NHS European Office

The key risks of no-deal Brexit


What is a no-deal Brexit?

The UK left the EU on 31 January 2020 after ratifying the Withdrawal Agreement with the EU. Unless an extension is agreed, the UK has to negotiate a framework for a future relationship with the EU before the end of the transition period on 31 December. If instead, the UK leaves the EU without a deal, the UK would become a third country, with no withdrawal agreement or framework for a future relationship in place between the UK and the EU. The UK and the EU both state that this is an unlikely but possible outcome of the current negotiations.

What would happen in this case?

As a third country, the UK would no longer be eligible for participation in EU organisations, networks and collaborative programmes. The UK is likely to deal with this situation by looking to adapt or create autonomous domestic systems, in the short-term at least, to mirror, or align with existing EU standards in order to maintain continuity and avoid disruption. They then will aim to develop new agreements and systems in the longer-term.


This infographic from the Brexit Health Alliance highlights the key areas for health that will be affected if the UK finds itself in a no-deal scenario. Further detail on the key areas can be found below.

Examples of impact on the NHS


In the short term, there could be delays in importing medicines due to new border arrangements, requiring stockpiling and good supply chain management to ensure there will be no shortages. The creation of a medicines authorisation regime separate from the rest of the EU could lead to further delays.

The UK could be excluded from the European Rare Diseases Network. This raises particular concerns regarding orphan medicines (treatments that aren’t commercially viable for the UK market alone) as to whether such medicines will even reach the UK market, which will have implications for the treatment of rare diseases.

Reciprocal healthcare

The ending of reciprocal healthcare agreements could disrupt patient care, effectively leaving UK nationals in the rest of the EU currently in receipt of medical cover through the S1 scheme without health care (see the updated Government guidance from 28 January 2019 and update from 28 August 2019). The arrangements in place for the European Health Insurance Card, which allows travellers to access the same level of state-provided emergency treatment as a resident of the country they are visiting, could also come to an end.

Public health

There may be a weakening of the UK’s response to pandemics and an increase in the chances of diseases spreading as we lose partnerships with key EU bodies, such as the European Centre for Disease Prevention and Control.


New immigration rules could affect the ability of the NHS to recruit doctors and other medical staff from the rest of the EU, and there may be changes to current rules around the mutual recognition of medical qualifications.

Find out more about how to prepare your NHS organisation for a no-deal scenario.

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