of shared clinical services and to maintain the right for UK and Irish nationals to access health services. Read more here.* Bernie McCrory is chief officer of Cooperation and Working Together (CAWT) cross-border health and social care agency in Northern Ireland.

 

How to use this at your Medical School Interview?

Ultimately, how Brexit will affect the UK and the EU health systems will depend on the deal that is struck between the two parties – and at the time of writing, that deal looks to be some time off. As with all topics that might come up at your interview, it is vital to keep up to speed with the latest developments by following the process through news outlets and newspaper commentaries.

 

You should be careful to ensure you engage with both sides of the debate, as on this issue you do not want to fall into the trap of not providing a balanced argument.

 

The British Medical Association has produced some briefings that cover some of the issues mentioned in this blog. Read more here.

 

Good luck all and remember you are awesome and everything is going to be okay!