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Information for doctors if there's a 'no deal' Brexit

Union Jack and EU flag being ripped apart

The UK could leave the EU on 31 October 2019 without a Brexit deal in place. As a doctor, you may have questions about what this outcome could mean for you both individually and professionally.

We have produced this information to answer some of the questions you may have in the event of a no deal Brexit on the following issues:

  • immigration
  • professional qualifications
  • employing EEA doctors
  • access to medicines
  • access to healthcare in the UK and EU
  • medical research
  • local no deal preparations.
  • Immigration

    This guidance has been updated following the Government announcement that it will introduce European Temporary Leave to Remain (Euro TLR) for EU citizens after 31 October 2019.

     

    Moving to the UK before exit day?

    If you arrived in the UK before 31 October 2019, you and your family can apply for pre-settled status or settled status.

    This will prove to employers, public service providers or others that you and your family members have the right to live and work in the UK, and to access public funds and services.

    You can apply to the scheme until 31 December 2020.

     

    Coming to the UK after exit day?

    You will be able to enter the UK until 31 December 2020, as you do now, to visit, live, study or work.

    To stay in the UK after 31 December 2020, you will need to apply for Euro TLR (European temporary leave to remain) or through the new immigration system which is due to come into effect from January 2021. 

    The Euro TLR scheme is voluntary and allows you to stay in the UK for 36 months from the date the leave is granted. You must apply in the UK. Your application will be subject to identity, criminality and security checks. You do not need to pay a fee.

    The visa is temporary, cannot be extended and will not lead to settled status under the EU settlement scheme. However, the Government has confirmed that the time you spend in the UK with Euro TLR status can count towards the qualifying period for settlement in the UK.

     

    Can I apply under the settled status scheme?

    No. You must be resident in the UK before exit day to be eligible to apply for settled status.

     

    Doctors or medical students planning to stay in the UK for longer than three years:

    The Euro TLR will last for three years from the point that leave is granted. To stay in the UK for longer than this, you will need to apply under the UK's new skills-based immigration system when your leave expires or before if you want. This system is due to come into effect from January 2021.

     

    Is there any other type of application I can make to stay for long-term work or study?

    You can apply under the current domestic points-based immigration system for non-EEA nationals as soon as you arrive in the UK, after exit day, and before the new immigration system is introduced in 2021. You can find more information on our immigration advice pages.

    If you are a BMA member, you can access our immigration advice service, which provides free, basic immigration advice in connection with your employment and/or study in the UK.

     

    Irish nationals moving to the UK:

    You can continue to live and work in the UK without requiring permission. Your non-Irish, non-British dependents, will need to apply for Euro TLR or through the new immigration system to stay in the UK after 31 December 2020.

     

    Regular travel from Northern Ireland to the Republic of Ireland: what impact will no deal will have on my travel?

    UK and Irish nationals can move freely between Northern Ireland and the Republic of Ireland. This includes healthcare professionals who travel between the two countries to provide healthcare on a regular basis.

    This is because of the CTA (common travel area). The CTA is an open borders arrangement between the UK, Ireland and the Crown Dependencies (Isle of Man, Guernsey and Jersey), which pre-dates the UK’s and Ireland’s membership of the EEA.

    This freedom will not apply to other EEA nationals moving between the Republic of Ireland and Northern Ireland in the event of a no deal Brexit. They will need to apply under the settlement scheme or meet the visa requirements set out above in the event of no deal.

    If you are a BMA member, you can access our immigration advice service which provides free, basic immigration advice in connection with your employment and/or study in the UK.

  • Professional qualifications

    As an EEA qualified doctor currently working in the UK, will my medical qualifications still be recognised if there’s a no deal Brexit?

    Yes, as an EEA qualified doctor currently practising in the UK your medical qualifications will continue to be recognised – your registration with the GMC will not be affected.

     

    As an EEA qualified doctor wanting to work in the UK, will my medical qualifications still be recognised if there’s a no-deal Brexit?

    In the vast majority of cases, medical qualifications that were automatically recognised before a no deal Brexit will continue to be recognised as being acceptable for the purposes of GMC registration.

