Cardiovascular research 2018 handbook:
Brexit – threat or opportunity

doi:10.5837/bjc.2018.s11 Leave a comment
Click any image to enlarge
Sponsorship Statement: This handbook was initiated and funded by Novartis. Editorial control, however, was retained by the authors/presenters and editors. Novartis reviewed the handbook for technical accuracy only before publication.
Date of preparation: August 2018.

Much is unclear regarding the future relationship with the European Union (EU) following Brexit. The UK government has made it clear that it wishes to build a new, deep and special partnership with the EU. In preparing to leave the EU, with regard to scientific research, one of the UK’s core objectives is to “seek agreement to continue to collaborate with European partners on major science, research, and technology initiatives”.1

Angina - BJC Learning programme
For healthcare professionals only

Importance of UK collaboration with the EU

CV research Brexit

The partnerships between the UK and other EU Member States significantly increase the impact and influence of the EU’s science and research activity. When collaborating with the UK, the share of EU co-authored publications in the top 10% of highly cited publications in medical and health research is higher.2 The UK is also a top five collaboration partner for each of the other 27 Member States,3 and contributed almost 20% of the total research work carried out within EU health programmes between 2007–2016.2

European collaboration is particularly important in some fields – stratified medicine and rare diseases, for example, as it provides access to large and diverse patient groups (including both rare disease and rare variants of common disease) for medical research and clinical trials. A report funded by eight leading UK medical research funders and charities, found that the UK has made key contributions in five areas:2

  1. Contributions to advisory bodies, networks and policies that underpin research across the EU and its member states.
  2. Participation in pan-EU clinical trials, providing notable leadership for rare disease and paediatric clinical trials.
  3. Co-ordination and hosting of some of Europe’s unique large-scale infrastructures for medical research.
  4. Development of new therapies and medical technologies that benefit EU patients, backed by a thriving pharmaceutical and biotechnology sector.
  5. Training early career researchers from across the EU, to develop their skills and launch their research careers.

    Key European collaborations

    European Strategy Forum on Research Infrastructures (ESFRI) – this has a key role in policy making on research infrastructures in Europe, particularly in helping develop a strategic road map that identifies vital new European research infrastructures for the next 10–20 years.
    European Molecular Biology Laboratory (EMBL) – comprising 23 EU Member States, two associate members, and five additional funding partners, this organisation focuses on molecular biology research and services.
    European Bioinformatics Institute (EBI) – one of six institutes of the EMBL, the EBI focuses on computational aspects. Through its platforms, life sciences data are freely available to support researchers across academia, medicine, and industry.
    European Life Science Infrastructure for Biological Information (ELIXIR) – unites Europe’s leading life science organisations in managing and safeguarding the increasing volume of data being generated by publicly funded research.
    European Reference Networks (ERNs) – help professionals and centres of expertise in different countries to share knowledge. The UK coordinates a quarter of the 24 thematic networks and participates in nearly all, thereby pooling knowledge and sharing research expertise.
    European Research Council’s Life Sciences panel – on which UK scientists delivered the highest number of evaluation assignments.
    European Research Infrastructure Consortia (ERICs) – structures set up to deliver international science and research collaborations in the EU.

‘The UK is seeking agreement to continue to collaborate with European partners on major science, research, and technology initiatives’

Impact on the NHS

The Government has made clear that, although freedom of movement will cease to apply in the UK, the UK will continue to welcome the brightest and best. Migration between the UK and the EU will continue after the UK leaves the EU – the UK is seeking to agree a continued system for the mutual recognition of professional qualifications, for example.

