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GPs buried under trusts' workload dump

GPs to monitor mental health of all patients who own guns

GPs are required from this month to keep a record of all patients who own a gun – and to inform police if any of these people develop mental health problems such as depression.

Practices are to place a ‘firearm reminder’ code in their records to act as an alert if the health of gun owners deteriorates.

Police will contact the GPs of all people who apply for a firearm certificate, to check whether there is a history of illnesses including depression or dementia.

Until now police have only contacted an individual’s GP before the issue of a firearm certificate if an applicant has declared a relevant medical condition.

The new referral system was drawn up by a partnership that included the police, the RCGP, the BMA and shooting associations. Guidance for GPs is being prepared, but police will have the final say on who is issued a firearm’s certificate.

Police watchdog Her Majesty’s Inspectorate of Constabulary previously recommended that GPs should provide medical reports for patients applying for firearm licences.

GPC member Dr John Canning said: ’We support measures to ensure closer working between the medical profession and police. Under current legislation doctors already have a responsibility to breach confidentiality if they think a patient presents a risk of serious harm to themselves or others.

’A system whereby patients’ medical records are noted as to indicate whether they hold a firearms or shotgun licence could act as a useful reminder to doctors that the patient has, or may have, access to a firearm.

’Doctors are never in a position to make assessments of future risks presented by firearms holders. The routine assessment of risk in relation to individuals who hold, or who wish to hold firearms is solely a matter for the police.’

Readers' comments (45)

  • April 1st?

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  • How can the BMA agree to this - in effect GPs are being set up to fall.

    Where is the payment for this?? The police get paid to grant the license, but we as always have to do the monitoring with no payment at all?

    Even with money - it should have been left to the police tondo regular checks - they can wash their hands off it now.

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  • Needs to be funded

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  • That's pretty well all the patients then!

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  • Further bullshit imposed on primary care.

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  • Nope not my job.

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  • Not a chance without payment

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  • Not an NHS service therefore up front with the sausages or foxtrot oscar.

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  • This comment has been removed by the moderator.

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  • Aren't BMA and RCGP meant to be on our side? Why are they always so happy to help making my working day just a bit longer?

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  • Who has the power to force GPs to do this? There is nothing in GMS or PMS contracts regarding this.

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  • Seems self-evident that anybody who wants to own a gun should be prevented from doing so

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  • More to the point will GPs be legally indemnified?

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  • Can someone perhaps define "monitor mental health" as a starting point?

    Until they do, I am with the get knotted crowd. Joe Public get more than enough for £136 per patient per year.

    Sky emailed me today to say my subs will go up in June by £51 per year. Would that we had even half that extra per year. As it is we have the worst of all models; the responsibilities of the private sector with the funding of a monopoly public sector contract and as much opprobrium as you can handle.

    Makes me want to buy a gun, funnily enough.

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  • we need to say yes to everything - must never say no

    why bother with a contract ?

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  • not sure why they are saying that we need to collect it from now.

    also I am a little concerned that we should inform police if someone with a gun develops depression.

    I think thas we should risk assess this as we do in normality in asking about suicidal or homicidal tendencies.

    It may create a barrier to seeking help for gun owners which in my view is even more damaging to the patient.

    - anonymous salaried!

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  • If anyone else in a government funded service that wants us to help out doing their job for no extra pay, preferably shifting responsibility for tricky decisions that can somehow be labled 'medical' or 'behavioural' or 'to do with people' then we'll of cause be ready with the KY gel.
    Glad to be of service.
    Who's next?

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  • If they want this to be done, where is the payment?????? Again slavery if they force gps to do this with no additional payment.
    Will this also affect indemnity in some way? Anyway this is looked at it will cost gps money. Gps will be funding this work out of their own pockets.
    But why should the government pay for their own decisions?????

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  • So what incentive is there now for gun owners to get help from their gps if they are going to be banned from owning a gun as a result?
    Gun owners are people too who get ill and need help. They have to jump through hoops to get their fire arms licence and have to have a whiter than white record before they are given a firearms licence.
    Target shooting is a popular international sport dicipline.
    They may also start hiding things from their gps if they think gps are now spying on them.
    If this is done then gps may be told to keep tabs on other people, parents and if they abuse children then other groups and before long people will have lost any and all confidence in their gps and will view them as government agents who are looking to trip them up.
    Then if there is a problem then it is more likely to fester and result in more problems than there would have been if the issue was dealt with properly at the beginning.

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  • Madman doesn't recognise or report he is mentally ill.Gets a gun.His GP signs him off in good faith that he has no history of mental illness.The madman shoots someone.The victim/victim's family sues the GP.

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  • So, GPs are supposed to do this as of now but 'the guidance is being prepared'. GPs are great but they're not psychic. More unfunded work being dumped on primary care. All firearms should be banned, then no one would need to monitor mental health of these people. No one in UK in 2016 needs to own a gun!

