Brexit—What can dentistry expect?
Time flies, doesn’t it? It seemed that the British government and the EU had all the time in the world to agree to terms for leaving and a potential future trading arrangement, yet here we are with a little over five months before the United Kingdom of Great Britain and Northern Ireland will be leaving the EU.
On 29 March 2019, the UK could move into a transitional period (which may be extended), off a cliff edge or anything in between. Nobody knows yet what the final deal—if there is one—will look like, although as of last week, the deal is apparently “95 per cent done”, according to Prime Minister Theresa May. It is somewhat likely that the entire issue will turn into a huge fudge and the UK will stay within the European Economic Area (EEA) agreement, which governs Norway, Iceland and Lichtenstein.
But what will Brexit mean for dentistry in the UK? The National Association of Specialist Dental Accountants and Lawyers (NASDAL) has taken a look at some of the possibilities.
Increased funding for the NHS?
We’re not sure how many people believed that Brexit would create an extra £350 million a week to fund the NHS—almost all commentators agree that the figure was, at best, based on selective data. However, with an end to austerity possibly in sight, there could be greater funds available, which could possibly benefit dentistry. Leaving the EU could also see flexibility regarding value added tax (VAT). This could see certain items being reduced or zero-rated and even VAT on professional fees being reduced.
The UK will also be able to create its own employment rules and regulations—these could be more relaxed than those of the EU.
It is likely that more stringent border controls will discourage foreign dentists from working in the UK. Many practices are already feeling the pinch with a lack of associates to fill their chairs. Large dental corporations are particularly dependent on recruiting their workforce from EU member states; this will pose a particular problem because dentists who qualify from outside the EEA have to sit the Overseas Registration Exam. Some analysis suggests this will discourage many from making the move to the UK to begin their careers. A third of all persons registering for the first time with the General Dental Council (GDC) in the UK over the last three years graduated outside the UK.
However, a review of the GDC register figures showed that the number of EEA-qualified dentists had been falling prior to the Brexit vote in 2016 and since has seemed to be broadly flat. Indeed, the number of EEA dentists working in the UK has already slowed—there have been fewer EEA dentists leaving the register since the Brexit announcement than in the two years prior.
To prevent a skills shortage, it would be ideal if EU-/EEA-qualified dentists were recognised as part of any deal to ensure that those already here are reassured and to attract new dentists.
If you have had to deal with NHS tenders and contracts and found them to be particularly arduous, then you may have heard from the NHS or a number of other regulators that they have to follow European tendering rules. Under Brexit, these tendering rules would no longer apply and this could result in a much simpler process. However, there is no guarantee that the UK won’t merely replace these rules with its own—the EU does not have a monopoly on bureaucratic and poorly drafted legislation!
Trade and regulation
The UK reducing its access to European knowledge-sharing bodies like the European Medicines Agency could lead not just to the loss of jobs but also to a lack of leading-edge participation in technology, treatment and medication.
Potentially, increased tariffs on goods imported from the EU could see practising dentistry become more expensive. Leaving the customs union (a move that currently hangs in the balance) will lead to increased import tariffs, increasing practice costs for dental equipment and materials and also personal items.
In the longer term, if trade deals are struck with countries around the globe—and the EU too, in due time—a resurgent UK economy could deliver a much-needed boost to private dentistry and an increased tax take for investment in NHS dentistry.
Many were affronted by the EU’s red tape and this will possibly lead to a scaling down of regulation of the medical and dental industries. Most recently, the EU announced a plan to reduce the use of mercury in dental amalgam. Mercury can be toxic to humans even in small doses, and amalgam remains its most popular application. Many practices are equipped with amalgam separators to lessen the adverse effects, but the goal of the EU is to eliminate the use of dental amalgam by 2030. What will an independent UK with an ever-expanding health bill decide to do?
The EU also enjoys preferential tariff treatment with a number of non-EU countries and is able to import a range of medical equipment at 0 per cent duty. It is possible that the UK could negotiate similar arrangements for life after Brexit, but that’s to underestimate the complexity of striking such trade deals.
Regrettably, there isn’t a solid conclusion at this point. This article obviously explores a number of what ifs, and though we have tried to consider various eventualities, we cannot be certain exactly what will happen. However, it is important as the dental profession that we consider the possibilities so that we can be as well informed and prepared for all eventualities as possible.
About the authors: Alan Suggett is the NASDAL media officer and a specialist dental accountant and partner in accountancy firm UNW, and Chris Baker is the NASDAL PR officer.