The paper's authors modelled the likely impact of three Brexit scenarios – a soft Brexit, where the UK retains access to the single market but has restrictions on free movement of people, a hard Brexit with a free trade agreement between the UK and EU and a failed Brexit where the UK would fall back on World Trade Organisation rules.
Each of these scenarios poses ‘substantial threats’ to the NHS workforce and finances, the licensing of medical products, scientific research and public health, the paper says. However a 'no deal' scenario is ‘potentially catastrophic’ and the UK negotiating team should make health issues a priority, the authors argue.
‘The health workforce is especially vulnerable to the effects of Brexit, with major effects on recruitment and retention of EU nationals within the NHS and social care,’ the report says. ‘It will be very difficult for the UK to be self-sufficient in the NHS or social care workforce in the foreseeable future.’
Estimates for 2017 suggest that 60,000 people from the EU work in the NHS and 90,000 work in adult social care.
However, RCGP chair Professor Helen Stokes-Lampard said that these figures did not take account of GPs and practice staff and so the picture was potentially ‘much bleaker’. 'The college's own research earlier this year found that 2,137 GPs across the UK – delivering care to over 3m patients – could be forced to leave if their status is not protected,' she said.
Other areas of concern highlighted in The Lancet report include the impact of Brexit on the licensing and purchasing of pharmaceuticals, which could lead to increased costs and delays in gaining access to new treatments, and scientific research, which receives significant funding from the EU and is reliant on EU research networks, standards and legal frameworks.
Public health could be affected as the report warns that UK environmental standards on air and water quality could slip backwards on leaving the EU and that ‘the UK could be a prime target for the tobacco industry post Brexit, as is the case in Switzerland’.
The authors also highlight that it will be essential to resolve issues around reciprocal healthcare arrangements for UK citizens living in the EU and cross-border care arrangements in Northern Ireland.
The report does point out that there are some opportunities, such as adapting competition laws, which could in theory protect against further competition in the NHS, as well as flexibility around training. However, they say it remains unclear whether the government would take such changes on board.
'The effects [of Brexit] depend on what type of Brexit is pursued; the harder the Brexit, the worse the effects, with no deal being the worst of all,' the report concludes.
'Intentionally or not, Brexit will reshape the health system in the UK in a variety of ways, and much momentum in the coming years will be stalled, as existing arrangements are reworked and adapted for the new situation. The impacts on the workforce of the NHS and on people depending on reciprocal healthcare arrangements will be substantial, and potentially devastating for the individuals involved.
'However, the largest impact on the health system is likely to come from Brexit’s impact on the wider economy, on the ability of the state to function, and thus on the ability of the UK to finance the health service.'
Professor Martin McKee, from the London School of Hygiene & Tropical Medicine, one of the authors and a member of the advisory board of Healthier In, a group which campaigned to remain in the EU, said: ‘Brexit in any form poses major risks to almost every part of the NHS, with a "no deal" scenario potentially catastrophic. The EU has shown that it recognises many of these threats, and we hope that our paper encourages the UK negotiating team to make health issues a priority.’
Professor Stokes-Lampard said: ‘This analysis paints a bleak picture and urgent action is needed to ensure these predictions don’t become a reality.
‘We join the paper’s authors in calling for health to be top of the agenda during Brexit negotiations – and from the point of view of general practice, we must ensure the status of every EU national working in UK general practice is protected as a matter of urgency, and for efforts to recruit overseas doctors as part of NHS England’s GP Forward View, not to be hampered in any way.'