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  • So if car drivers are stressed out driving cars then cars should be banned.
    Cars are lethal weapons and every year there are approximately fifty times more deaths on the road than there are firearms murders.
    So should anyone who owns a car who develops depression also be monitered and referred to the government by gps?

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  • Not my job, I presume this is an april fool joke?

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  • never mind being set up to fail - GPs are now ideally placed - to carry the can for the next shooting spree

    THIS is insane

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  • I think the replies show a fair bit of misuderstanding. Lots of people own guns and take part in perfectly legal, very enjoyable sport of target shooting - myself included. It is an olympic sport you know - do you want to ban it worldwide now ? Some of us even own some land and need to get rid of vermin with them. Gun ownership is decided by a very rigorous interview and scrutiny, you don't just fill in a form and get it. It used to be that the GP had to fill out a tedious report, funded by patient. Now you just have to flag records and tell Firearms police if you are worried. They will then request a report - and you can charge either them or the patient. If you have it flagged on the persons notes then you know they own a gun and to discuss it.
    How is this different from telling the DVLA that a person you feel is unfit to drive is still driving ?

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  • Does the GP waive patient's confidentiality?

    Would this breach of GMC rules- the guidance here is not comprehensive.

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  • "How is this different from telling the DVLA that a person you feel is unfit to drive is still driving "

    Because a) we have a statutory duty to inform the DVLA and waive confidentiality and b) most people continue to drive when unfit because they lack insight/competence (although their actions have the potential to cause carnage)

    whereas someone with a gun, with or without mental health problems, may suddenly decide to go out deliberately to kill - and the notes will be mercilessly trawled for anything that could be interpreted retrospectivly as "warning signs" so the GP can be hung out to dry.

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  • Took Early Retirement

    What's the deal here? Are we saying no one with depression, however well-controlled, can own a gun? Sounds very discriminatory to me.

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  • Hang on, if a GP says no, who offers protection to the GP? And we pay our royal college to not say anything about this nonsense?

    So if there is an issue, will the "mental health team" see them urgently? I don't think so.

    So much for the contract and independent contractor status.

    Bargepole indeed

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  • I find the comment of an anonymous (cowardly) GP partner @ 5.08pm deeply offensive &, as he/she is ALSO a patient then I assume he/she includes him/herself !!!

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  • Sorry ! It was the sessional GP locum on Apr 1st @ 5.21pm whose comment I found offensive !

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  • Is it possible the scientific basis is being missed here?
    The major risk factor re depression in non gun owners as well as gun owners, and associated suicidality and violence, (on occasion, indisputably homicide) is the akathisia induced by SSRI's in those vulnerable to developing akathisia. The duties of a prescribing physician are to alert the depressed patient to the most serious ADR's produced by these drugs. Those most likely to be at greatest risk of akathisia are have cytochrome CYP 450 genomic variants predisposing to slow metabolism or more complex variation from normal metabolism. It may well be far more acceptable, ethical and appropriate to advise those seeking a gun licence to undergo CYP 450 genomic sequencing, at least for CYP 2C9, CYP 2C19 and CYP 2D6, Other alleles may be required. This means that should the fastidiously careful gun owner be unfortunate enough (on a bad day) to fill in a HAM D scale "identifying" depression - and to be given an SSRI, the risk of free serotonin in the brain exceeding 80% increase may be anticipated. The prevention of serotonin toxicity and akathisia is an evidence based means of preventing suicide and violence. Safer still, never prescribe SSRI's if not absolutely confident in the diagnosis and safe management of akathisia, and ideally, only prescibe to normal metabolisers.

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  • Dear All,
    I was part of the team that negotiated this with the Home Office. There is a need to protect the public and individuals from weapons. The existing system was not working. it is not unreasonable nor contrary to professional behaviour to contribute to a decision whether or not someone should posses a firearm. there was no new money on the table. so we negotiated what we thoght was the best we could in teh circumstances. Points to note; the gp does not have to respond. for most patients that you know the initial response can be made from a memory sweep and is a simple tick box and send back - maybe 2 minutes. entering the read code is 10 seconds at most. the systems will be modified to automatically flag the code thereafter. the applicant has given consent by default and in any event GMC would expect you to divulge relevant info on public interest basis. if a formal report is requested it is made as plain as day that the applicant pays what you charge. finally despite your input its not you who decides.
    Not ideal but as i said best we could make of it.
    Yes if patients want to lie then they will and there is nothing we can do about it.
    Regards

    Paul C
    D.O.I past firearms and shotgun licence holder and currently renewing.

