As Brexit preparations continue, the impacts upon the NHS are becoming starker. A crucial aspect of the impact of Brexit upon the NHS will be staffing which is already under immense strain.
There are over 200 nationalities represented amongst the NHS workforce. Of the 1.2 million NHS workforce, about 139,000 report a non-British nationality, of which about 42,000 come from EU countries. However, the NHS in England is already reporting that one in 11 posts remain unfilled, equivalent to about 100,000.
There have been concerns that Brexit might worsen the workforce situation for the NHS, with staff unwilling or unable to remain in the NHS and/or dissuaded from coming to the NHS in the first place.
Surveys by the General Medical Council and the British Medical Association have found that 61% and 42% of EU doctors, respectively, are considering leaving the NHS. Whether or not these figures are borne out in reality, Brexit has created huge uncertainty for such doctors. Yet, there has been very limited investigation of the views of EU doctors who are already working in the NHS.
An interview study* (conducted in 2017) of EU doctors who were working in the NHS found some surprising reactions.
Although most doctors felt that they would not be forced to leave (given current staff shortages), some were concerned by the uncertainty that Brexit had wrought. Perhaps more significantly, doctors at all levels said that the Brexit vote had made them feel unwelcome and undervalued in the UK.
“I have never actually, wrongly perhaps, considered myself as a migrant, but now I suddenly am” (German doctor).
Brexit’s impact upon the NHS was seen as negative, by the EU doctors. Under-funding and staff shortages would, they felt, only add to its woes. This would make the NHS less appealing to EU doctors who might otherwise be attracted.
“Why would you want to go to a country that is openly closing its borders? Why would you want to do that?” (Croatian doctor).
Most doctors reported that Brexit had not affected their career intentions and that they planned to remain working in the NHS. Commonly, EU doctors wanted to remain because they felt settled, professionally and personally; this was especially relevant to those with children.
“She [daughter] feels probably more British than Italian, so when I joke and say let’s go back home, back to Italy, she says “no, this is home for me”. So in a way I’m stuck for another 8, 9 years, at least till she’s grown up” (Italian doctor).
Nonetheless, several said that Brexit made them seriously consider their options. For these, Brexit had accelerated or affirmed their intentions to emigrate.
"[Brexit] was the final straw that broke the camel’s back” (German doctor).
Some doctors who planned to leave following Brexit did acknowledge that they could be persuaded to stay; one had given themselves a year to see if the Government could convince them, for example.
In summary, most EU doctors (in this study) intended to stay in the NHS but the Brexit referendum had made them feel different and separated from both their colleagues in the NHS, and the rest of society.
This is significant because, if these feelings were to persist long-term, it could lead to the loss of these EU doctors because perceptions of not belonging to a society are often associated with decisions to migrate.
Equally, some EU doctors might be deterred from moving to the UK. The balance between push and pull factors will be professional and personal but the impacts will be felt not just in the NHS but across British society.
*This article is based upon research undertaken by Will Chick as part of his inter-calated BMedSci degree in Health Management and Leadership (2016-2017). This article is also based on the paper by the authors which was recently published in BMJ Leader