Despite these assurances, it has been reported that, since the Brexit vote, applications to work in the UK from EU nurses are down 96% (1,304 to 46).3 About 57,000 EU nationals work in the National Health Service (NHS), 20,000 of whom are nurses. The proportion of doctors working in the NHS from EU member states is 9.3%.4 Certain specialties are more reliant on doctors from EU members states than others – 11% of cardiology specialists are from EU member states, for example.4 About a fifth (21%) of doctors who qualified overseas have told the Royal College of Physicians that they plan to leave the UK in the next five years or are unsure of their plans.5

European Medicines Agency

The European Medicines Agency (EMA) is responsible for the scientific evaluation, supervision and safety monitoring of medicines in the EU. It has been based in London since 1995, but its relocation to Amsterdam, The Netherlands, has been announced since the Brexit vote. The UK Government has stated that its aim is to “ensure that patients in the UK and across the EU continue to be able to access the best and most innovative medicines and be assured that their safety is protected by the strongest regulatory framework and sharing of data.”1

The government states that the UK will look to continue to work closely with the EMA and other international partners. In areas such as inspections, safety of medicines, and exchange of information, the EMA cooperates with regulatory bodies around the world. The EU has specific agreements in place with the USA, Canada, Japan, Switzerland, Australia, New Zealand and Israel, that enable this. These provide precedents that the UK and the EU could seek to build on.1

Horizon 2020

The central EU platform for research and innovation is known as the Research and Innovation (R&I) Framework Programmes. Horizon 2020 is the largest Framework Programme to date, with nearly €80 billion of funding available over seven years (2014 to 2020).

Non-EU countries can also participate in Horizon 2020 either with associated country status or with automatic third country status.1 Currently, 16 countries, mainly within the wider European region, are associated to Horizon 2020. They have the same level of access to Horizon 2020 as EU Member States but they do not have a formal vote over the work programme, although they can attend programme committees, which provide them with a degree of influence. All third countries without formal associate status can participate in specific parts of the programme, with some restrictions.6

The UK government has recognised the need to provide certainty to all stakeholders, wherever possible, and has committed to underwrite bids for Horizon 2020 projects submitted while the UK is still a member of the EU. The UK will work with the Commission to ensure payments when funds are awarded, and Horizon 2020 participants should continue to collaborate as normal.1

Future collaborations

The UK’s top research collaboration partners, as measured by co-authored publications in the EU, are currently Germany, France, Italy, the Netherlands and Spain. Some of the UK’s most important collaborators lie outside the EU, notably the USA (as the UK’s top research partner), Australia, China, Canada and Japan.7

The EU has concluded bilateral Scientific and Technological Partnership agreements (STPs) with 20 individual countries, such as Canada and the USA. These agreements constitute a framework and a ‘privileged forum’ to identify common interests, priorities, policy dialogue, and the necessary tools for science and technological collaboration. Activities conducted through an STP can include researcher exchanges, sharing of research facilities, and joint research projects.

The government intends that the UK will continue to strengthen its bilateral and multilateral research relationships with EU Member States and the UK’s other international partners around the world. To this end, the UK will seek to agree a far-reaching science and innovation agreement with the EU that establishes a framework for future collaboration. There are a range of existing precedents for collaboration that the UK and the EU can build on, but our uniquely close relationship means there may be merit in designing a more ambitious agreement.1

Articles in the handbook

1. Introduction
2. National Institute for Health Research
3. Optimising clinical research using electronic medical records
4. Recent research at the Institute of Cardiovascular Medicine and Science
5. Clinical trials in the UK from a commercial perspective
7. How to initiate a clinical trial in the UK
8. Useful organisations


1. Department for Exiting the European Union. Collaboration on Science and Innovation: A Future Partnership paper. London: HM Government, 6 September 2017. Available from:

2. Varnai P, Rentel M, Dave A et al. The Impact of Collaboration: The Value of UK Medical Research to EU Science and Health. Technopolis Group, May 2017. Available from:

3. Sky News. EU nurses’ applications to work in UK down 96% since Brexit vote. Available at:

4. NHS Digital, NHS Hospital and Community Health Services (HCHS). All staff by nationality grouping, staff group secondary area of work and Health Education England region, in NHS Trusts and CCGs in England, 30 June 2016 to 30 September 2016, headcount, 2017. Available from:

5. Royal College of Physicians. RCP Census 2015–16. London: RCP, December 2016. Available from:

6. European Commission. Research and Innovation Performance and Horizon 2020 Country Participation. Available at:

7. Adams J. International research collaboration after the UK leaves the European Union. Universities UK, April 2017. Available from: