The United Kingdom's decision to leave the European Union (EU) was associated with major changes in health care worker migration and increased shortages of physicians in England, according to a new study published in JAMA Health Forum.
It said the Brexit policy led to a sustained decline in EU-origin health care worker immigration, which was partially offset by recruitment from non-EU countries.
However, this substitution did not prevent increases in physician vacancies and persistent nursing shortfalls, underscoring the sensitivity of health workforce supply to migration policy.
The UK voted to withdraw from the EU in June 2016, triggering a process culminating in the formal exit from the EU in January 2020.
The 2016 Brexit referendum introduced policy uncertainty and raised concerns about new restrictions on migration from the EU.
Researchers from the Harvard Pilgrim Health Care Institute, Massachusetts General Hospital, London South Bank University and the WHO Europe Human Resources for Health Group analysed health workforce data from 2008 to 2019, including more than 418,000 physicians and 358,000 nurses who migrated to Organisation for Economic Co-operation and Development (OECD) countries.
The study aims to highlight how anticipation of Brexit affected immigration of health care workers and NHS workforce shortages.
It focused on six primary outcomes using the annual OECD data: EU origin physician inflow to the UK, non−EU origin physician inflow to the UK, overall physician inflow to the UK, EU origin nurse inflow to the UK, non-EU origin nurse inflow to the UK, and overall nurse inflow to the UK.
Historically, the UK’s membership in the EU has allowed for largely unrestricted migration between the UK and other EU member countries. As a result, the National Health Service (NHS) had benefited from the health care workforce from the EU.
Countries with the largest relative decrease in the annual number of physicians immigrating to the UK between 2015 and 2019 were Austria (−52%, from 33 to 16), Italy (−34%, from 328 to 215), Latvia (−33%, from 24 to 16), and France (−27%, from 48 to 35), respectively—all are EU countries. Similar trends were identified among nurse migration patterns.
Countries with the largest relative increase in migration to the UK during the same period were Egypt (588%, an increase of 191 to 1,314), Malta (521%, 38 to 236), Nigeria (478%, 233 to 1,347), and Sudan (494%, 82 to 487).
The study confirmed "an anticipatory effect" of uncertain migration policies caused by the referendum, which had implications extending beyond Brexit.
"As other countries enter and exit free movement zones, such as the EU, or implement restrictive migratory policies, they should consider both the anticipatory and unanticipated consequences on the health workforce and on patient health outcomes."
