There are many ways to think about how Brexit will change health care. In the following article I suggest four categories which might be used to understand the different impacts upon health care professionals. This isn’t a comprehensive list, but it is an example of how to start thinking and planning for how practice and management will need to adjust. Importantly, and as you will see, although my analysis identifies four categories, the effects of leaving the EU will not be so clearly divided in daily experiences of health care practice. Four key areas that need consideration in the light of Brexit are:
- Education of health care professionals
- Regulation of health care professionals
- Recognition of health care professional qualifications
- Recruiting of EU trained health care professionals
Education of health care professionals
Currently the training and education of health care professionals is based on Regulations from the EU in relation to the number of hours in certain specialities and the amount of theory and practice within programmes for education.
These requirements have been set in the UK through the relevant statutory provisions, such as the Medical Act 1983 and the Nurses and Midwifery Order 2002 No 253. Once Brexit has been competed, there will be no requirement to follow the EU rules on health care professional education and training. So on the one hand, Brexit will allow these regulations to be revisited. This will mean that the standards for education for health care professionals can be specifically suited to the needs of the UK heath care systems and different types of health care worker can be trained for different roles and needs with these health care systems.
If British qualifications are to be valid in the EU, and if EU qualifications are to be valid in the UK (‘free movement of qualifications’) there will need to be a high level of compliance with the existing requirements. The greater the shared compliance maintained, the less that health care practice can diverge and adapt. However, greater divergence will increase the amount of re-education and training that will need to take place if health care professionals move between countries.
Regulation of health care professionals
- Fitness to practise
The health care professional regulatory bodies such as the General Medical Council, Nursing and Midwifery Council and the Health and Care Professions Council, amongst others, were established through various legislative provisions. Their duty is to serve and protect the public through the setting of standards and by maintaining registers of health care professionals who are deemed competent to practise in their respective area.
The ‘professional register’ held by each of the health care professional regulators is a control to provide public safety. It creates the ability to use ‘fitness to practise procedures’ to sanction and remove those whose practise is deemed to fall below the required standard.
Presently if a doctor or nurse receives a sanction in the UK, the organisations which regulate that profession in other EU countries are notified, and vice versa. This prevents people from escaping sanctions by moving to a different country.
In contrast to the education requirements, which form a ‘positive filter’ to ensure that practitioners are qualified, the sharing of professional registers is a ‘negative filter’ that removes those unfit to practice. It therefore performs a different role to a requirement that individuals moving country are re-trained in its professional standards.
- Competency requirement
At present, health care professionals from the EU who meet the ‘mutual recognition of qualification’ requirement cannot have their competence examined before they are allowed to work in the UK, (which I will explain further in the next point). Non-EU health care professionals can be examined before they are allowed to work. . Following Brexit it is an option to allow the UK’s health care professional regulatory bodies to set the competence standard for all non-UK trained health care professionals in the UK.
Recognition of health care professional qualifications
Presently there exists throughout the EU the policy of mutual recognition of qualifications for health care professionals. In other words, so long as the qualification is agreed to be valid across the EU, the individual holding it does not have to prove their personal expertise in the area. This is similar to the way that someone with a UK driving licence can hire a car elsewhere in the EU without having to take a local driving test.
If the UK leaves and diverges from the single market, this will make mutual recognition more difficult in a number of ways.
Mutual recognition has both benefits and drawbacks. The drawback is that an individual’s personal competency cannot be examined before allowing them to register with a UK health care professional regulatory body (see ‘competency requirement’, above). The main benefit is that EU health care professionals can have their qualifications recognised in the UK, and those from the UK can have their qualifications recognised in the EU - all without the need for further education and training. This reduces the time and cost for the individuals concerned, as well as for the respective health care systems.
It is not known what the position on mutual recognition will be after Brexit. Firstly, any new form of mutual recognition will need to be agreed by both the UK and EU. But secondly, the way that the EU governs mutual recognition of qualification is linked to the principle and mechanisms for governing free movement and the single market. If the UK leaves and diverges from the single market, this will make mutual recognition more difficult in a number of ways.
Recruiting of EU trained health care professionals
At present it is possible to recruit a nurse or doctor from an EU country and be automatically assured about their level of qualification and their fitness to practise, via the mutual recognition of qualifications policy and the fitness to practise reciprocal arrangements. From a recruitment perspective, if the mutual recognition system is not maintained this is likely to result in delays in recognising an individual health care professional’s qualification as well as being able to check their standing with their own country’s professional regulatory body.
UK-trained health care professionals are put at a disadvantage in having their qualifications and competence recognised in the countries of Europe.
The UK currently employs more health care professionals than it trains, and a significant number of these positions are filled by people trained in the EU. If the need for EU health care professionals is maintained post-Brexit, a system is needed that allows for the quick and safe recruitment of health care professionals to fill workforce demands. In the long-term, this recruitment system could focus on EU-trained professionals, non-EU professionals, or both. However, after many years of regulatory and professional convergence between the health care systems in the EU, in the short term the EU is likely to remain a significant potential source of labour that is trained in UK-compatible standards and practices
The opposite side of this is also true. The mutual recognition of qualifications policy and the fitness to practise reciprocal arrangements currently allow for UK trained health care professionals to work within the EU. Post-Brexit this may not be the case, if these systems are not maintained or replaced in similar forms. That will mean that UK-trained health care professionals are put at a disadvantage in having their qualifications and competence recognised in the countries of Europe.
In conclusion, Brexit will provide opportunities and pose problems for health care professionals from the EU who wish to work in the UK, and for those trained in the UK who may wish to work in the EU. There needs to be careful consideration given to the issues above to ensure that the NHS can continue to employ the health care professionals it needs.