BMA Chairman tells it as it is. Even he still refers to an “N”HS… and he has ignored the need to ration.

Paul Gallagher in the BMJ reports: BMA chair warns: ‘Deal or no deal, Brexit will be bad for the NHS’  Dr Chaand Nagpaul tells i a no deal Brexit would be disastrous, leading to potentially thousands of EU doctors leaving the service.

Whoever wins the Tory leadership contest and takes the UK out of the European Union will be responsible for damaging the NHS, the head of the British Medical Association (BMA) has warned.


Dr Chaand Nagpaul told i that a no deal Brexit would be disastrous for the health service, leading to potentially thousands of EU doctors leaving the country. Even if either Boris Johnson or Jeremy Hunt secures a new deal with Brussels, which is supported by Parliament, European health staff will still consider walking away among other risks to the NHS, he said.


Asked whether it matters who becomes Prime Minister next month, Dr Nagpaul said: “I think the important thing is to focus on what this is going to mean in terms of the impact of the NHS and admittedly that will depend on whether we leave with a deal or not. Although there’s still the option of not leaving at all, but nevertheless.


“The most immediate issue for us, and what will affect the NHS, is that we have about 12,000 Europeans who work here. We know from our own figures that 1 in 3 intend to leave if we leave the EU without a deal – and that’s because they want to feel stable and secure and they already feel uncertain about their future.


“In an NHS where we have 10,000 doctoral vacancies and where the impact on services that is already being felt by the profession and patients, we can’t afford to lose a single doctor let alone several thousand.”

Dr Nagpaul said that a no deal Brexit would effectively end the mutual recognition of professional qualifications, which means that doctors from the EU can come here to work immediately.
“So not only might we lose the doctors who are here, but the doctors that would be coming here will dwindle in number because there would be new barriers – from examinations to other restrictions for them to enter the UK to work. That would be the worst situation.

Biggest impact

“On top of that, other effects on the NHS, such as the regulations of medicines, the movement of specialist drugs like radioisotopes, there will be impact to us in a lot of those areas too. Reciprocal healthcare which we take for granted, that will also cost us considerably if UK residents living in the EU are no longer covered and in terms of those travelling to the EU.
“Even in a Brexit deal, if there is one, we run some of those risks because the deal is only going to be applicable in a couple of years and the uncertainty for EU doctors is there. We’re still very worried [in that scenario] EU doctors will leave the UK and there will be less incentive for anyone to come and work here.”
Speaking to i on the eve of the BMA’s annual conference, which begins in Belfast on Monday, Dr Nagpaul said the UK remains far behind the rest of Europe when it comes to the number of doctors per head: 1 doctor per 366 people here compared to an EU average of 1 in 288.
“So we are trying to provide a service similar to other nations but tens of thousands of doctors short. It just isn’t possible to square that circle.”



The future of the NHS has been linked to both candidates for Number 10. Mr Hunt said in recent leadership debates he – as Health Secretary – was responsible for securing the extra £20bn funding settlement for the NHS, while Mr Johnson infamously claimed during the referndum that leaving the EU will enable the UK government to spend an extra £350m a week on the health service instead.


Dr Nagpaul would not be drawn on either claim, but in what will be seen as a thinly-veiled attack on the pair he said that the public has had enough of political rhetoric that fails to match reality.


“We’ve got a very good system, and a system we can be proud of, but what we need is the resourcing that matches that which a comparative developed nation takes for granted.


“What I hope and believe is that the public have become much wiser to the fallacy of some of the political pronouncements we’ve had over the last decade. The public expect a more honest government. They’re experiencing the realities of a pressurised health service. The public understand that.


“They recognise it’s the government’s duty to enable and staff the NHS to provide good quality care. A lot of it is about stripping out the political motives that have plagued the NHS for too long.”

Workplace bullying

The future of the NHS in a post-Brexit world is expected to be among the main talking point among members at this week’s conference. Several motions will be also be debated on the widespread problem of workplace bullying – some 4 in 10 doctors reported experience of bullying and harassment in a recent major survey by the BMA.


It is an area the BMA has focused on under Dr Nagpaul’s leadership since he became council chair in July 2017, hosting a one-day summit on the problem last November where several recommendations emerged on how each trust can clamp it down.


Another motion calls to remove the postcode lottery that restricts NHS funding for IVF and other NICE evidence based recommended procedures in some areas, something Dr Nagpaul supports.


“I think it’s really important to remember that we call ourselves a National Health Service. That word ‘national’ is really important, because it defines the origins and principles of our health service which is one of fairness, one of insuring patients receive care according to need not who they are and because it’s national it’s delivered wherever you live in the UK, that you have access to comprehensive services.

“The current reality where different parts of the country takes different approaches, which means a patient may get a treatment like IVF in one part but not in another is not acceptable. It’s not in keeping with the principles of the NHS, it’s not fair and not therefore a national health service. That’s not keeping in what we stand for and not what the BMA would support.”


Dr Nagpaul is yet to receive a reply from Theresa May to the letter he sent her two weeks ago on “punitive” pension reforms which the BMA believe will exacerbate the NHS workforce crisis by forcing staff into early retirement, although he believes actions will be more important than words. He remains upbeat about the future, despite the mounting challenges facing the health service.


“The NHS is as a system remarkably cost effective and an organisation that is rooted in making best use of the public resource. The values and principles on which it was founded are as relevant today as they were then.”

This entry was posted in Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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