The free movement of European citizens to live and work within the European Union (EU) is one of the fundamental pillars of the European single market. Directive 2013/55/EU updates the framework within which doctors, nurses and other registered professionals can migrate freely between EU member states to practise their profession.
The law covers the rules to be applied by regulators on (for example) assuring language competence, an alert mechanism to warn regulators in other member states of practitioners subject to sanctions, fast track registration based on mutual recognition of professional qualifications, agreed minimum education and training requirements for mutual recognition, and encouragement of continuing professional development.
How might Brexit affect practitioners wising to move from the EU to the UK and vice-versa?
During the transition period (due to end on 31 December 2020) following the Withdrawal Agreement between the UK and EU, the situation regarding professional mobility will remain unchanged. The likelihood is that the UK and EU will wish to continue with reciprocal arrangements similar to the existing ones after the transition period ends, but the nature and scope of any arrangements will of course depend on the details of the future relationship between the UK and EU and the extent to which it diverges from the status quo.
From the point of view of recruitment and retention, it is in the interests of the NHS to be able to continue to recruit EEA-qualified practitioners to address staffing shortages. For patient safety reasons, we would also wish regulators to be able to continue to share information on “rogue” practitioners, if possible through the pan-EU IMI alert system established under the Directive.
Minimum education and training standards
Regulatory bodies across Europe agree that the minimum education and training standards specifying the duration and in some cases the competences of training for the health professions set out in the EU Directive need to be regularly revised and updated in the light of scientific, technological, social and cultural change. Such updating is welcome but given the wide divergence between Member States in the length, level and content of curricula it can also be sensitive, given that education and training is a Member State not an EU competence.
The European Commission has commissioned a consultancy, Spark Legal Network, to map Member State minimum training requirements for knowledge and skills, to see where these may be disproportionate and/or need updating in the light of professional, scientific and technical developments. The first profession to be reviewed in this way is the nursing profession – see the project description here. The consultants held a livestreamed stakeholder workshop in 2019, to which the NHS European Office input through our membership of HOSPEEM. The discussion paper prepared for the workshop can be found here.
The study is currently being finalised and will be published in 2020. The Commission will then decide whether or not to proceed with legislation (a “delegated act”) to make changes to the existing standards.
Even after the UK has left the EU we will want to monitor and if possible influence this process as:
(a) professional mobility between the UK and EU won’t stop just because the UK is no longer an EU Member State, and
(b) decisions will need to be made about the extent to which the UK continues to align to, or diverge from, the agreed EU minima.
Directive EU/2018/958 on a proportionality test before the adoption of new regulation of professions attempts to curb “disproportionate” regulation by Member States which restricts the freedom of professionals to provide services across borders. As this Directive was passed in 2018 and must be implemented in national law by summer 2020, it will still apply in the UK after Brexit at least for any transitional period.
Before introducing legislation regulating new professions or restricting the conditions of access to or pursuit of existing regulated professions Member States must assess the proportionality of these proposals. However, “where provisions….concern the regulation of healthcare professions and have patient safety implications, MS shall take account of the objective of ensuring a high level of human health protection”.
Member States will be obliged to share their proposals and the evidence for proportionality with the Commission and other MS, and the Commission will report on the effectiveness of the Directive after five years (January 2024).
We used our influence through HOSPEEM, CEEP and HOPE to amend this legislation, as we were (and remain) concerned about how it may affect the ability of the UK to regulate “new” professions such as nurse associates in future, or to tighten up requirements e.g. for CPD. The NHS European Office will continue to engage in this way with this process as it may still have implications for health professionals joining the NHS workforce from the EU after Brexit.