Brexit white paper – the answer to all our concerns?

RCP president Professor Dame Jane Dacre takes a look at the government's new Brexit white paper, explains what it tells us and asks what we still need to know. 

Yesterday the government released their promised Brexit white paper. It follows the cabinet away day at Chequers last week where the cabinet came together to agree their collective position for the next stages of Brexit negotiations.

Over the past 2 years the RCP has laid out the key policy challenges of Brexit across workforce, collaboration, research, air quality and reciprocal healthcare arrangements. It’s clear that on some issues we’ve been heard, the recent recognition by government ministers of the importance of continued research funding and collaboration post-Brexit being one example.

However, as with most things Brexit-related, the detail is key and unknown.

With less than a year to go until we leave the EU, followed by a short transition period there are still many unanswered questions.

Professor Dame Jane Dacre, RCP president

As health professionals, what we need more than anything is certainty. With less than a year to go until we leave the EU, followed by a short transition period, there are still many unanswered questions. Our focus continues to be on the NHS’s ability to meet patient need and support one another through what could be a considerable period of change.

What does the white paper tell us?

  1. European Medicines Agency (EMA) - The white paper once again sets out the government's ambitions to remain a part of the EMA and they have now set out their negotiation position which would see UK regulators still able to conduct technical work, including acting as a ‘leading authority’ for assessment of medicines. Only time will tell whether the EU will accept this position, but it is very welcome to see the government undertake to attempt to secure a long-term partnership for medicines and devices post-Brexit.
  2. Mutual recognition of professional qualifications (MRPQ) – The white paper sets out the government's wish to evolve the existing MRPQ framework that would be of similar scope to the current approach.
  3. Health security – In a dedicated section on health security the government lays out its commitment to seeking ‘ continuing close collaboration with the Health Security Committee and bodies such as the European Centre for Disease Prevention and Control (ECDC)
  4. Reciprocal healthcare arrangements – In a welcome move the government has set out their position for UK and EU nations to continue to be able to use European Health Insurance Cards (EHIC) to receive healthcare should they need it while on holiday and for reciprocal healthcare cover for state pensioners retiring to the EU or UK.

What do we still not know?

  1. EU doctors – 9.3% of doctors working in the NHS are from EU member states; they are a vital part of the NHS community. It’s disappointing that there is still no certainty about the future for EU doctors wanting to come to live, work and train in the UK. Two years on from the referendum, and the uncertainty about the future immigration system continues to place additional strain on an overstretched workforce.  
  2. Air quality – The white paper is silent on the issue of air quality. We know that air quality is an international problem, as no individual nation is in complete control of their air quality. It is vital that the government sets out its approach to working with the EU on air quality post-Brexit.
  3. Data – Data sharing is crucial to our ability to collaborate across the EU on a range of projects. While the white paper touches on data sharing, this is little detail. The introduction of GDPR in May raised public awareness of the use of their data; it will be vital that the public has confidence in the future of data sharing while maintaining the UK's opportunities to collaborate to benefit patients.

Our challenge to government is for them to set out clearly and quickly how the NHS will continue to attract highly qualified staff from across the EU after Brexit.

Professor Dame Jane Dacre, RCP president

For health, the white paper helps clarify the government’s direction of travel, but it’s yet to get to grips with some key policy challenges. The most worrying of which is workforce; it’s clear that in the short to medium term the only way to reduce pressure on the workforce is through immigration. The UK has to position itself as a destination of choice for doctors. EU doctors are vital to the NHS; we simply cannot meet patient need without them. 

Our challenge to government is for them to set out clearly and quickly how the NHS will continue to attract highly qualified staff from across the EU after Brexit. They must also set out to create a welcoming environment that avoids unnecessary bureaucracy and cost.

We’ll be watching carefully how the EU responds. This is a negotiation and nothing in the white paper is a certainty. The government must place patient safety at the heart of Brexit negotiations. The timeline ahead is tight with the EU's targeted completion date for article 50 negotiations less than 3 months away at the end of September, for a deal ‘in principle’ to be discussed at the October meeting of the European Council.

Professor Dame Jane Dacre

Follow the president of the RCP on Twitter: @DacreJane