It’s been a long time coming, but Brexit has now happened.
The UK has left the European Union (EU), almost 4 years since voters were asked to choose in the 2016 referendum.
The long withdrawal period allowed space for a huge amount of rumour and misinformation to grow, and health has been central to the debate.
So, what will happen?
According to the NHS Confederation, "we don’t expect any changes to people's health and healthcare between 31st January and 1st February as a result of Brexit. In fact, there will be no obvious changes for the rest of the year. This is because we have an agreed 'deal'."
That deal means an implementation period lasting until 31st December 2020.
During those 11 months, the UK will continue to follow EU law while negotiations take place.
So, what could happen?
UK and EU Healthcare
There will be no change because of Brexit to healthcare arrangements in the UK for British citizens, EU citizens, or anyone else on February 1st .
Current systems for healthcare when living, travelling or working in the EU will remain valid throughout 2020, and travellers to the EU will still be able to use their European Health Insurance Card (EHIC), including cover for pre-existing medical conditions.
The longer-term future of the EHIC will be decided as part of the negotiations on the future EU-UK relationship, but the Government has previously stated that it wanted "UK and EU nationals to continue to be able to use the EHIC to receive health care should they need it while on holiday".
According to the NHS Confederation: "British retirees in receipt of a UK pension will continue to be entitled to receive healthcare in the EU country in which they reside, until the end of 2020. This arrangement is likely to continue indefinitely for British people who reside in EU countries on Brexit day, but is subject to the next stage of the negotiations."
The Future for Health and Social Care Workers
Any EU citizen currently living in the UK, including the 165,000 European Economic Area (EEA) staff already working in health and social care, can stay in the UK for the rest of 2020 without their immigration or employment status needing to change.
However, they do need to apply this year for the UK Government-run EU settlement scheme to ensure they will have the right to stay legally in the UK in future.
Also, during the transition period, there should be no change in how doctors from the UK who want to work in Europe should gain registration in the EU, as well as Iceland, Liechtenstein, and Norway, the General Medical Council has confirmed. However, it said what happened after the transition period would depend on the outcome of negotiations.
In October 2019, The King's Fund health think-tank had estimated there was then a shortage of almost 100,000 staff (9% of posts) in the health and social care sectors. It said that “international recruitment is a key factor in addressing these vacancies” and that "the impact of Brexit on the health and care workforce will depend on future migration policy and the barriers or incentives to live in the UK and work in the NHS and social care that are put forward".
Dr Eliezer Ramírez, an occupational medicine specialist from Spain, who lives and works in London, commented to Medscape in Spanish: "In my experience and regarding this process, nothing has changed in the way of practicing the medical profession.
"In my current job they are quite understanding in the face of any questions that may arise and keep us promptly informed."
Dr Ramírez has no intention of leaving the UK: "In my particular case, my pre-settled status was approved in November 2019, which allows me to reside and work while preserving my rights as a European citizen until 2024 when I will have to apply for settled status."
Dr Guillaume Lafaurie, a French doctor employed in London as the head of a digestive surgery clinic, told Medscape in French now that Brexit is a reality there are three scenarios for medical personnel who are natives of the European Union:
"Those who are already working in the UK will have no worries. Any expatriate who works at the NHS will continue to work for the NHS. Until now, the right of permanent residence could be applied for after 5 years, as I did myself. But now, any worker from the European Union residing and working in the United Kingdom before the Brexit date, can apply for a provisional right of residence which will run out until the period of 5 years required to obtain the right of permanent residence. It will therefore not be necessary to apply for a work visa.
"For those who will come between January 31 st 2020 and December 31 st 2020, it will be practically the same, with a right of temporary residence.
"However, for those who wish to come to work as caregivers after December 31 st 2020, we don't yet know what's going to happen. We do not know whether it will be necessary to retake an exam as it was the case so far for non-EU citizens."
He believes there are some positives for healthcare professionals. He says the British Government has "proposed to create bridges between disciplines and allow, for example, pharmacists and paramedics to become doctors after 3 years of training (in the UK medical studies are 5 years)".
He adds: "I would like to point out, moreover, that so far it has been rather attractive for a nurse to come to work in the United Kingdom because of the possibilities of career progression. For example, an endoscopic nurse who helps gastroenterologists and surgeons do endoscopies for 2 years can pass an exam and become an endoscopist."
Access to Medicines and Medical Devices
The threat of a no-deal Brexit generated huge amounts of concern about the availability of medicines if the UK left the EU without a deal.
The Government invested significant amounts of cash into fast-tracking supplies from Europe.
Due to the UK and EU agreeing a ratified deal, the UK will continue to follow EU regulations, trade, and customs arrangements until the end of 2020.
That has eliminated the need to stockpile medicines, or for health companies to change their import or export arrangements.
Access to Medical Research or Clinical Trials
There should be no change to current research arrangements.
Patients currently participating in an EU trial should be able to continue to do that.
Also, researchers will be able to continue to cooperate as usual through EU framework programmes
However, the NHS Confederation warned that from 2021 "if there are not specific arrangements agreed on reciprocal healthcare, vulnerable travellers will be at risk”.
Also: "If we do not have an agreement on how to manage regulations and customs for medicines and healthcare products, medicines could be delayed, and complex medical supply chains could cease to work."
More Reading on Brexit Implications
Gov.uk: Study in the European Union
University of Birmingham: The impact of Brexit on the NHS
Nuffield Trust: The NHS will now need to get Brexit begun
Editor's Note, 3rd February 2020: This article was updated to add additional information for UK doctors working in the EU and additional information links.
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Cite this: Peter Russell. Brexit: Implications for Health and EU Doctors - Medscape - Feb 01, 2020.