Brexit: What are the consequences?

Issue: June 2016

OSN Europe Edition posed the following question: How do you see Brexit impacting ophthalmology in Europe or the UK?

Richard B. Packard

I think it is much too early to judge. In the short term, there will be no changes. The so-called bonus for the NHS of £350 million that someone said would appear by leaving the EU will never materialize. This has now been admitted by one of the senior Brexit politicians. We do not know whether the UK will be able to access the single market and avoid tariffs for British ophthalmic products going to Europe. As for the medical personnel who come from the EU or outside and are essential for the functioning of the NHS, again nothing is yet clear. Things may revert to how they were before the UK entered the European Economic Community, with large numbers of doctors and nurses coming from ex-colonies such as India. With the pound having lost value, all capital equipment and items such as IOLs, if they come from the USA, will be much more expensive. On the other hand, items produced in the UK will become much cheaper if exported to the USA. We are in for an extended period of uncertainty.

Richard B. Packard, MD, FRCS, FRCOphth, Director of Arnott Eye Associates, London, OSN Europe Edition Board Member

In my opinion, we should not be overly alarmed by Brexit. The UK is an island and was not in the Eurozone nor in the Schengen Area. It has always been halfhearted about EU integration, reflecting a historically ambivalent attitude to Europe. I do not see great changes on the horizon.

Paolo Lanzetta

The UK has one of the best education systems in the world and historically has offered the entire world opportunities for studying and training. The quality will not change because being devoted to education and investing in education are core values of British culture and identity. The flow of young students and trainees from all over the world will continue, and the doors of UK universities will remain open, as they have always been. As Europeans, we might lose the privileges we had over non-Europeans, and it might happen that qualifications obtained in the UK are no longer recognized in EU countries. But this is the worst possible scenario, which is only possible if the EU lets self-destructive revengeful attitudes prevail over constructive agreements.

Ophthalmology, science and research have no boundaries and need international partnership, investments and resources. Where common projects have started, they will continue, Brexit or no Brexit.

Paolo Lanzetta, MD, Associate professor and head of ophthalmology, University of Udine, Italy, Chairperson of OSN Europe Edition Board

David Spalton

It is really difficult to know what the consequences might be. I would not imagine that Brexit will lead to much change within the EU, and the changes will be more limited to the UK itself. It is not of course going to change demand, but there are financial implications that could affect provision of services. Much of our equipment and consumables are manufactured outside the UK and imported, and the fall in the value of the pound will make these more expensive, leading to an increase in cost pressure on an already financially stretched service. This may lead to a more restrictive choice of consumables, such as viscoelastics and IOLs, with providers looking to enforce lower cost options. The health service relies heavily on a large contingent of overseas doctors and nurses who are essential, and this will continue to be the case; it would be political suicide to change this so I do not see any change here. The effect on British research and development is completely inestimable, but if there is a longer-term reduction in the value of the pound, it could, in fact, make it more beneficial for companies to move more R&D to the UK. Overseas travel will become more expensive, which might be reflected in a more selective approach for attendance at conferences and meetings.

David Spalton, FRCS, FRCP, FRCOphth, President of the European Society of Cataract and Refractive Surgeons, Consultant ophthalmic surgeon at St Thomas’ Hospital, London

Jan Tjeerd de Faber

The news came as a shock to us during the 2nd European Meeting of Young Ophthalmologists in which I participated as president of the European Society of Ophthalmology. However, the SOE is for all European countries, they are all represented in our board, and we will continue pursuing our mission to help ophthalmology thrive in all these countries, whether they belong to the European Union or not. So, the SOE is united, but I think we might have a divided kingdom. Problems may arise for British citizens who would like to spend some time working in European countries; they will have more of a hurdle, and on the other hand, it might be a lot more difficult for our young people to get training in the UK, to have access to one of the best European centers such as Moorfields. I do see some problems, but problems are there to be solved.

Jan Tjeerd de Faber, MD, President of the European Society of Ophthalmology, Erasmus University, Past chief of medical staff of the Rotterdam Eye Hospital, Rotterdam, The Netherlands, OSN Europe Edition Board Member

Andrew Scott

The vast majority of fellowship opportunities exist in the UK. Until recently, whoever got a certificate of completion of training in an EU country was entitled to register with the UK General Medical Council. This will no longer be possible. EU members will lose the advantage they had over overseas applicants, and this will result in a huge disadvantage because most residency training programs in Europe are far from providing the bare minimum of surgeries required by the UK. We will have to compete with the rest of the world and will have no chance because in other parts of the world, such as Australia and New Zealand, residents perform much more surgeries. Looking at the positive, I hope that this will stimulate European countries to raise their basic level of surgical training and to organize more fellowships in Europe.

Andrew Scott, MD, FRCOphth, MRCSEd, PhD, Fellow at Moorfields Eye Hospital, London, Chair of SOE Young Ophthalmologists, OSN Europe Edition Board Member

There are two considerations I would like to make. First, the outcome of the UK’s EU referendum lays bare the difference between generations. The past European Board of Ophthalmology had to face the attitude of the older generation of British ophthalmologists who refused to take part in the EBO exam because the standard was, as they said, below what they did in their country. On the other hand, there is now a considerable number of young ophthalmologists who are eager and willing to sit the EBO examination and are very focused on what is going on outside the UK. The different attitudes of these two generations have clearly emerged in the voting behavior in the UK. A second consideration comes from the primary aim of the EBO, which is to harmonize ophthalmology throughout Europe and make it strong, and Europe, for me, includes the UK — there is no question about that.

Peter J. Ringens

Our approach now is that we are not going to be taken hostage by the xenophobe voters. I wish them good luck if they want to keep staring at their own belly button, but the focus of EBO is on the younger generation that is looking out and wants to create a strong ophthalmology field and be part of it. Therefore, if politicians leave us the room to acknowledge their diploma all over Europe, I invite the UK candidates to keep sitting the EBO examination. From our point of view, nothing changes. We want to include the British YO in the project of European ophthalmology for the future. Our vision is very future-oriented, very young generation-oriented, and this view is shared by the American Academy of Ophthalmology, which has now recognized the enormous changes that EBO is making in ophthalmology in Europe and will acknowledge this with an award at the upcoming meeting. We are keeping our focus on this vision, and Brexit is not going to come in our way.

Peter J. Ringens, MD, PhD, FEBO, President of the European Board of Ophthalmology, Head of Department of Ophthalmology, VU Medical Center, Amsterdam, The Netherlands

Sathish Srinivasan

In the UK, we do get a lot of European trainees who come and work with us. As EU members, it was easy for them to register with the General Medical Council and practice medicine in the UK. Whether this will change, it is something the GMC will have to work out. There are, on the other hand, UK doctors applying for research fellowships in Europe, and their future possibilities and conditions will need renegotiation. The UK might come to individual agreements with countries, but this is just a guess. In Scotland, which strongly wanted to be part of the EU, there is a feeling of uncertainty, and we are afraid of what might happen to our clinics and research projects. Some of the EU grants, such as the ESCRS grants, were a substantial help, and we do not know how the ESCRS is going to react to the UK closing the door to Europe. Brexit opens up a lot of questions, and politicians are not prepared for the answers because nobody really expected that this was going to happen. Now that it has, it will take time for each governing body to decide what kind of arrangement they want to have. We are feeling very unsettled.

Sathish Srinivasan, FRCSEd, FRCOphth, Consultant ophthalmologist at Ayr and Crosshouse University Hospitals, Ayrshire, Scotland