    Further information on how the UK’s withdrawal from the EU will affect doctors from Europe already working in the UK, and those who may wish to work here in the future, is available on the GMC website.

  • Employing EEA staff

    What are the rules regarding the right to work in the UK in the event of no deal?

    As an employer, you will already conduct right to work checks on EEA nationals.

    In December 2018, the Government confirmed that in the event of a no deal Brexit, you will not need to make additional right to work checks. You will need to confirm the individual is an EEA national, which can be evidenced by a passport or national identity card.

    As an employer, you can access employment law advice by contacting [email protected] or calling 0300 123 1233.

    If your employees are BMA members, they can access our immigration advice service, which provides free, basic immigration advice.

     

    I employ EEA staff who have been here since before 31 October. How can I help them?

    You can tell your staff about the EU settlement scheme. The Home Office has produced some guidance, a briefing pack and poster to raise awareness of the scheme.

    You can also use the employer toolkit which includes more information about the scheme.

    If your employees are BMA members, they can access our immigration advice service which provides free, basic immigration advice.

  • Access to medicines

    As a doctor prescribing drugs to patients in both primary and secondary care, what should I do if there are medicines shortages?

    The Government has instructed:

    • clinicians to not write longer NHS prescriptions than normal; and
    • hospitals, GPs and community pharmacists throughout the UK to not stockpile additional medicines, beyond their usual business levels.

    This guidance is set out in:

    • letter to the healthcare sector from the Secretary of State for Health and Social Care in August 2018,
    • a letter from the NHS England’s Chief Pharmaceutical Officer in January 2019
    • a letter to all health and social care staff in April 2019.

    NHS England has published FAQs on access to medicines which you may find helpful in any discussions with patients about their medicines and medical products.

     

    I’ve heard changes have been made to allow pharmacists to prescribe more widely in the event of a serious shortage of a medicine. Can you tell me more?

    In December 2018, the Government consulted on changes to the Human Medicines Regulations, relating to serious shortage protocols. This is a framework for alternative prescribing arrangements in the event of a serious shortage of a medicine, including in a no deal Brexit.

    The serious shortage protocols have now been implemented and, in restricted circumstances determined by ministers, pharmacies are now permitted to substitute a different strength, quantity or pharmaceutical form of a prescription-only medicine, or an alternative prescription-only medicine to that ordered by the prescriber.

    Previously, if a pharmacist did not have in stock the supply ordered by the prescriber, the patient would be sent back to the prescriber.

    Read our guidance to LMCs on the serious shortages protocols.

    If you have further queries, please get in touch with the BMA. Call 0300 123 1233 or email [email protected].

     

    As a doctor referring patients for treatment or treating patients, what should I do if that treatment is not possible due to shortages in radioisotopes?

    In March 2019, the Royal College of Radiologists published practical guidance and advice for those working in radiopharmacy and nuclear medicine services in the event of a no deal Brexit. This includes advice on carrying out risk assessments, ensuring clear communication and making local contingencies. Read the Royal College’s guidance.

    The guidance should be read alongside the Government’s update on preparations for no deal, which applies for medicines and radioisotopes.

    If you have further queries, please get in touch with the BMA. Call 0300 123 1233 or email [email protected].

     

    What will happen to the FMD (Falsified Medicines Directive) if the UK leaves the EU without a deal?

    In the event of a no deal Brexit, the MHRA (Medicines and Healthcare products Regulatory Agency) would be a stand-alone medicines and medical devices regulator, taking any decisions and carrying out any functions that are currently taken or carried out at EU-level.

    This would include licensing routes, the possibility of new global partnerships, and a competitive fee structure. In other words, the FMD would no longer have any effect in UK law.

  • Access to healthcare

    As a GP, can I treat an EU citizen who comes to the UK after exit day?

    In the event of a no deal Brexit, arrangements which currently enable EU citizens to access care in the UK in the same way as local residents will come to an end. EU citizens visiting the UK may therefore need to be treated as overseas visitors.

     

    What are the rules for treating overseas visitors in primary care?

