The BMA has been working to safeguard the future of the medical profession and the patients we serve following the UK's vote to leave the European Union (EU) on 23 June 2016.
As the UK's leading voice in representing doctors and medical students, the BMA must be involved in consultations that affect the profession and patients during the negotiations to leave the EU.
We are raising key priorities for health, which should be central to the negotiations, including:
- the retention and recruitment of EU staff
- mutual recognition of professional qualifications
- science and research
- health and safety legislation
- public health protection and procurement.
Brexit briefings: An introduction
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 benefited patients, the health workforce and health services, as well as the risks of leaving the EU without a deal in place.
At our annual representative meeting in June 2018, the BMA voted on a motion that declared our opposition to Brexit and called for the public to have the final say on Brexit.
There is far too much uncertainty around the implications of Brexit for patients, doctors and health services. Any form of Brexit could have wide ranging, and damaging consequences for health services across the UK and Europe, including on workforce and immigration, Northern Ireland, access to medicines, reciprocal health care, professional qualifications and patient safety, access to medical radioisotopes, medical research and rare diseases.
Read more about the potential damaging consequences of Brexit - and what the UK Government must do to mitigate against the risk.
Securing a future relationship that protects health
To protect and improve health and healthcare the UK must negotiate a future relationship with the EU that:
- protects employment rights
- supports the medical workforce
- maintains cooperation on health protection and security
- safeguards the NHS
- ensure access to medicines
- promotes medical research
- maintains reciprocal healthcare arrangements
- facilitates cross-border healthcare.
Health protection and health security
Health protection and security in the UK has been fundamentally shaped by our membership of the EU. This includes efforts to combat infectious diseases, AMR (antimicrobial resistance), climate change, water, waste and air pollution and maintaining high food standards.
The UK and EU currently interact in a number of important ways to tackle preventable conditions and address health inequalities in the UK. These include developing policy and legislation to promote public health, supporting evidence-based decision making, and supporting investment in economically disadvantaged areas.
To avoid widening health inequalities, the BMA believes it is important to maintain a strong focus on preventing ill-health after the UK leaves the EU.
Impact on patient care
Patient care across the UK is supported by important collaborations, safeguards and agreements with the EU. Brexit has the potential to significantly affect the care patients expect to receive in a variety of ways.
Collaboration on medical research has brought wide-ranging benefits as part of the UK’s membership of the EU. Supporting coordinated research and development activities between European countries, as well as an aligned approach to clinical trials has meant that patients in the UK and across Europe have accessed new and innovative medicines faster.
The UK’s decision to leave the EU has the potential to limit the benefits of this collaborative approach and presents a substantial risk to the continued success of European medical research, and to the successful development of the European Research Area. It is vital that the UK Government’s negotiations with the EU prioritise the ability for the UK and EU to work closely across these areas.
Medicine and medical device regulation
Collaboration across borders on the way medicines and medical devices are regulated has been a key advantage of the UK’s membership of the EU. Establishing a robust common framework for assessing and monitoring drug safety and efficacy has meant patients across Europe have timely access to new therapies and technologies.
The CE marking system for medical devices has facilitated access to innovative medical devices from across Europe. The UK’s decision to leave the EU has the significant risk of limiting the benefits of this harmonised approach. It is vital that the UK Government’s negotiations with the EU prioritise the ability for the UK and EU to work closely across these areas.
The challenges facing doctors and health services ahead of Brexit are considerable, but they have the potential to be felt even more profoundly in Northern Ireland, which shares a land border with another EU country.
The BMA believes that retaining existing reciprocal healthcare arrangements, or the agreement of comparable alternatives, should be an important consideration for the UK Government as negotiations continue with the EU.
If access to reciprocal healthcare schemes is not retained or suitably replaced, and if the rights of EEA and UK citizens living abroad are compromised, the impact on them and on the NHS would be significant.
Workforce and future immigration policy
For the UK to continue to provide safe and reliable healthcare services and to remain globally competitive in the life sciences, it must be able to recruit and retain doctors and other healthcare staff from the EU and elsewhere in the world.
The BMA is calling on the government to implement a flexible immigration system, which facilitates the entry of doctors, nurses and other important health and social care staff to the UK, and enables UK-trained doctors to work in the EU should they so choose.
The UK’s membership of the EU has had a significant impact on the development of employment rights for doctors. Legislation such at the European Working Time Directive, the right to equal pay between men and women, and other EU laws around equality have strengthened safety and equality provisions for doctors in the UK. This improves patient care, as well as working towards creating a better work environment, which is more likely to retain doctors – the effect of which is incredibly important given the current pressures on the NHS.
Once the UK has left the EU, Parliament will decide which areas of EU-derived legislation, including legislation on employment rights, should remain, undergo amendments, or be repealed. The BMA is aware of the potential risks to doctors if such legislation is repealed and opposes Brexit for a number of reasons, including the threat posed to the NHS workforce by allowing important employment protections to be repealed.
As a member of Euratom, the UK currently has access to a secure and consistent supply of radioisotopes, which are vital in medicine for diagnosis, clinical pathology and treatment.
The UK’s decision to leave the EU will risk the UK’s ability to secure timely access to these radioisotopes, as well as funding for nuclear research. It is vital that the UK continues to work with Euratom to maintain the benefits of collaboration in these areas.
Competition and procurement
Competition and procurement are areas where the UK’s decision to leave the EU has presented some opportunities to make positive reform.
Brexit presents a chance for the UK to extricate itself from the EU laws which, in part, have helped to establish the rules by which publicly funded healthcare services, particularly in the English NHS, must be procured and open to competition.
Beyond Brexit: International trade and health
The UK will be able to negotiate new international trade agreements after Brexit. Trade agreements can change policy in ways that affect health, both within the UK and globally. These include policies on procurement and provision of public services, regulation to promote public health, food safety standards and intellectual property rights.
To avoid negatively impacting public health and the healthcare sector, the UK should not enter into agreements that prioritise economic benefits over health.
ARM 2018 motion on Brexit
At our annual representative meeting in June 2018, doctors made clear their worries that Brexit poses a major threat to the NHS and the nation’s health.
While we acknowledge there has been some progress in the negotiations, the challenges and the risks to the NHS posed by Brexit remain considerable.
Given what we now know about the potential impact of Brexit on the NHS and the nation’s health, and the dangers a 'no deal' Brexit presents for the NHS, the BMA's ARM voted in June 2018 to change our policy to opposition to Brexit.
The full text of the motion supported by doctors at our conference is as follows:
That this meeting notes the concerns raised in the "BMA Brexit briefings" also notes that the BMA is non-partisan but that there is a plurality of opinions within political parties on Brexit.
We call on the BMA to:
- support the UK remaining in the European single market
- support open border arrangements with free movement of healthcare and medical research staff
- support the UK remaining a member of Euratom to ensure the protection of supply of radioisotopes
- support the early adoption of the European Clinical Trials Regulation in the UK
- publicly announce that it is concerned that Brexit poses a major threat to the NHS and the nation's health
- support the idea of the public having a final say on the Brexit deal, now that more is known regarding the potential impact of Brexit on the NHS and the nation's health
- oppose Brexit as a whole.