J. Meirion Thomas was until recently a Professor of Surgery and Consultant Surgeon in the NHS.

Theresa May has confirmed that limiting migration from the European Union will be a red line in the Brexit negotiations. To achieve this, she favours the introduction of a rigid work permit system to stop EU migrants coming to Britain without a job.

Whatever is decided, there must be no compromise on correcting the harm done to the NHS by uncontrolled migration from the EU. As of January 2016, the population of the European Union was 510.1 million and currently, all of those people, if they chose to exercise their Treaty rights to reside in UK, would, from the moment of arrival, be entitled to full and free NHS care, without the exclusion of pre-existing conditions. Needless to say, this automatic right is not offered or reciprocated elsewhere in Europe.

This happens because of the Department of Health’s definition of “ordinarily resident” (OR) status, and because free NHS care is dependent on residency rather than contribution. This is contrary to any other European country with a healthcare system comparable to ours. The Department of Health’s document “Guidance on implementing the overseas visitor hospital charging regulations 2015” states that a person is defined as ordinarily resident “if that residence is lawful and for settled purposes as part of the regular order of their life, whether of long or short duration”.

Furthermore, “a person can be ordinarily resident in more than one country at once” and “it is perfectly possible to be ordinarily resident from the day of arrival providing that person has taken up settled residence”. This definition of OR provides an incontestable loophole for any EU health tourist to gain access to the NHS. I saw this happening on many occasions in my role as a specialist cancer surgeon. For some migrants with a pre-existing condition, access to free, high quality health care, unavailable in their native country, is the reason to relocate to UK.

This concept of ordinarily resident was not imposed on us by EU decree. It was created in Whitehall and is not contained in any Act of Parliament. It was extrapolated from House of Lords judicial reviews, all delivered before 1983, and relating to education and immigration disputes. It must be reversed as part of Brexit. Migrants from the EU should be working and make National Insurance contributions for a minimum period of time, yet to be defined, before being entitled to any welfare benefits, including access to the NHS.


During the referendum debates, we were reminded that the NHS is heavily dependent on foreign trained doctors, about half of whom come from EU countries. Sadly, for decades, 30-40 per cent of all new doctors registering with the General Medical Council (GMC) are foreign-trained, because we don’t train enough doctors of our own. Every year there are several thousand disappointed school leavers with the required A-level grades who can’t obtain a place in a British medical school. This is a tragic loss of resource for the NHS and amounts to a governmental admission that it’s cheaper to import doctors than to educate them. Should the UK be so continuously dependent on so many foreign-trained doctors?

To register with the GMC from outside the EU, candidates must pass the Professional Linguistics Assessments Board (PLAB) examination, which is intended to test competence and communication skills. The pass rate for PLAB (2011 – 2015) varied between 35 per cent and 69 per cent and the website confirms that some candidates took the exam more than four times. Despite this attempt to maintain standards and patient safety in the NHS, it was reported in 2014 that only 20 per cent of PLAB graduates reach the median standard of British-trained graduates in the two most common post-graduate examinations. For this and other reasons, the GMC plans to raise the pass mark for PLAB.

PLAB is not a requirement for EU doctors because primary medical qualifications are reciprocally accepted meaning that European doctors are entitled to register with the GMC without any checks. The entry criteria for some European medical schools are not as stringent as our own and the GMC has no control over their standards, such as hours and quality of tuition or their curriculum. Therefore, as part of Brexit there should be a PLAB-like examination for GMC applicants from within the EU.

For these reasons, before Article 50 is triggered, there must be rigorous and well-rehearsed policies in place to protect the NHS and its patients. There should be no compromise on the two issues discussed in this article. These measures will help to reduce capacity pressures in the NHS, improve standards of care and save taxpayers’ money. The amount saved should be used to train more British medical students.