Hello to all who reads this!
I recently attended a royal society of medicine event which alerted me of the crisis called Brexit that is to hit us, but used the word “opportunity” as a euphemism. I wanted to share some of the topics discussed in terms of the areas that will be affected and the potential solutions to the issues that Brexit brings.
The first speaker was Youssef El Gingihy, a GP working in Tower Hamlets who spoke about the NHS 5 year forward view, which is a 60 page document which outlines the seven new models of care in the NHS, over the next 5 years. It focusses on workforce investment, care redesign and practise infrastructure.
Chapter 1 proposes an increase the funding for primary care which is said to rise to 2.5 billion annually by 2020. This funding will come with resilience programmes which sets out to decrease the burnouts of employees due to stress, and works on reducing sickness absence in the workplace. Dr Youssef next spoke about the 5 year forward view promising 5000 extra GP’s, 1000 extra Physician associate & 5000 non med staff which will be cheaper than international recruitment. He mentioned the 5 year forward view mentions reducing the number of GP appointments by 1/3 , by having a wider use of the primary care staff and not solely going to GP’s for all issues.
He mentioned having social prescribing being introduced more often. Social prescribing is a mechanism for giving patients non-medical sources of support within the community. This would include the chance to learn new skills, opportunities for arts and creativity, physical activity, volunteering, self help etc as well as support with e.g. employment, benefits, housing, debt etc. This would be directed to patients by GP’s.
He spoke about the issue of high quality healthcare being substituted for efficiency savings. E.g. with digital models such as NEXUS health group substituting the knowledge of a family doctor. With the direction of travel we’ve seen over the last few decades, there is the risk of taking the private health care route and having to charge patients for their treatments.
Professor Martin McKee, mentioned the implications to public health being;
⁃ No money–> £290 million per week will be lost, the money will not be going to the NHS.
⁃ No staff –> People will be leaving as they European staff have lost their rights in the UK.
⁃ Starvation –> As there will be this risk of a lower supply of food, from a public health point of view. Due to the UK not being able to grow enough in the UK, without EU migrant workers. The rise of food banks in the UK can suggest a supply/demand failure meaning increasing reliance on food banks.
⁃ Government failure –> Parliament can’t cope with a “legislative tsunami”.
⁃ Civil disorder –> In the north east of England the terrorist force spent 50% of their time on right wing neo Nazi, and 50% on Islamic fundamentalists.
Professor Tamara Harvey spoke about the legal impacts of brexit affecting healthcare. Medicines regulations, workers rights and many more will be affected when abolishing international legal frameworks, which will happen once the UK leaves the EU, which loses the efficiency of the system.
Professor Michael Manns’ spoke about the effects of funding to research companies and big drug companies in the UK. The UK receives a lot of grants across the board for research in contrast to other EU countries. Therefore due to Brexit, pharmaceutical companies will have to leave the UK, due to the complexity of having to conduct clinical trials once the EU regulations have been abolished. However, companies like GSK and other private industries who have saved the funding will not need to leave the UK. The new EU regulations make it much easier for EU countries to test pioneering new treatments in other EU countries. If the UK now leaves the EU, which is set to happen, it’ll be harder with our population being 60 mill, in comparison to 500 mil being that of all the EU countries, to run trials in the UK.
The main healthcare professionals that is suffering the most are Nurses. with 1 in 5 vacancies unfilled in every hospital and approximately 24,000 unfilled nursing vacancies. Social care staff are also unskilled and there is a high demand of social care stuff which the small supply doesn’t meet. Overall there are severe staffing challenges, with an increasing population the needs are not being met.
⁃ Keep freedom of movement like Norway and Switzerland but the problem is politics and optics
⁃ Look for a loophole such as the NHS being exempted from the migration system however there are two problems with that –
1) families may need to be brought over
2) social care workers are hard to be exempted as they are deemed unskilled and unsure with what job they want to do
⁃ Raise the pay in order to raise the value of working relative to other things i.e. those who are part time or just retired. However, the NHS and social care are financially strained and at their limits.
⁃ Changing the working time directive back to a shift where doctors were on call to 100 hours a week rather than 48 now as will fill gaps but the problems with this;
1) only applies to doctors and are only 10% of staff and are not the ones who are in shortage
2) will not solve workforce issues that Brexit brings
3) Extremely dangerous to over work Doctor as this puts patients’ at risk.
Disruptions to the EU working time directive
· Post Brexit, the EU working time directive which protects workers rights, entitling them to breaks will no longer be applicable to the UK. This could be dangerous to the rights of workers in the UK, as the hours worked without a break could increase to get rid of the issue of the NHS staff shortages. Trainee’s are overworked and this recruitment and retention issues and widespread rota gaps.
· The long hours worked by Foundation year 2 doctors have caused a 50% drop out.
· There has been an increase in road traffic accidents due to doctors coming home after a long shift with extreme exhaustion and, this exhaustion is equally to patients’, civilian’s as well as the Doctors’ themselves.
· By diluting safeguards is sacrificing safety for efficiency savings
Mutual recognition of professional qualifications;
· A UK system of recognition isn’t required until the government specifically chooses to amend the medical act 1983.
· A GMC survey showed that 60% of doctors are considering leaving the UK. This is because the current existing European framework (MPRQ) allows for automatic recognition of qualifications from EEA applicants allowing fast entry into the UK medical register. This would benefit the NHS and EEA applicants, however this can be changed due to Brexit.
The Medical Licensing Assessment (MLA) would allow for UK university fees to be abolished for UK applicants but have a fee for overseas applicants, this will be implemented from 2022.The MLA would also provide a core for UK university assessments.
So this was my overview of the effects of leaving the European union as learnt from the #RSMdebatesBREXIT conference. The costs outweigh the benefits by a milestone and the effects will hit us harder depending on which type of Brexit is implemented (hard/soft).