    The rules around treating overseas visitors are different in England, Scotland, Wales and Northern Ireland. Emergency care is provided for free throughout the UK, and primary care services are also typically provided without charge.

    GP practices are required to provide patients with a supplementary question form as part of the registration process. This is included as part of a revised GMS1 form or can be provided separately if the practice uses its own registration forms. This will allow patients to self-declare if they hold either a non-UK issued EHIC or a S1 (formerly E106), and provide the relevant details. The practice will not be required to follow up with the patient if they do not fill in these details and the practice should register them as normal.

    Many NHS services outside of primary care are chargeable for overseas visitors (eg elective surgery). In England, overseas visitors staying for longer than six months have to pay the immigration health surcharge (IHS) in advance, after which they will be eligible for care in the same way as UK residents.

    British citizens who live in Ireland, and Irish citizens who live in the UK, will continue to have the right to access healthcare there. The UK and Irish governments have said they are committed to continuing to help people access healthcare after the UK leaves the EU.

    There is further information on the websites of health authorities in each of England, Scotland and Wales:

    You may find it useful to read the BMA's guidance on registering patients and our briefing on reciprocal healthcare arrangements. The BMA’s guidance on access to healthcare for overseas visitors might also be useful.

     

    As a secondary care doctor, can I treat an EU citizen who comes to the UK after exit day?

    In the event of a no-deal Brexit, arrangements which currently enable EU citizens to access care in the UK in the same way as local residents will come to an end. EU citizens visiting the UK will be treated as overseas visitors and may need to be charged for care.

     

    What are the rules for treating overseas visitors in secondary care?

    The rules around treating overseas visitors are different in England, Scotland, Wales and Northern Ireland. Emergency care is provided for free throughout the UK. Access to non-emergency care will usually be subject to charges. In England, overseas visitors staying for longer than six months have to pay the immigration health surcharge (IHS) in advance, after which they will be eligible for care in the same way as UK residents.

    British citizens who live in Ireland and Irish citizens who live in the UK will continue to have the right to access healthcare there. The UK and Irish governments have said they are committed to continuing to help people access healthcare after the UK leaves the EU.

    The websites of the national health authorities provide more detailed information:

     

    Can a UK citizen who has returned from living in the EU access healthcare on the NHS?

    Former UK residents who have emigrated and no longer reside in the UK are usually chargeable for non-emergency care on short visits to the UK.

    The UK Government has announced that patients returning from the EU/EEA to the UK in the event of a no deal Brexit will be considered ordinarily resident, and therefore eligible for NHS treatment, provided they plan to reside in the UK for the time being.

    UK pensioners living in the EU/EEA will be able to access NHS care on temporary visits to the UK, if they have already registered with the S1 scheme.

    UK citizens who return to the UK while already undergoing a course of treatment within the EU/EEA will also be able to continue that treatment under the NHS.

    Former UK residents who are working abroad as part of an armed service, as a Crown servant, or in UK Government-funded employment abroad are typically exempt from charges, as are their families.

    Former residents who are war pensioners and armed forces compensation recipients are also exempt from charges while visiting the UK.

    If you would like more information on specific eligibility criteria and exemptions, you may wish to read DHSC’s guidance on implementing the overseas charging regulations.

     

    As a doctor, is it my role to determine a patient's eligibility for NHS care?

    Doctors working in a hospital environment should only be responsible for assessing the urgency of a patient’s need for treatment and should not be expected to determine a patient’s eligibility for NHS care.

    Overseas visitors managers are responsible for this, but doctors may wish to seek their advice on treating non-UK residents. You may also find it useful to read the BMA’s briefing on reciprocal healthcare arrangements and our guidance on access to healthcare for overseas visitors.

    As above, practices are required to provide patients with a supplementary question form as part of the registration process, which is included as part of a revised GMS1 form or can be provided separately if the practice uses its own registration forms. This will allow patients to self-declare if they hold either a non-UK issued EHIC or a S1 (formerly E106) and provide the relevant details.

