Approaching the end of the Brexit transition: practical implications for the NHS

Whether the UK leaves the EU with or without a deal, Brexit will have a significant impact on the sector, including on healthcare delivery, access and patient safety. There is a risk that some or all of the agreements required will not be reached. Despite significant arrangements by the government, the NHS, its providers and suppliers and UK patients may still be impacted. This means that the NHS will need to prepare for potential disruption.

This briefing reviews the most recent government guidance and provides a checklist that covers the areas that may require additional preparations by the NHS. This includes advice to patients, changes to processes or systems, recruitment and retention planning, and ensuring continuity in areas such as research, funding and medicines and medical device supply.

• Key points
• Background
• Practical implications for the NHS
• How to prepare
• Where you can find out more

Key points

• The UK’s future relationship with the EU that is currently being negotiated will determine how aspects of health and social care are delivered and how some patients will access care from 2021.
• There is a risk that the negotiations do not result in agreements being found for some or all of the aspects of health that will be affected, or that the agreements will be associated with various forms of disruption.
• Whether the UK leaves with or without a deal, Brexit will have a significant impact on the sector, including access to reciprocal healthcare arrangements, protecting public health and the supply of medicines and medical technologies.

On 3 August, the government published guidance for commissioners and healthcare providers. It provides advice, contacts and actions to help to plan for and manage potential service disruption around the supply of medical products, business continuity, workforce issues and EU funding through the Third Health Programme.

Background

The Brexit transition period will end on 31 December 2020, at which point the UK and EU’s relationship will be governed by what is agreed in the future relationship agreement. This agreement is currently being negotiated with the aim of reaching a deal by October.

As this future relationship with the EU will also determine how aspects of health and social care are delivered and how patients access care in the UK from 2021, the NHS will benefit from health-related agreements being included in the deal.

These areas of agreement include: protecting citizens’ rights to reciprocal healthcare when in the EU; supporting international research collaboration into innovative treatments, such as those needed to fight coronavirus; allowing alignment of standards and trade arrangements for medicines and medical devices; protecting access to shared public health networks and alert systems; and allowing international recruitment for health and care services.

With only two months left for agreements to be made, the potential for a ‘light deal’ is emerging more strongly. With no agreements, or limited agreements, in place on the issues related to health, the adjustment for the NHS and health sector more widely will be significant and could affect the health and wellbeing of patients and citizens. These are the same organisations and staff who are currently working to manage the coronavirus.

The coronavirus pandemic has hit the UK hard. As a result, the UK healthcare system not only has a responsibility to safeguard population health and wellbeing but needs to do so from a position of rebuilding services and stocks, with a less than certain winter approaching.

The end of the Brexit transition is also expected to impact on funding available for UK public services. The EU has been a significant source of funds for infrastructure investment by the NHS, which is unlikely to be continued past 2020. In addition, it is expected that there will be wider long-term negative economic impacts of leaving the EU and a reduction in GDP, which could impact on funds available for the NHS and social care.

Practical implications for the NHS

How Brexit will affect healthcare: what do chief executives, chief operating officers and other health leaders need to know?
At the end of the transition period, there could be changes to many aspects of our cooperation with the EU on health. Whether the UK leaves with or without a deal, Brexit will have a significant impact on the sector, including:

• Access to reciprocal healthcare arrangements – The European Health Insurance Card (EHIC) could cease to apply from January 2021 for UK citizens living, travelling or working in the EU. With new requirements, there could be additional burden for health providers required to handle new, complex admin and funding processes.
• Protecting public health security – The UK could lose access to EU data sharing platforms and alert systems to exchange information and early warnings about health threats.
• Continuity for medical research and innovation – The UK could lose access to EU clinical trials and associated infrastructure, which risks disrupting UK participation in research and testing of new treatments so that patients can benefit as soon as these become available.
• Supply of medicines and medical technologies – New border arrangements and requirements on goods, as well as regulatory barriers, could cause delays in release of supplies onto the UK market.
• The health and care workforce – In addition to the changes that a new future relationship will bring, from January 2021 the UK will have a new immigration system, which will affect international recruitment for the health and care services.

On 3 August, the government published two key Brexit-related pieces of advice. The first was in the form of a letter from Department of Health and Social Care (DHSC) to medicine suppliers setting out the government’s plan, and requests of industry and the wider supply chain ahead of the end of the transition period to help ensure the continuity of supply of medical goods into and out of the UK.

The letter advised medicine suppliers to stockpile six weeks’ worth of drugs to guard against disruption at the end of the Brexit transition period and to make boosting reserves a priority. It also reiterated that ministers will not be asking for an extension to the transition period past 31 December, despite the coronavirus pandemic, so suppliers should plan for all scenarios, including disruption to usual trading routes with the EU.

The second, directly relevant to members, is guidance on what healthcare services can do to prepare for 1 January 2021 and is aimed at commissioners and healthcare providers, including hospitals, care homes, GP practices and community pharmacies. It covers advice, contacts and actions to help to plan for and manage potential service disruption around the supply of medical products, business continuity, workforce issues such as recognition of professional qualifications and EU settlement scheme applications, and EU funding through the Third Health Programme.

How to prepare

There is a risk that the negotiations do not result in agreements being found on some or all of the areas affecting health. The following checklist covers the areas that may require additional preparations by the NHS, based on what is expected to change from 1 January 2021 and the latest government guidance:

• Encourage your non-British EU staff to apply for settled status. Visit the NHS Employers website for more information on how to support staff in their application to the EU Settlement Scheme.
• Provide advice to patients on travelling abroad from January 2021, particularly if they require planned care. Head to the Gov.UK website for further advice on travel and insurance requirements; our further detailed analysis and support will be available soon.
• Prepare your overseas visitors teams for changes to the EHIC system and access to healthcare for EU citizens, which may impact procedures and systems for cost recovery. Find out more.
• Review your workforce capacity and activity plans regularly and ensure business continuity plans cover the supply of staff needed to deliver services beyond 31 December 2020. Government advice is to read about business continuity. For professional registration queries, contact the relevant regulator.
• Ensure that you are have procedures in place to escalate continuity of supply issues particularly for medicines and medical devices that are supplied on a just-in-time basis, need controlled conditions or have a short life. Access links to more information on the plan to introduce import controls on EU goods from January 2021 and key government contacts.
• Review clinical trials and European Reference Networks you are involved with for eligibility to take part and changes to approval and information sharing rules and procedures.
• Ensure your bid for EU funding from the Third Health Programme is made before 31 December 2020 to receive the full financial allocation for the lifetime of the project or joint action. Access information on how to apply for additional help and advice from the UK National Focal Point.

We await the outcome of the talks this autumn in which we hope there will be agreements that support health. In the meantime, all health and care organisations are advised to consider the steps they need to prepare for these not being in place on 1 January and for potential disruptions.

Where you can find out more

Given the uncertainty around which agreements will be secured during the future relationship talks, if any, planning for the end of Brexit transition has to remain iterative. We will continue to monitor developments and analyse implications for health and care, including guidance from NHS England and NHS Improvement. Subscribe to our regular Brexit Bulletin to stay up to date.

The government is expected to continue to update and publish guidance on what providers and commissioners of healthcare services can do to prepare for 1 January 2021. The latest official advice from 3 August 2020 can be found on Gov.UK.