A team of researchers reports that the United Kingdom’s 2016 vote to leave the European Union was associated with sharp shifts in where the country recruited clinicians and with worsening physician shortages in England. The analysis, published in JAMA Health Forum, found an immediate fall in doctors and nurses arriving from EU countries after the referendum, and concluded that later increases in recruitment from non-EU countries did not prevent a rise in physician vacancies within the National Health Service.
The research team drew on health workforce records spanning 2008 to 2019. Their dataset included more than 418,000 physicians and 358,000 nurses who migrated to Organization for Economic Co-operation and Development (OECD) countries. Investigators used quasi-experimental approaches — notably a controlled interrupted time series design — to compare migration trends in the UK with those in 32 high-income OECD countries before and after the 2016 referendum.
Participating institutions named in the report include the Harvard Pilgrim Health Care Institute, Massachusetts General Hospital, London South Bank University and the WHO Europe Human Resources for Health Group. The study’s findings were summarised by the Harvard Pilgrim Health Care Institute on 23.08.2026.
According to the study, the Brexit referendum was associated with an immediate decline in incoming clinicians from EU countries in 2016: about 825 physicians and 2,771 nurses fewer arrived that year. In the years after 2016, immigration from non-EU countries rose, estimated at an additional 3,110 physicians and 1,437 nurses annually. Despite those increases, the analysis reports that England’s NHS experienced an estimated rise of 383 physician vacancies, and overall nurse immigration declined.
Those figures form the core evidence the authors use to link the referendum and ensuing uncertainty with changes in the composition and adequacy of the UK health workforce.
Lead author Tarun Ramesh, a research fellow at the Harvard Pilgrim Health Care Institute, summarised the overall pattern: the referendum “changed where the United Kingdom recruited its health care workforce, with fewer clinicians arriving from Europe and more from countries in Africa and Asia.” Ramesh added that these shifts were insufficient to stop growing physician shortages in the NHS.
Senior author Hao Yu, an associate professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, emphasised the sensitivity of health workforce migration to policy signals. The researchers note that migration from EU countries began to fall well before the UK’s formal withdrawal from the EU in 2020, indicating that uncertainty about future immigration rules influenced clinicians’ decisions to move.
The study highlights two related issues for health system planners and policymakers. First, change in migration sources can alter how quickly and reliably workforce shortfalls are filled. Second, even when recruitment from non-EU countries increased, that rise did not fully replace the lost inflow from Europe and was accompanied by a net increase in physician vacancies.
The authors suggest that policymakers weighing immigration restrictions should consider potential impacts on health care staffing and access to services. They also flag the ethical and practical concern that increased recruitment from countries in Africa and Asia could place additional strain on health systems that may already be experiencing their own workforce shortages.
The findings intersect with other analyses linking health worker shortages to worse outcomes and greater pressure on clinical staff. Related reporting on workforce stressors — such as rising physician burnout and links between staffing shortfalls and excess deaths — frames the Brexit-related migration changes as one among several forces testing the NHS’s capacity.
However, the study’s focus is narrow and empirical: it examines migration flows and vacancy estimates using international comparisons and time-series techniques to infer the association between the referendum and subsequent workforce patterns.
The article reports the study’s methods and headline numeric findings but does not provide detailed year-by-year breakdowns or regional NHS vacancy trends within England beyond the aggregate estimate of an increase of 383 physician vacancies. The piece does not specify how long it would take for non-EU recruitment gains to match pre-referendum EU inflows in full, nor does it report on the roles, specialties or levels of seniority of the clinicians involved.
The study’s authors recommend that policymakers take account of how immigration policy signals can affect health workforce migration. The timing of the decline — beginning before the UK’s formal exit in 2020 — is presented as an important lesson for workforce planning: uncertainty alone can reshape recruitment patterns. The researchers also point to the need to balance national staffing goals with the potential effects of international recruitment on source countries.
Readers should note the study’s publication in JAMA Health Forum and the institutional affiliations behind the analysis. The Harvard Pilgrim Health Care Institute is listed as the source for the summary released on 23.08.2026.
The 2016 Brexit referendum coincided with a measurable drop in EU-trained doctors and nurses arriving in the UK and a shift toward recruitment from non-EU countries. Despite those replacement flows, the analysis reports a net worsening of physician vacancies in England’s NHS, and it finds that migration patterns began changing before formal withdrawal, indicating that policy uncertainty had real effects on health workforce movement.
Personalise this feed
Your specialty. Your sources. Your digest.
All set up in under 2 minutes.
Personalise this feed
Your specialty. Your sources. Your digest.
All set up in under 2 minutes.