Intended for healthcare professionals


Long division: summing up Brexit and the NHS

BMJ 2018; 360 doi: (Published 26 March 2018) Cite this as: BMJ 2018;360:k1320
  1. Mark Dayan, policy and public affairs analyst
  1. Nuffield Trust, London, UK
  1. Mark.Dayan{at}

The UK’s exit from the EU in a year’s time is still largely an unknown quantity, but we do already know some of the likely pluses and minuses for the health service and its employees, says Mark Dayan

With one year until the day of Brexit (29 March 2019), our exact destination is still unknown; it remains the subject of cryptic slogans from a divided Cabinet and high stakes clashes in Brussels. But we have learnt enough about the positions of the EU, the UK government, and parliament to sketch out some of the ways in which Brexit might affect the NHS and those who work in it, including staffing, working hours, funding, and medicines regulation.

The biggest issue is migration. The NHS has long relied on workers from overseas to compensate for its chronic failure to train enough staff. Traditionally these were mostly from beyond Europe, but migration and recruitment restrictions introduced from 2006 to 2010 made that more difficult.1 We were left with one safety valve open: migration under the EU’s free movement of labour, which provided tens of thousands of nurses, social care workers, and other staff in the first half of this decade.

Now British government policy is to end free movement in 2021, after a transition period during which we keep following EU rules. Parliamentary rebels are focusing on keeping the UK …

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