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  • This isn't my job. It's not down to me to monitor who is fit to hold a firearms license. What do they mean by 'monitor'. Happy to provide information for a fee. the police should monitor this

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  • If there is no new money, no new work. Are we a charity ? Do barristers work for free? Have we any value at all?
    Just do not become a GP, when you have this stuff from a GPC member.
    No new money, but lots of new work.
    I hope all the GPs leave this cesspit.
    There never is any new money. So we now do almost 90% on 7% of the budget.
    Great!!

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  • It is the mismatch of increased responsibility with no money attached that is making us angry and worried.

    You want my practice staff to do searches and maintain registers and then write to the police. That is time and therefore money. It will not in my opinion be a few seconds here and there.

    When things go wrong we risk getting sued. If you want me to shoulder that risk then I will tell you how much I charge for that. If you dont like my prices then you pay someone else to do it.

    GP workload is getting to or is already beyond safe. Giving more work and responsibility without funding makes the system even less safe.

    The risk is that surgeries might not feel capable of ensuring this is done safely but have no option to say they cant do it.

    I dont accept there is no money on the table for something that is so important to them.

    No money = No time = Not safe = Not happening.

    Should have been no negotiating if no money on table.

    I would hope that the RCGP which is an optional club will keep their opinion to themselves on such matters.

    I look forward to the GPC or BMA expressing their concern that dumping unfunded work on GPs is not safe.

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  • Well said 10.09pm.
    No money no deal!
    If the government wants this work to be done and this responsibility to be shouldered, they need to pay for it themselves.

    The problem is that all the non police personal in scotland (I don't know about in England or elsewhere) who normally worked full time in dealing with firearms licencing have been sacked to save money.
    All the work is now done by local unspecialised policemen/women who really do not have a clue or much experience in firearms licencing.
    So this is why doctors are being drafted in as free labour in sorting out this issue and shouldering this burden for FREE!!!!!

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  • 10:09 - could not agree more:

    Why should we as GP partners personally pick up the bill to deliver a state service that has no funding?

    If an organisation (The Police/Home Office) wants something then it should be willing to pay for it. If it is not willing to pay, then either it cannot afford it or it does not really want it - in which case I have no interest in expending my energy to provide it.

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  • Lot of comments about no money= no deal.Are we in position to negotiate when BMA/ RCGP not supporting our say.
    Just wait when it would be imposed anyway. Till then you are allowed to moan.

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  • Took Early Retirement

    Sadly Paul, a typical BMA response: "It was the best we could do". No new money- should have walked away.

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  • To Dr Paul Cundy
    I don't get it: we don't have to respond? It pretty much says we do.

    And as for a "memory sweep": are you insane? No competent professional would agree to doing this without looking at the notes just in case my partners have recently Prozaced him. Then we've got to remember the bloody Read code and add it. 10 seconds? It takes that long to load a patient

    I seriously doubt you'll be eligible to get another shotgun licence with that type of thought disorder. Oh well, I'm an inner city gp. We don't have to worry about licences here...

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  • "Pass the buck" to GPs--yet again !!!!!
    Havent we got too much to do already!

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  • I have to agree with John Glasspool here. Paul Cundy advances a very weak argument and shows he (and the BMA) to bean even weaker negotiator. By far the majority of gun offences are committed with illegally held firearms which this will not address.

    If this is an example of how the BMA (paid by doctors to represent THEIR interests) negotiates no wonder the Junior Doctors are resorting to strikes to achieve any progress.

    If the BMA had shown a bit more grit earlier in the negotiations the present crisis could have been avoided.

    Negotiators need to learn that when the deal looks unattractive or unachievable it is better to walk away early and stop wasting time effort and political capital on flogging a dead horse.

    The latest figures on manpower in the NHS released by DoH reveals the extent of the mess which the collective "negotiators" have created. Any halfwit could have predicted that WTEs would be drastically reduced as soon as it emerged that a majority of medical students were women. This is not discriminatory or sexist but simply a statement of fact. As more women showed that you could have a medical career as a part timer more men adopted the same lifestyle choice exacerbating the problem. As usual short term blinkered vision by DoH has created the problems which will take a decade or more to resolve.

    Time to call a halt to lunacy.

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  • No new money=no new work. Period!
    Actually how about the money saved in sacking all the existing firearms staff.
    The BMA are negociating away our lives here. They think doctors are worthless and not worthy of being paid. There should be a rival union for doctors as.I am.sick of the BMA and its inability to help doctors.

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  • Our entire practice has just opted out. You have to conscientiously object.
    It only costs us a stamp or a fax every time we get one now.


    Fundamentally its an unsafe system, but personally I'm especially dismayed that the BMA would

    a) underestimate the work that is involved or the importance of it. they actually say its okay to sign the form if you have no knowledge of the patient, and

    b) expect me to do the work for nothing because it wont take very long. Is this the same BMA that still charges its members for whatever it is that it does?

    What on earth has gone wrong with our profession?

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