The Department of Health and Social Care (DHSC) issued guidance to NHS providers in England on issues linked to a potential no-deal Brexit just before Christmas.
EU Exit Operational Readiness Guidance, accompanied by a
letter from the Permanent Secretary at the Department of Health and Social Care, Chris Wormald, considers seven priority areas, informs of some government preparations in these areas and requires providers of health and social care (including NHS dental contractors) to undertake certain actions to review their preparedness for a potentially problematic situation at the end of March 2019 and beyond.
The guidance document notes that information is currently being gathered better to assess potential impacts in various areas. It explains the framework for reporting and dealing with potential shortages and other issues. The establishment of the Operational Response Centre between DHSC, NHS England and Improvement, and Public Health England (PHE), which will monitor issues in England and also work closely with the devolved administrations, is detailed. Furthermore, an Operational Support Structure for EU Exit is being established to enable rapid support on emerging local incidents. Contacts for seven regional leads (North East, North West, Midlands, East of England, London, South East and South West) are given in the guidance document.
The seven areas of priority that have been established, and where provider action is required as necessary are:
- Supply of medicines and vaccines
- Supply of medical devices and clinical consumables
- Supply of non-clinical consumables, goods and services
- Reciprocal healthcare
- Research and clinical trials
- Data sharing
The document notes that other areas not currently outlined are also being considered but does not provide further detail. The text explains current knowledge and assumptions on how a no-deal exit would affect these areas, current government discussions with relevant organisations, and a note to expect further guidance as the detail becomes clearer.
Actions for providers
The guidance appears to ask all providers of NHS services, including dentists, to undertake certain defined actions for no-deal planning, including detailed risk assessment, business continuity planning, naming a ‘senior responsible officer’ and making them known to the EU Exit Team.
In conversation with NHS England and the Department of Health, it has been suggested, however, that this approach may not be required for individual dental practices at the present time.
What is likely instead is that a formal approach will be made to LDCs to collect indicative local information on risks and considerations being undertaken.
We are awaiting clarification of the situation from NHS England and will update this page with any new information.
Dental practices are not currently asked to undertake any of the actions listed, although consideration and awareness of the guidance is advised.
All providers of NHS services, including dentists, are asked to do the following:
- Undertake a risk assessment associated with EU Exit by the end of January 2019, considering the seven priority areas (and other issues where appropriate), potential increases in demand, and locally specific risks
- Continue business continuity planning in line with current legal requirements and bearing in mind the new guidance; planning should be completed by the end of January 2019
- Test existing business continuity plans against EU Exit risk assessment scenarios by the end of February 2019
- Name a 'Senior Responsible Officer for EU Exit preparation' and identify them to the regional EU Exit team.
- Participate in exchanges of information where requested and possible
- Consider your organisation's reliance on transfers of personal data from the EU/EEA to the UK which is likely to be affected. Specific advice from the ICO is highlighted.
- Record costs (both revenue and capital) incurred in complying with the guidance.
Other aspects of the guidance
Reporting: The document has sections around communications, reporting, assurance and information provision, explaining how providers should understand and raise awareness of the guidance to staff and colleagues. Regional EU Exit teams are likely to be in touch to discuss progress on the risk assessment and business continuity planning. Local meetings with colleagues around these issues are also encouraged. It is not clear how dental practices will interact with these processes and Local Health Resilience Partnerships, Local Resilience Forums and Local A&E Delivery Boards, and local guidance might need to be requested on these matters from the NHS Area Team.
There is an explicit directive from the DHSC not to stockpile medicines beyond business as usual levels, and not to provide longer prescriptions for patients. It also advises to promote messages of continuity and reassurance to patients, and to discourage them from stockpiling medicines at home. It is noted that any unusual ordering or prescribing patterns will be investigated.
The accompanying text seeks to assure that new freight capacity arrangements will prioritise the swift delivery of medicines and medical devices, and that cooperation with the pharmaceutical and other industries have been positive. The BDA is aware of significant concerns around the supply of medicines in particular under a no-deal scenario. Practices should take into account the DHSC advice on stockpiling, but will also want to ensure necessary supplies so as to avoid potential shortfalls below 'business as usual' levels. We are also raising with the NHS the necessity to invoke force majeure provisions in case of serious shortages.
The document encourages providers to assess whether the number of EU staff members is likely to reduce over the next few months, and notes that the
EU Settlement Scheme should be promoted once it opens fully (the pilot for health professionals is now closed). EU nationals will be able to apply from 21 January and must make their application before June 2021.
Applications for registration received by UK regulators before 29 March 2018 will be dealt with under current arrangements. No specific information is provided in this document on the system for the recognition of professional qualifications after 29 March 2019 if there is no deal.
However, new draft amendment regulations have been published (not finalised) in the "European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018", which suggest that EEA qualifications will continue to be registered for around two years while the Secretary of State will be tasked to review the operation of the new provisions and report on them in due course; this will be on the basis of where the qualification was gained, not on the basis of the nationality of the applicant.
BDA members are advised to
read the document in full, consider how it affects them and discuss with their LDC and local NHS and EU Exit Team the activities mentioned in the text.
We have an advice sheet on
risk assessment and business continuity planning available free for BDA members - for further information, please email