July 15, 2016
5 min read

Brexit: What are the consequences?

Orthopaedics Today Europe posed the following question: How will Brexit impact orthopaedics in the United Kingdom and Europe?

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Brexit may add to staffing shortages

The unexpected result of the referendum on leaving the European Union is still sending shockwaves through the financial and political systems of the United Kingdom. It is still too early to know the full impact this will have on the NHS because of doubt on the timing and terms of Britain’s exit. However, concerns are already being expressed of its effects on increasing shortages in medical and nurse staffing.

At present, the most acute shortages are in general practice (primary care), but vacancies in some hospitals’ specialties are also increasing even at consultant level. The current NHS workforce contains 10% of registered doctors and 4% of nurses from the European Union (EU). Separate figures for orthopaedic surgeons are not easy to obtain, but in all surgical specialties 20% of physicians have come from other EU countries. Most of these will be happy to continue working in the United Kingdom (U.K.), but uncertainty about their future may unsettle some and will certainly discourage others from following them.

At present, surgeons who have completed their training in the EU can have their qualifications recognized under European Directive 2005/36/EC, but this could be rescinded unilaterally or bilaterally. The alternative sources of non-U.K. surgeons are the countries of the old Commonwealth, which currently supply about double the number of EU applicants. Previously, they were at a disadvantage under EU regulations, which gave priority to doctors from Europe. These rules will no longer apply, but whether these surgeons will be available or willing to make up the shortfall is uncertain.

David L. Hamblen
David L. Hamblen

Concern about funding sources

There is also concern for the mobile workforce that supports research and academic activity alongside the NHS. Funding for their research will also be affected as currently the United Kingdon gets 15% of this funding from the EU. Regulations for clinical trials in the EU were to be standardized from 2017, but the United Kingdom will now fall out with these plans with no guarantee of continued involvement. The impact on post-graduate education should be minimal, as U.K. surgeons will continue to collaborate with their colleagues in Europe within the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), specialist society meetings and on editorial boards.

One key area of European collaboration that could be lost is the Medical Device Directive standardization for the production and approval of orthopaedic implants. The United Kingdom has developed some of its own standards, and these will need to be quickly adopted by manufacturers to conform with the new political arrangements.

Effect on training, work time

There are some positive aspects of moving away from EU requirements in training and work patterns, especially those related to the European Working Time Directive. Surgical trainees, particularly those in orthopaedic surgery, have always been opposed to a rigid 48-hour week which limits their time for gaining adequate operative experience because of the need for shift working. The return to the traditional “team” or “firm” working would allow more effective continuity of patient care, but again, this is dependent on retaining or recruiting enough staff.

The biggest uncertainty underlying all these other issues is the funding of the NHS, which currently faces major deficits in the hospital sector. Brexit has already led to a sharp fall in government finances, which will necessitate further severe economies. Inevitably, these will impact on elective orthopaedic surgery, and the time patients wait for treatment in the United Kingdom will increase.

Disclosure: Hamblen reports no relevant financial disclosures.


United Kingdom remains a key part of Europe

Several articles and comments have been written about the outcome of the United Kingdom’s EU referendum. Many people were surprised about the outcome. England voters favored Brexit at 53% who wanted to leave the EU and 46% who wanted to remain. Wales also wanted to leave as 52% of the voters favored that and 47% voted to remain in the EU. The majority of voters in Scotland and Northern Ireland backed remaining in the EU, as well.

Through its size, with 28 European countries involved in the EU, and the resultant economic and political partnership, the EU has grown to become a single market. As such, it is recognized this allows goods and people to move freely around the EU, seemingly as if the member states were one country. However, Euroscepticism has long been a strong factor within the United Kingdom, a fact that is well known. But, in spite of that attitude, few people inside and outside the United Kingdom expected U.K. citizens would actually vote to leave the EU.

Jan A.N. Verhaar

United Kingdom still part of Europe

In the wake of Brexit, it is important to recognize the United Kingdom remains a European country. English will continue to be the official language used at many international medical meetings. People from the United Kingdom will be welcome at international meetings and will no doubt continue to contribute to scientific and cultural developments. At the end of the day, we are still friends and colleagues.

The United Kingdom is one of the countries that initiated the EFORT. A great many participants at EFORT meetings are from the U.K. meetings as either presenters or attendees. The British Orthopaedic Association is one of the largest EFORT member associations and it actively supports the EFORT organization and its board. Thus, the relations between the orthopaedic communities in the United Kingdom and continental Europe began long before the EU came into existence.

Little effect on orthopaedics anticipated

From my perspective as president of EFORT, I am sure Brexit will have no impact on orthopaedics in the United Kingdom and Europe. However, the consequences of Brexit may be that it will become more difficult for physicians in continental Europe to work in the United Kingdom or the other way around.

This is unfortunate for young people in the field, and orthopaedic leaders should discuss how to resolve this issue. I am convinced fellowship programs and the exchange of ideas and techniques in other ways will help improve the quality of life and the musculoskeletal health of people living in all the European countries, including the United Kingdom.

One of the important ambitions of EFORT’s new strategic plan is to further improve the European orthopaedic curriculum. That plan includes harmonization of training and education in orthopaedics and traumatology, the exchange of ideas and guidelines and a central European examination that support the national orthopaedic examinations. I hope the United Kingdom continues to lend its support to this plan.

EFORT is a federation of national associations and the key platform for European orthopaedics, of which the orthopaedic community in the United Kingdom is an accepted and highly valued component. Brexit will not be able break the bond between us. I am sure about that.

Disclosure: Verhaar reports no relevant financial disclosures.