Description of the sector

The market provision of medical services includes the following three sub sectors:
a. The ophthalmology sub-sector, which combines provision of medical services and retail alongside provision of services to the NHS.
b. The dentistry sub-sector, which provides private medical services alongside NHS services, as well as cosmetic dentistry, which is not available on the NHS.
c. The community pharmacy sub-sector, which includes provision of retail alongside provision of NHS services. This sub-sector includes retail driven high street chains and an independent sector.

The current EU regulatory regime

The protection and improvement of human health is an area in which the EU is generally limited to supporting competence. Article 168(7) in the treaties of the European Union expressly recognises that Member States are responsible for their definition of health policy, management of health services and medical care and the allocation of the resources assigned to them.

In certain aspects relevant to health, the EU shares competence with the Member States. A group of shared competences relating to common safety concerns was introduced in the Treaty of Amsterdam and extended by the Treaty of Lisbon. Article 168(4) makes provision for the Union to adopt measures relating to: the quality and safety of organs and blood; certain measures in the veterinary and phytosanitary fields and medicinal products and medical devices. Similarly, Article 168(5), which was extended in scope by the Treaty of Lisbon, provides EU competence to adopt certain incentive measures designed to protect and improve human health.

EU public health bodies contribute to our ability to share data, expertise, exchange information and collaborate closely. These include the European Centre for DiseasePrevention and Control (ECDC), agreed under Article 30 of Regulation (EC) 851/2004 and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), agreed under Article 21 of Regulation (EC) No 1920/2006.

The International Health Regulations 2005 (IHR) require all countries to report cases of disease and other health threats. The UK also participates in World Health Organisation (WHO) public health activity, both through WHO-Europe and directly with WHO headquarters in Geneva, and is a member, along with other G7 countries, of the Global Health Security Initiative (GHSI) and associated Global Health Security Action Group (GHSAG).

This means that in terms of the provision of medical services there is little direct regulation from the EU that has an impact on this sector.

Given that the provision of medical services and social care cuts across a number of areas of the economy, the medical services sector is impacted less directly by other aspects of the EU regulatory regime. Most notably:
• The Mutual Recognition of Professional Qualifications (MRPQ) Directive enables qualifications in regulated professions in one Member State to be recognised in all others. Professions that fall under the automatic recognition system, such as dental practitioners and pharmacists, have harmonised training conditions and are therefore able to practice across EU Member States without meeting additional conditions. For other regulated professions, including social workers, EU Member States may impose proportional measures, such as an adaptation period of up to three years or an aptitude test;
• The training of medical services providers – general considerations on training in the higher education sector are set out in the Higher Education Sector Report; and
• The regulation of medicines, medical devices and clinical trials, which is set out in the Life Sciences Sector Report.

Existing frameworks for how trade is facilitated between countries in this sector

The arrangements described in this section are examples of existing arrangements between countries. They should not be taken to represent the options being considered by the Government for the future economic relationship between the UK and the EU. The Government has been clear that it is seeking pragmatic and innovative solutions to issues related to the future deep and special partnership that we want with the EU.

As noted above medical services are sparsely traded and consequently it is the general provisions on services trade that provide the framework for trade in these services outside of the EU.

There are a number of existing arrangements that govern the way in which other countries trade with each other in this sector.

The baseline for trade in services is the WTO’s General Agreement on Trade in Services (GATS). All WTO Members are parties to GATS which sets out general rules, principles and obligations as a framework for trade in services; plus a schedule of commitments which set out how open and non-discriminatory parties commit to be across the service sectors covered.18 GATS also sets out ‘how’ parties will allow services to be traded and this is split into four principal ‘modes’:

• where a product rather than a service supplier/consumer crosses a border (e.g. an architect sending architectural drawings to a client overseas);
• where the consumer of the service crosses a border (e.g. tourism);
• where the company crosses a border (e.g. a retail chain opening a new establishment in another country); and
• where the service provider moves (e.g. a lawyer spends nine months working in her firm’s office in another country). Commitments taken by parties vary and parties can unilaterally choose to improve their GATS offers at any point (subject to a certification procedure) or lower the level of their commitments, but in order to do so they will be expected to offer compensatory concessions.