The UK left the European Union (EU) on 31 January 2020; however, a transitional period set until 31 December 2020, following the UK Withdrawal Agreement of 12 November 2019, meant that the UK continued to comply with EU laws and rules, and remained a participant in the European Union Customs Union and European Single Market until the new agreement came into effect on 1 January 2021. You can find more information about Brexit on the government website, including information relating to the ‘agreements reached between the United Kingdom of Great Britain and Northern Ireland and the European Union’ on 24 December 2020.
If you’re asked to discuss Brexit during your medical school interview, your main focus should be the effects that Brexit will potentially have on healthcare and the NHS. As the new agreement between the UK and EU only recently came into effect, it’s still unclear exactly what the full effect of this will be; however, some potential areas of concern or issues facing medicine and healthcare are:
Following the 2016 EU referendum and the UK’s vote to leave the EU, there has been substantial uncertainty and concerns for how this will affect the NHS workforce.
According to the 'NHS staff from overseas: statistics', over 67,000 NHS staff in England are EU nationals, which equates to 5.5% of all staff. As a result of the UK leaving the EU, free movement of labour between the UK and the EU has been revoked, which ultimately affects these members of staff, as well as potential NHS staff in the future. The government website confirms that for citizens from the EU, European Economic Area (EEA) – this includes EU countries, as well as Iceland, Liechtenstein and Norway – and Switzerland, the following rules will apply regarding working and living in the UK:
It’s unclear whether these new rules and processes will have an impact on NHS staff retention or recruitment of EEA citizens, but it is an area which you may want to explore as a possible consequence of Brexit.
Likewise, there are changes to the rules and processes for EEA and Switzerland nationals in relation to study in the UK from 1 January 2021; more information is available here. This could potentially impact medical school applications, but again, it’s unclear whether this will be the case.
The UK’s future involvement in EU-wide scientific research programmes was an area of concern prior to a Brexit deal being agreed; however, a Joint Declaration on Participation in Union Programmes was agreed, which means that the UK will continue to be involved in a number of these programmes. The King’s Fund states that ‘the UK’s continuing participation in EU scientific research programmes means that the country will continue to benefit from collaboration and pooling of expertise across the EU’. However, it does share that the ‘academic, pharmaceutical and medical research community’ was concerned about the ‘ability to attract researchers from EEA countries’ and concludes that the ‘UK’s ability to attract researchers to work in UK scientific institutions in the future is less clear’. The NHS Confederation confirmed that the ‘UK and EU agree to facilitate movement of researchers with as few barriers as possible now that freedom of movement has ended’, which should aid the process of attracting researchers to UK programmes.
Another area of uncertainty associated with Brexit is the implications for scientific research funding. The Royal Society reported that between 2007 and 2013 the UK received ‘€8.8 billion in direct EU funding for research, development and innovation activities’; this is compared to a contribution of €5.4 billion to the EU research and development fund. To balance this, it’s important to note that as a member of the EU the UK was a ‘net contributor to the EU budget’, meaning that overall the UK contributed more than it received. It is unclear what funding will be dedicated to scientific research following Brexit, but you may want to explore this area of uncertainty further, and consider how this could potentially affect medicine in the future.
There are a range of potential implications and uncertainties associated with healthcare and the NHS as a result of the UK leaving the EU, providing you with plenty of choice of what to focus on and discuss if you’re asked about Brexit during your medical school interview. Whatever you choose, focus on the impact on healthcare and ultimately try to relate this to patient care and wellbeing. Remember the General Medical Council (GMC) ethical guidance states that as a doctor you should ‘make the care of your patient your first concern [and] provide a good standard of practice and care’. The following are areas which may impact patient care, which you may want to explore further and include in your discussions:
As mentioned previously, the impact of revoking free moment between the UK and the EU/EEA is unknown at the moment; however, any effects on NHS staff retention and recruitment which resulted in staffing issues or staff storages would ultimately impact patients and the level of care they receive.
As discussed above, there are guarantees in relation to scientific research, with the UK continuing to be involved in some EU programmes; however, there are also unknowns in relation to funding and the recruitment of researchers for UK scientific research. Scientific research and the development of medicines and treatments are important areas to consider for patients and the level of care they receive.
The King’s Fund provides a breakdown of the new regulation rules for importing medical products and how this will be processed. The main concern in relation to this area, is that as a standalone regulator manufacturers may ‘de-prioritise the United Kingdom as a country to introduce new medicines and devices to, meaning that people and patients may face delays in accessing new medicines’. If this were the case, what impact could this potentially have on patients and the treatment they receive? You may also want to consider, and research further as this develops, the impact of the new regulations on imports and whether this causes any issues or delays.
Linked to the area above, with a new trade deal in place, there is a risk of delays for imports which could affect the NHS. No doubt you will have read news articles about this already and it’s worth continuing to follow these and any ongoing effects. Steps were taken to reduce any impact on the NHS with the government urging ‘medicine suppliers to stockpile six weeks’ worth of drugs as a “buffer” against disruption’ following the end of the Brexit transition period. Any disruption to medicine supply would impact patients, especially during a particularly busy time for the NHS, while dealing with the COVID-19 pandemic.
Brexit is no doubt a topic that you’re well aware of, therefore, to support you in your interview preparations, simply ensure that you understand the basics about Brexit and the potential implications for the NHS. For further research, focus on areas which you find interesting and have a good grasp on, to ensure that you can relate them to medicine and the impact on patient care.
As usual, if drawing upon articles to support your discussions, ensure that you use reputable sources, and where possible try to engage with medical articles specifically.
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