    If the patient does not fill out the additional section for the EHIC/S1 details then the practice should register them as normal. There is no requirement for the practice to follow this up with the patient.

     

    Can a UK patient get healthcare in the EU?

    In the event of a no deal Brexit, current arrangements that enable UK citizens to access care in the EU in the same way local residents do, will come to an end. This means UK patients will still be able to access care in the EU, but they are likely to be charged for the care they receive, depending on the laws in each country.

    EU countries provide emergency care for free to non-EU residents (although the definition of what is covered may vary from country to country), but access to primary care and non-emergency hospital services may be subject to charges. UK patients travelling to EU countries on holiday have been advised to ensure they have suitable travel insurance in place beforehand.

    UK citizens currently living in EU countries, or planning longer stays, should be aware of how access to care is governed in their country of residence and the potential financial implications that may carry, including the potential cost of private healthcare insurance.

    The UK Government has confirmed it will cover the cost of healthcare for UK pensioners living in the EU/EEA (who currently receive care funded by the UK under the S1 scheme) for one year following Brexit, if a deal is not secured.

    You may find it useful to read the BMA’s briefing on reciprocal healthcare arrangements.

  • Medical research

    I am a lead sponsor on a clinical trial, working with colleagues in the EU. Will I have to make changes to the legal representation or sponsorship of the trial?

    The MHRA (Medicines and Healthcare products Regulatory Agency) has produced guidance on what changes would be required to sponsors of clinical trials and legal representatives. Key details include:

    • if a trial sponsor is from the rest of the word and the legal representative is established in the UK and there are trial sites in the EU/EEA (European Economic Area), the sponsor will need to assign an EU/EEA legal representative
    • no amendment is required where the sponsor or legal representative for an ongoing trial is established in the EU/EEA as the UK will continue to accept this
    • no amendment will need to be submitted in the UK if the sponsor retains the UK legal representative for the UK study.

    The Health Research Authority has also produced guidance about when amendments are required to be submitted to the Research Ethics Committee for review.

     

    Are there any further amendments I will have to make to the management of the study?

    The Health Research Authority has produced guidance on the circumstances in which amendments are substantial:

    • any change in supplier or central laboratory may be implemented as a non-identifiable amendment to the Research Ethics Committee
    • any change to Investigational Medicinal Products, drugs, devices or radioisotopes used in research should be notified as substantial amendments
    • if the only participating sites are in England and Wales, a non-notifiable amendment can be implemented immediately with sites, without submission to the Health Research Authority.

     

    I currently have responsibility for processing and sharing personal data from the UK and the EU, which I use for clinical trials. How will no deal affect my ability to use this data?

    In a letter to the Health and Social Care Community in February 2019, NHS England confirmed that there would be implications for data flows, which apply to the research community in the event of a no deal Brexit. 

    NHS England have also published a set of questions and answers on data protection issues affecting the NHS.

    This should be read alongside the DHSC Brexit operational readiness guidance for the health and social care system.

     

    Staff from the rest of the EU are employed as part of my team. What should I be advising them?

    Please see the advice that we have issued under 'Employing EEA staff'. 

     

    We are currently recruiting staff from the rest of the EU.  Will they still be able to work here?

    Please see the advice that we have issued under 'Immigration'.

    The prime minister has said that the Government will develop a new 'fast-track' route for elite researchers and scientists, which will build on the existing Tier 1 (exceptional talent) route. 

     

    Will my team and I still be able to access research funding from the EU?

    This will be dependent on what kind of agreements are reached between the UK and the EU on research. In the event of no deal, the UK Government has confirmed that it will meet the funding bids submitted before we leave the EU through Horizon 2020. It is unclear what the arrangements will be beyond that.

    We do know that the UK will not be able to take more out of research funding than it puts in, as has been the case as a member of the EU.

    The Department for Business, Energy and Industrial Strategy has produced guidance.

  • Local no deal preparations

    As a doctor, I’m concerned about no-deal preparations in my local area. Who should I contact?

    If you have specific concerns about issues relating to a no-deal Brexit, please escalate them to your regional NHS EU Exit team (England only):